Pneumonia: Can Vaccination and Treatment Coincide?

My patient has been hospitalized for pneumonia several times by different physicians.He has never received the pneumococcal vaccine. Can this vaccine begiven during the patient's hospital stay? If not, how soon after discharge can it beadministered? Should the patient be immunized again after 5 to 10 years?
-- MD
Pneumococcal vaccine can be given to patientswhile they are still in the hospital recovering frompneumonia--preferably at discharge. Pneumococcalvaccine is recommended for the followinggroups of patients:

• Immunocompetent adults older than 65 years or whoare at increased risk (because of conditions such as cardiovasculardisease, pulmonary disease, diabetes, alcoholism,cirrhosis, or cerebrovascular leaks).
• Immunocompromised adults who are at increased riskfor pneumococcal disease or its complications (eg, thosewith splenic dysfunction, asplenia, Hodgkin disease, lymphoma,multiple myeloma, chronic renal failure, or conditionssuch as organ transplantation that are associatedwith immunosuppression).
• Patients with HIV infection, either symptomatic orasymptomatic.
• Children aged 2 years or older who have chronic conditionsassociated with increased risk of pneumococcal disease,such as asplenia, sickle cell disease, nephrotic syndrome,or immunosuppression.

Whether because of age or because of other factors,your patient appears to be at increased risk for pneumonia.Thus, he should receive influenza vaccine as well aspneumococcal vaccine. Both vaccines can be given on thesame day at different sites.If your patient is younger than 50 years, carefully reviewrisk factors for pneumococcal infection (cardiovasculardisease, pulmonary disease, diabetes, alcoholism, cirrhosis,HIV infection) and initiate treatment for these ifnecessary.If your patient is immunosuppressed or younger than50 years at the time of initial vaccination, he should be revaccinatedin 5 years. Revaccination after less than 2 yearsis more likely to result in a reaction. There are no dataabout a third course of vaccine, but most authorities thinkit is not needed.

-- Darwin Palmer, MD
   Professor of Medicine, Emeritus
   Division of Infectious Diseases
   University of New Mexico School of Medicine
   Albuquerque