Bacteria are the main pathogens that can cause pneumonia in old age. Among them, it is important to mention pneumococcus, which is responsible for the occurrence of community pneumonia, especially in the elderly, and can also cause numerous other invasive infections.
They are the main pathogens that can cause pneumonia in the elderly.
To reduce the incidence of pneumococcal disease, the pneumococcal vaccine is recommended, unless specifically contraindicated, for children, the elderly over 65, and frail individuals. Vaccination also avoids the administration of antibiotic therapy, which is often associated with resistance.
Pneumococcal infections
Pneumococcus, scientific name Streptococcus pneumoniae, is a bacterium encased in a polysaccharide capsule that colonizes the nasopharynx and upper respiratory tract especially in children aged < 2 years, sometimes, even in the absence of symptoms, particularly in the winter and early spring seasons.
The high prevalence of pneumococcal infections is caused by the presence of healthy carriers that promote person-to-person transmission. The infection is spread by airborne droplets of saliva emitted outside by individuals with the infectious disease while they are talking, or by respiratory tract secretions such as coughing and sneezing.
The pneumococcal agent is transmitted by air.
This pathogen can cause noninvasive pathologies such as acute otitis media, sinusitis, and community-acquired pneumonia, or invasive pneumococcal pathologies (MIP) by the spread of the bacterium into the central nervous and/or circulatory systems, such as meningitis (especially in children) osteomyelitis, sepsis, endocarditis, and bacteremic pneumonias (especially in adults).
Invasive pneumococcal pneumococcal disease is a serious condition that often occurs in people over 65 years of age; aging, in fact, is correlated with an increased risk of contracting infectious diseases. Problems associated with coexisting chronic degenerative diseases and the loss of immune system efficiency due to aging (immunosenescence) promote the occurrence of vaccine-preventable infectious diseases.
Pneumococcal vaccination
.Pneumococcal vaccination is essential to effectively prevent the infection and to prevent it from evolving into more severe clinical pictures.
Vaccination, moreover, is essential to counteract:
- pneumococcal diseases related to high morbidity and mortality, particularly in individuals over 65 years old;
- phenomena of antibiotic resistance, in fact, resistance to multiple antibiotics occurs in 15-30% of pneumococcal infection cases, complicating pneumonia management;
- the aggravation of some chronic diseases such as diabetes, respiratory and cardiovascular diseases.
Where pneumococcal infections evolve into severe disease (osteomyelitis, bacteremia, meningitis, pneumonia, and septicemia) they can cause permanent damage and in some cases be fatal.
Vaccination also addresses an important public health problem with significant savings in health care costs (better cost-benefit ratio). These communicable diseases, in patients with chronic diseases, increase the risk of hospitalization and can lead to a rapid loss of the elderly person's autonomy, with a burdensome economic impact on the health care system due to the costs resulting from the hospital stay.
The vaccination of the elderly can also address a major public health problem with significant savings in health care costs.
Controlling the occurrence of infectious diseases, therefore, is critical for health systems because disabilities, hospitalizations, drug use, and deaths are reduced, so as to ensure healthy aging with a reduced economic burden on the National Health Service.
Recommendations for antipneumococcal vaccination in the elderly
The antipneumococcal vaccine contains purified fragments of the polysaccharide capsule of different strains of Streptococcus pneumoniae. There are, in fact, more than 90 types of pneumococcus that differ chemically in clinical impact and immunogenicity (ability of a substance to stimulate immune system activity). The vaccine protects against type 3, 4, 6B, 9V, 14, 18C, 19F and 23F viruses, the ones that generally cause the onset of the disease.
In individuals over age 65, pneumococcal vaccination is offered by the SSN (National Health Service) by administering one dose of conjugate vaccine (PCV13), followed by one dose of polysaccharide vaccine (PPSV23).
It is very important not to reverse the order of administration of the two vaccines, to avoid a weak immune response.
The pneumococcal vaccine is recommended, but not mandatory, for children, the elderly aged 65 years and older, and all individuals with risk factors or suffering from the following diseases:
- chronic lung diseases e.g., chronic obstructive pulmonary disease (COPD), asthma
- chronic cardiopathies
- chronic hepatopathologies, including those evolving from alcohol, liver cirrhosis
- congenital or acquired immunodeficiencies
- diffuse neoplasms
- asplenia, anatomical or functional absence of the spleen
- diabetes mellitus
- onco-hematologic diseases (lymphomas, leukemias, and multiple myeloma)
- chronic adrenal/renal insufficiency
- chronic alcoholism
- HIV infection
- hemoglobinopathies (sickle cell anemia and thalassemia)
- people with CSF leakage from trauma or surgery
- presence of cochlear implantation
- marrow or organ transplantation,
- pathologies undergoing continuous immunosuppressive treatment
Pneumococcal and influenza vaccination schedules
.Vaccinations are essential for the adult population and, in particular, in old age to prevent the occurrence of diseases such as influenza and pneumococcal infections that affect millions of people each year, with a higher incidence in the elderly population, potentially evolving into pneumonia.
For a more effective preventive approach against pneumococcal pneumonia, reduce hospitalization and lethality related to this disease it is possible to combine the pneumococcal vaccine with the influenza vaccine, or it can be given alone at any season of the year and only once in a lifetime.
To whom it is recommended
All age targets can get the pneumococcal vaccination; it can also be given to infants and is generally included in the mandatory vaccination schedule. The most suitable categories, unless specifically contraindicated, are, however, the most fragile ones, such as the elderly but also children and adolescents, it is recommended, in fact, to individuals aged between 6 and 64 years.
How to get the pneumococcal vaccination
.The pneumococcal vaccine, like the flu vaccine, is given through an intramuscular injection, precisely into the deltoid muscle (right or left shoulder).
In younger children, the vaccine is administered, usually, by intramuscular injection into the thigh.
Vaccine efficacy begins 10-15 days after administration, ensuring lifelong protection, without the need for further booster shots.
Prevention from pneumococcal infections in the elderly: vaccination strategies
.Health institutions have emphasized the importance of an age-appropriate vaccination strategy in relation to age and different possible subjective health states.
It is important to pay attention to elderly individuals who are more susceptible to infections and the development of chronic diseases. Elderly, frail, or chronically ill patients and children may be more at risk of developing complications such as pneumonia or worsening of previous conditions such as diabetes, respiratory disease, or cardiovascular disease.
These patients may be at higher risk of developing complications such as pneumonia or worsening of previous conditions such as diabetes, respiratory disease, or cardiovascular disease.
For patients over 65 years of age, in order to counteract infectious diseases and promote the maintenance of protracted good health, it is essential to set up a specific vaccination program.
In Italy, in relation to Global Burden of Disease data, pneumococcal disease causes more than 6.7 deaths per 100,000 inhabitants (equal to 0.9% of all deaths) and more than 2.7 years lived with disability per 100,000 inhabitants each year. Pneumococcal infection has a higher incidence in children under 5 years of age and in the over-65s (in 2020, the rate in infants <1 year olds was equal to 2.65 per 100,000 population and in adults >65 years of age equal to 2.04 per 100,000 population). It was shown that getting pneumococcal vaccination led to a reduction in multidrug-resistant pneumococcal infections in 64% of children and 45% of adults over 65, reducing the risk of developing antibiotic-resistant infections.
