Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, drives a discussion around preventative measures to limit the spread of pneumococcal infection.
Ryan Haumschild, PharmD, MS, MBA: One thing that stands out to me is the patient type and how we want to work them up for hospitalization. There are going to be a lot of patients who might be more susceptible, might have greater risk factors, and sometimes it could be the aging population. Sometimes patients might be in nursing homes or assisted living communities, and there can be outbreaks. Ms Bridgeman, how can pneumococcal outbreaks be managed so we can minimize the spread to healthy populations, especially in these unique environments?
Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: Coughing, sneezing, and close contact can spread the pneumococcal bacteria—anytime, anywhere, any season. Those are some key features to consider. It’s by anybody who could be healthy or sick, as we talked about. Children in particular can be asymptomatic carriers colonized with bacteria in their nose and throat without demonstrating those signs of illness. Outbreak management in long-term-care settings, congregate living environments, military encampments, military facilities, prisons, and other closed communities is essential. We can hypothesize that health care workers can likely transmit pneumococcus to patients if they’re colonized with pneumococcus. That’s a key feature to consider. Patient-to-patient transmission is a possible source of exposure from contact with contaminated respiratory secretions. In those institutions, perhaps ventilation isn’t increasingly adequate or there’s less-than-ideal crowding situations where folks are in a fairly confined space.
Some of the best practices for preventing the spread of pneumococcus include the appropriate use of personal protective equipment [PPE]. This includes the appropriate use of safeguards that we got used to during COVID-19 and the prudent use of antibiotics. Pneumococcus is a great opportunity to talk about the importance of antimicrobial stewardship to prevent the emergence of resistant pneumococci. And vaccination in the first place: an ounce of prevention is worth a pound of cure in trying to minimize the potential for infection. Vaccination and revaccination when indicated are the best ways to prevent pneumococcal disease.
This is a bacteria where over 90 or 100 serotypes have been identified. Just because you’ve had a pneumococcal infection in the past doesn’t mean you’re necessarily protected against subsequent infection in the future as well. It’s important to note that antibiotic prophylaxis—prophylactically taking antibiotics to try to reduce the risk of transmission—hasn’t been indicated by the CDC [Centers for Disease Control and Prevention].
Christina Madison, PharmD, FCCP, AAHIVP: I love that you pointed out carceral health. As big supporters of public health, we forget about our individuals who are incarcerated and may be in high-congregate settings with poor ventilation. A lot of times the number of air exchanges per minute in those facilities isn’t good. If it is, they’re not using things like HEPA [high-efficiency particulate air] filtration and ultraviolet light. That’s a place where we can do such good work with prevention. If we can’t change the facility, we can change the risk of the inmate. That’s going to be through vaccination.
The other thing I wanted to plug is that we continue to use public health measures in health care facilities and wear appropriate PPE. [We need] masking in all health care facilities, so we aren’t inadvertently making our patients sick. Unfortunately, we brought an infection in-house. That’s a plug for continued masking in health care facilities.
Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: Great point. Thank you. I appreciate that.
Transcript edited for clarity.