© Prevention ofpneumococcal disease by use of vaccination is a national goal. Vaccination is used to prevent or minimize the severity of pneumonia caused by S. pneumoniae or the influenza virus.

The influenza vaccine is available in two forms, injectable and nasal inhalation. The injectable product is an inactivated vaccine (containing killed virus) and is approved for use in people older than 6 months of age, including healthy people and people with chronic medical conditions. The nasal-spray influenza vaccine is made with live, weakened influenza viruses that do not cause influenza (live attenuated influenza vaccine). This formulation is approved for use in healthy people 5 to 49 years of age who are not pregnant. The ability of influenza vaccine to protect a person depends on two key factors: the age and health status of the person getting the vaccine, and the similarity or "match" between the virus strains in the vaccine and those in circulation. Given these factors, the vaccine has been effective. The influenza vaccine is recommended for the following groups of people40:

1. People at high risk for complications from the flu :

• People 65 years and older

• People who live in nursing homes and other long-term care facilities that house those with long-term illnesses

• Adults and children 6 months and older with chronic heart or lung conditions, including asthma

• Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (like diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicines or by infection with HIV)

• Women who will be pregnant during the influenza season

• Children 6 months to 18 years of age who are on long-term aspirin therapy

• All children 5 to 18 years of age

• People with any condition that can compromise respiratory function or the handling of respiratory secretions (i.e., a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders)

2. People 50 to 64 years of age: Comorbid conditions are present in nearly one-third of people 50 to 64 years of age in the United States, and that places them at increased risk for serious flu complications. Therefore, vaccination is recommended for all persons aged 50 to 64 years.

3. People who can transmit flu to others at high risk for complications: Any person in close contact with someone in a high-risk group should get vaccinated. This includes all health care workers, household contacts, and out-of-home caregivers of children 0 to 23 months of age and adults 65 years and older.

There are two pneumococcal vaccines, a seven-valent conjugated vaccine for children younger than 6 years of age and a 23-purified-capsular polysaccharide antigen vaccine for adults. The 23 capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children and adults in the United States.41 After vaccination, an antigen-specific antibody response, indicated by a twofold or greater rise in serotype-specific antibody, develops within 2 to 3

weeks in 80% or more of healthy young adults. However, immune responses may

not be consistent among all 23 serotypes in the vaccine. Those who should receive the polysaccharide vaccine include4 :

1. All adults 65 years of age or older

2. Anyone over 6 years of age who has a long-term health problem such as heart disease, lung disease, sickle cell disease, diabetes, alcoholism, cirrhosis, and leakage of cerebrospinal fluid.

3. Anyone over 6 years of age who has a disease or condition or is taking any drug that lowers the body's resistance to infection, such as Hodgkin's disease, lymphoma, leukemia, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, damaged spleen or no spleen, organ transplant, long-term steroids, certain cancer drugs, or radiation therapy

4. Alaskan Natives and certain Native American populations: The conjugated pneumococcal vaccine is recommended for all children aged 2 to 23 months and for certain children aged 24 to 59 months. If there are underlying health issues such as diabetes mellitus, or cardiopulmonary disease then children 24 to 59 months should receive this vaccine as well. The seven capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children in the United States.41

Abbreviations Introduced in This Chapter

A R DS Acute respiratory distress synd nome

BUN Blood urea nitrogen

CA-MRSA Community-acquired me t h ic ill in - resist ant

Staphylococcus aureus

CAP Community-acquired pneumonia

COP D Ch ro n ic obstractivë pulmonary disea se

CPIS Clinical Pul in oil a ry Infection S core

DFA Direct fluorescence antigen

CER(D) Gastroesophageal reilux (disease)

HCAP Health care-associated pneumonia

HAP Hospital-acquired pneumonia

IPSA Infectious Diseases Society of America

M DR Multidrug resistant

MRSA MeihiciNin-resistant Staphylococcus aureus

MS SA Me tili ci Ii in-susceptible S. aureus

PaOyFiO, Arterial oxygen pressure/fraction of inspired oxygen

PB P Penicillin bi nd i ng p ro te in

PCR Polymerase chain reaction

TRUST Tracking Resistance in the United States Today

VAP Vent il a Lor-associated pneumonia

Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

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