Pneumonia Fact Sheet

Pneumonia is an inflammation of the lung most often caused by infection with bacteria, viruses, and other organisms, although there are also non-infectious causes. Pneumonia is often a complication of a pre-existing condition/infection and is triggered when a patient's defense system is weakened, most often by a simple viral respiratory tract infection or a case of influenza, especially in the elderly. Pneumonia affects the lungs in different ways. Lobar pneumonia affects a lobe of the lungs, and bronchial pneumonia can affect patches throughout both lungs. Together, pneumonia and influenza represented a cost to the U.S. economy in 2005 of $40.2 billion, $6 billion due to indirect mortality I costs and $34.2 billion in direct II costs.1

  • Pneumonia and influenza together are ranked as the eighth leading cause of death in the United States.2  Pneumonia consistently accounts for the overwhelming majority of deaths between the two. In 2006, 55,477 people died of pneumonia.3
  • There were an estimated 589,000 hospital discharges in males (40.2 per 10,000) and 643,000 discharges in females (42.4 per 10,000) attributable to pneumonia in 2006. The highest pneumonia discharge rate that year was seen in those 65 and over at 189.0 per 10,000.4
  • Pneumonia is mainly caused by viruses, bacteria and other organisms. Pneumonia can also be caused by the inhalation of food, liquid, gases or dust. One type of pneumonia caused by fungi is pneumocystis carinii pneumonia (PCP) which primarily affects AIDS patients. Certain diseases, such as tuberculosis, can also predispose someone to pneumonia.
  • Approximately 50 percent of pneumonia cases are believed to be caused by viruses and tend to result in less severe illness than bacteria-caused pneumonia. Most pneumonia in the very young is caused by viral infection, including respiratory syncytial virus (RSV). The symptoms of viral pneumonia are similar to influenza symptoms and include fever, dry cough, headache, muscle pain, weakness, fever and increasing breathlessness.
  • Streptococcus pneumoniae or pneumococcal pneumonia is the most common cause of bacterial pneumonia acquired outside of hospitals.  The bacteria can multiply and cause serious damage to healthy individual lungs, bloodstream (bacteremia), brain (meningitis) and other parts of the body, especially when the body's defenses are weakened.  It is estimated that 175,000 cases of pneumococcal pneumonia occur each year, with a fatality rate of 5-7%, or even much higher among the elderly.5
  • The onset of bacterial pneumonia can vary from gradual to sudden.  In most severe cases, the patient may experience shaking/chills, chattering teeth, severe chest pains, sweats, cough that produces rust colored or greenish mucus, increased breathing and pulse rate, and bluish colored lips or nails due to lack of oxygen.
  • Mycoplasmas are the smallest free-living agents of disease in man, with characteristics of both bacteria and viruses. The agents generally cause a mild and widespread pneumonia.  The most prominent symptom of mycoplasma pneumonia is a cough that tends to come in violent attacks, but produces only sparse whitish mucus.  Mycoplasmas are responsible for approximately 15-50 percent of all adult cases of pneumonia and an even higher rate in school-aged children.6
  • People considered at high risk for pneumonia include the elderly (over 65 years of age), the very young, and those with underlying health problems, such as chronic obstructive pulmonary disease (COPD), diabetes mellitus, congestive heart failure and sickle cell anemia. Patients with diseases that impair the immune system, such as AIDS, or those undergoing cancer therapy or organ transplantation, or patients with other chronic illnesses are particularly vulnerable.7
  • There are no generally effective treatments for most types of viral pneumonia, which usually heal on their own. Early treatment with antibiotics can cure bacterial pneumonia and speed recovery from mycoplasma pneumonia. However, the disease has become more resistant to these drugs, making treatment of pneumococcal infections more difficult. For this reason, pneumococcal vaccination is important. There are two types of pneumococcal vaccinations: Pneumococcal Conjugate Vaccine (PCV 13) and Pneumococcal Polysaccharide Vaccine (PPSV 23).
  • Overall in 2008, 67 percent of those 65 years of age or older received the PPSV 23 vaccine (median for the 50 states and DC).8
  • In 2008, only 53.6 percent of African Americans 65 years of age or older received the PPSV 23 vaccine, compared to 69.5 percent of whites in the same age group (median for the 50 states and DC).9  This is despite it being covered by Medicare and available to seniors.10
  • The pneumococcal polysaccharide vaccine (PPSV) is recommended for anyone over 65 years of age and all those over 2 years of age who have asthma, long-term health problems, lowered infection resistance (from disease, condition, or treatment), are a candidate for or recipient of a cochlear implant, or are a smoker.11
  • PPSV protects against 23 types of pneumococcal bacteria populations and is effective in approximately 60-80 percent of adults over 65 years of age with immune systems that are not compromised.12 Unfortunately, the vaccine may be less effective for certain people in high-risk groups. These people should still be vaccinated as they are more likely to have serious complications from pneumococcal disease.13
  • Vaccination with PPSV is usually only required once, although a second dose may be necessary after 5 years among those over 65 years of age who received their first dose before they were 65 years of age and among those with medical conditions that may impair the immune system.14
  • The pneumococcal conjugate vaccine (PCV 13) is recommended for children less than 5 years of age, all adults 65 years and older and those over 6 years old with certain medical conditions. This vaccine is given as 4 doses over time to children under 2 years of age or as a single dose for healthy children between their second and fifth birthdays. Children who did not receive the 4-dose series may require a second dose if they have a medical condition that may impair the immune system, chronic heart or lung condition, or a cochlear implant.15
  • Influenza vaccination is also recommended since pneumonia often occurs as a complication of the flu. Pneumonia and influenza vaccines are covered by Medicare, as well as some state and private health insurance.

For more information call the American Lung Association at 1-800-LUNGUSA (1-800-586-4872).  

Footnotes:

I.  Indirect mortality costs represent lost future earning by those who died from the given disease.

II.  Personal health care expenditures allocated to diagnosis are primarily hospital care, physician and professional health services, drugs and nursing home care.

Sources:


1 Centers for Disease Control. MMWR  Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. Vol. 56: June 2007.

2 National Center for Health Statistics. National Vital Statistics Report. Deaths: Final Data for 2006. Vol. 57, 14 April 2009.

3 Ibid.

4 National Center for Health Statistics. National Hospital Discharge Survey, 1988‑2006.

5 Immunization Action Committee. Ask the Experts. Pneumococcal polysaccharide vaccine (PPSV). July 2009. Available at http://www.immunize.org/askexperts/experts_ppv.asp. Accessed on August 19, 2009.

6 US National Library of Medicine and US National Institutes of Health. Medline Plus. Medical Encyclopedia: Mycoplasma pneumonia. July 2007. Available at http://www.nlm.nih.gov/medlineplus/ency/article/000082.htm. Accessed on August 12, 2009.

7 Centers for Disease Control and Prevention. Vaccines and Preventable Diseases: Pneumococcal Disease in Short. January 2009. Available at http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm. Accessed on August 12, 2009.

8 Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System. Prevalence and Trends Data, 2008. Available at http://apps.nccd.cdc.gov/brfss/display.asp?cat=IM&yr=2008&qkey=4408&state=UB.  Accessed on August 19, 2009.

9 Ibid

10 Centers for Disease Control and Prevention. Public health and aging: Influenza vaccination coverage among adults aged >50 years and pneumococcal vaccination coverage among adults aged >65 years – United States, 2003. Morbidity and Mortality Weekly Report. October 2003;52(41): 987-992.

11 Centers for Disease Control and Prevention. Vaccines and Preventable Diseases: Pneumococcal Disease in Short. January 2009. Available at http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm. Accessed on August 12, 2009.

12 Immunization Action Committee. Ask the Experts. Pneumococcal polysaccharide vaccine (PPSV). July 2009. Available at http://www.immunize.org/askexperts/experts_ppv.asp. Accessed on August 19, 2009.

13 Centers for Disease Control and Prevention. Pneumococcal Polysaccharide Vaccine. What You Need To Know. April 2009. Available at http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-ppv.pdf. Accessed on August 19, 2009.

14 Ibid.

15 Centers for Disease Control and Prevention. Vaccines and Preventable Diseases: Pneumococcal Disease in Short. January 2009. Available at http://www.cdc.gov/vaccines/vpd-vac/pneumo/in-short-both.htm. Accessed on August 12, 2009.