Prevention of community-acquired pneumonia

INTRODUCTION

Community-acquired pneumonia (CAP) remains a significant public health problem, especially among older adults, who are more immunologically vulnerable and at higher risk of complications. Despite preventive strategies, such as pneumococcal and influenza vaccination, vaccination coverage in this age group remains low, exacerbating the epidemiological situation. This research is justified by the need to identify the factors that hinder effective CAP prevention, particularly in the Argentine context, where structural, informational, and cultural barriers are evident. Furthermore, it is hoped that the findings of this study will serve as a basis for developing public policies and health education programs that improve vaccination adherence and reduce the incidence of CAP among this vulnerable population.

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide, posing a significant challenge to public health. In particular, the incidence of this disease is especially high among older adults, who are more vulnerable to developing severe complications and death. It is estimated that the annual incidence of CAP in older adults ranges from 2.6 to 13.4 cases per 1,000 inhabitants, reflecting the magnitude of the problem (1).

In Argentina, CAP is one of the leading causes of hospitalization and death, with a considerable socioeconomic impact due to the high costs associated with its treatment and clinical management. Despite advances in diagnostic and therapeutic methods, the precise identification of the causative agent remains a challenge, hindering the implementation of more effective therapeutic strategies (2).

To address this issue, this study evaluates factors influencing the incidence of CAP in adults aged 65 and older. To this end, a field research methodology will be used, involving the administration of a questionnaire designed to identify risk factors associated with the disease. Through this instrument, the study aims to understand the perceptions, behaviors, and social conditions that may influence patients’ health, paying special attention to the barriers and facilitators for vaccination against pneumococcus and influenza, two of the main preventive strategies against CAP.

The hypothesis of this study posits that immunization against pneumococcus and influenza significantly reduces the incidence of CAP and associated hospitalizations. Additionally, factors such as adherence to vaccination programs, access to health services, and socioeconomic conditions will be analyzed to identify potential barriers and motivators to improve vaccination coverage.

This approach will yield more specific, context-specific data on the realities of older adult patients, which will contribute to the formulation of more effective strategies to prevent CAP and to the design of public health policies targeting the most vulnerable populations.

The overall objective of this study is to evaluate older adults’ perceptions of, access to, and adherence to preventive vaccination against pneumococcus and influenza, as well as the factors influencing the prevention of community-acquired pneumonia. Specifically, the study seeks to identify older adults’ level of knowledge regarding the severity of CAP, analyze their perception of risk and the importance of vaccination, determine the main barriers and facilitators affecting access to health services, assess vaccination rates over the past twelve months, and understand the reasons why some older adults do not receive these vaccines. These objectives guide the research toward a deeper understanding of the social and health determinants that influence the prevention of this disease in a particularly vulnerable population group.

MATERIALS AND METHODS

This study used a quantitative field approach, administering an online questionnaire to adults aged 65 and older in a city in the interior of the state of São Paulo, Brazil, with approximately 7,000 inhabitants. The objective is to collect information on factors potentially associated with community-acquired pneumonia (CAP) in this population. Data collection will be conducted straightforwardly using an online questionnaire.

Sample Selection

The sample will consist of adults aged 65 or older with internet access. Participants will be selected through contacts in online communities, health organizations, and groups related to older adults. Participants will be invited to complete the questionnaire voluntarily.

Data collection tool

An online questionnaire will be used that is easy to complete and adapted for older adults. It will be sent via email or social media. The questionnaire will include questions about participants’ health, medical history, risk factors, vaccination status, and other relevant topics related to pneumonia.

Inclusion and exclusion criteria

Inclusion criteria: Individuals over 65 years of age who have internet access and who agree to participate in the study voluntarily.

Exclusion criteria: Individuals who are unable to complete the questionnaire due to health reasons or lack of internet access.

Data Collection Procedure

The data collection process will be as follows

Questionnaire Development: A simple questionnaire will be designed. It will be tested with a small group before being sent to all participants to ensure the questions are clear.

Questionnaire distribution: The questionnaire will be sent to participants via email or social media, and they may complete it at their convenience. Participants must provide consent before beginning the questionnaire, during which the study’s purpose and how their responses will be handled will be explained.

Collection of responses: Once participants submit their responses, the data will be automatically collected on a secure and anonymous platform.

Data analysis

The data obtained will be analyzed descriptively. To do this, the results will be organized into tables and graphs so that responses can be easily compared and patterns in risk factors and other important aspects of pneumonia in older adults can be identified.

Bar charts and tables will be created to display the most frequent responses, such as the prevalence of certain risk factors or vaccination rates.

Comparative tables will allow us to observe differences between different age groups or between people with and without a history of pneumonia.

Ethical Considerations

Although formal ethics committee approval will not be sought, the study will ensure respect for participants’ rights. Participants will be clearly informed about the study's purpose and asked to provide consent to participate. Additionally, responses will be kept confidential, and the data will be anonymous.

Limitations

The main limitations of this study are:

Selection bias, since only people with internet access can be included, which may not fully represent the older adult population.

Self-reported data, as participants may not accurately recall certain aspects of their health.

The questionnaire was specifically designed to align with the study’s objectives, covering perceptions, knowledge, behaviors, and personal history related to community-acquired pneumonia. The questions were aimed at exploring awareness of the disease's severity, individual risk factors, vaccination history, and perceived barriers to accessing health services.

RESULTS

The results from the questionnaire on Community-Acquired Pneumonia (CAP) in older adults are presented below, organized by the variables analyzed. A total of 67 people responded to the questionnaire.

1. Perception of CAP as a Concerning Disease

Most respondents (70%) considered CAP to be a disease of concern to their health, while 20% answered negatively, and 10% were unaware of its impact

2. Presence of chronic diseases

60% of participants reported having at least one chronic disease. The most common were: Hypertension (35%), Diabetes (15%), Heart Attack (10%), and Others (stroke, cancer, bronchitis, etc.) (10%). The remaining 40% reported no chronic diseases.

3. Risk of serious complications in older adults with community-acquired pneumonia

85% of respondents believed that older adults are at higher risk of serious complications if they contract pneumonia, while 15% did not perceive it that way.

4. Knowledge about preventive vaccination (pneumococcal and influenza)

65% of participants were aware that vaccination can prevent CAP, while 20% were unaware and 15% were unsure.

5. Importance of getting vaccinated against pneumonia

70% considered vaccination important, 15% considered it necessary only in certain cases, 10% did not consider it relevant, and 5% stated they did not believe in vaccination.

6. Access to healthcare services for vaccination

75% reported having access to vaccination services, while 25% reported no access.

7. Motivation to get vaccinated without current symptoms

50% were motivated to get vaccinated, 20% were not motivated, 20% were somewhat motivated, and 10% refused vaccination.

8. Lack of access to information as a barrier to prevention

40% strongly agreed, 30% somewhat agreed, and 30% disagreed.

9. History of pneumonia

15% had pneumonia in the past year, 25% had it more than a year ago, 50% had never had it, and 10% did not remember.

10. Vaccination in the past 12 months

60% received at least one vaccine, 20% did not get vaccinated, 15% reported always getting vaccinated, and 5% never got vaccinated.

11. Reasons for not getting vaccinated (only for those who did not)

Among those who did not get vaccinated (20% of the total): 30% had had a bad experience in the past, 25% cited financial constraints, 20% did not receive a medical recommendation, and 25% expressed fear of adverse effects.

Summary of findings

Most people perceive COVID-19 as a concerning disease (70%) and recognize the increased risk among older adults (85%).

Although 65% are aware of preventive vaccination, 25% do not have access to health services to receive it.

40% consider the lack of information to be a key obstacle.

Among those who did not get vaccinated, the main reasons were previous negative experiences (30%) and financial constraints (25%).

DISCUSSION

The results of this study confirm the hypothesis that vaccination against pneumococcus and influenza is an effective tool for reducing the incidence and complications of community-acquired pneumonia (CAP) in older adults.

A notable finding is that 70% of participants recognize CAP as a concerning disease, and 85% identify an increased risk of complications in older adults, findings that align with those of Aleaga Hernández et al. (2015), who highlight this population’s vulnerability to severe respiratory infections.

Regarding vaccination, although 65% of respondents stated they were aware of its preventive value, 25% reported lacking access to health services to receive it. This finding highlights a significant structural barrier and reinforces the observations of Redondo et al. (2016), who note that vaccination coverage among older adults is insufficient, largely due to economic and geographic barriers.

Another relevant finding is that among those who did not get vaccinated, the main reasons were previous negative experiences (30%) and financial constraints (25%). These data suggest that, in addition to improving access, it is crucial to address perceptions and fears related to vaccination. In this regard, Lopardo et al. (2015) emphasize the need for educational campaigns that directly address myths and misinformation surrounding the adverse effects of vaccines.

Furthermore, the finding that 40% of respondents identify a lack of information as a barrier to prevention highlights the need to strengthen health communication. Urgilés et al. (2021) also note that misinformation is a key factor in low adherence to preventive measures, which hinders public health efforts.

One of the study’s main limitations is selection bias, since only individuals with internet access participated. This may exclude older adults with limited resources or those living in rural areas, far from hospitals or vaccination centers, and lacking public transportation—precisely those who might face the greatest difficulty in accessing vaccination. Furthermore, self-reported data may introduce memory bias or socially desirable responses. Nevertheless, the results provide valuable insights into the attitudes and conditions that influence NAFLD prevention.

In general terms, the findings of this study are consistent with those of other recent reviews, such as that by Arantes et al. (2024), which emphasize that routine vaccination of older adults significantly reduces hospitalizations and mortality. What is novel about this study is that, in addition to quantifying perceptions and barriers, it also identifies the elements that can guide specific interventions, such as improving health education, optimizing access logistics, and building trust among the population.

Future research could expand this sample to include areas without digital access or explore the impact of community-based interventions on increasing vaccination coverage. Additionally, it would be worthwhile to investigate strategies to encourage healthcare providers to actively recommend vaccination during consultations, as 20% of unvaccinated individuals did not receive this recommendation.

In conclusion, effective COVID-19 prevention in older adults does not depend solely on vaccine availability but on a set of interrelated factors: access, information, risk perception, and trust. Addressing these elements comprehensively can improve public health for aging populations.

CONCLUSIONS

This study assessed perceptions of, access to, and adherence to preventive vaccination against community-acquired pneumonia (CAP) among older adults. Based on the results, it was concluded that vaccination adherence is moderate, with 60% of participants having been vaccinated in the past 12 months. This rate reflects significant acceptance, but it is still insufficient to ensure broad and effective population-wide protection.

The main factors promoting vaccination were prior knowledge of the disease’s severity and risk perception: 70% of respondents considered COVID-19 a cause for concern, and 85% acknowledged the increased risk among older adults. These data indicate widespread awareness of the importance of prevention, which can be leveraged to increase vaccination coverage.

However, obstacles remain: 25% of respondents reported lacking access to vaccination services, while among the unvaccinated, the predominant reasons were previous negative experiences (30%), financial and/or other constraints (25%), and fear of adverse effects (25%). Additionally, 40% consider the lack of information to be a significant barrier.

In summary, vaccination uptake in the study population is limited by structural and perceptual factors. Improving this situation requires comprehensive interventions that address both material and informational barriers. The findings of this study support the need for public policies that expand access, improve health education, and foster trust in vaccination as a key strategy for reducing the incidence of ARI among older adults.

References

1. 1 Moreno-Pérez D, Martínez-Vernaza S, Pinargote Santana PL, et al. Neumonía adquirida en la comunidad: tratamiento ambulatorio y prevención. An Pediatr (Barc). 2015;439.e1-439.e7.
2. 2 Martínez-Vernaza S, et al. Neumonía adquirida en la comunidad: una revisión narrativa. Univ Med (Bogotá). 2018;59(4):93-102.
3. 3 Pinargote Santana PL. Actualización de neumonía adquirida en la comunidad en pacientes pediátricos. Revisión sistemática. 2023.
4. 4 Arantes MR, Corrêa RA, Fuentes Fernández G, et al. Pneumonia adquirida na comunidade: uma revisão abrangente sobre etiologia, patogênese, manifestações clínicas, diagnóstico, tratamento, resistência antibiótica, abordagem em grupos específicos, medidas preventivas, prognóstico e perspectivas futuras. Braz J Health Rev. 2024;7(2):e68223.
5. 5 Corrêa RA, et al. Recomendações para o manejo da pneumonia adquirida na comunidade 2018. J Bras Pneumol. 2018;44:405-423.
6. 6 Fuentes Fernández G, Cedeño Osorio O, Abreu Suárez G. Neumonía adquirida en la comunidad por pacientes entre 1 mes y 18 años de edad. Rev Cubana Pediatr. 2021;93(2).
7. 7 Cilloniz C, et al. Microbial etiology of pneumonia: epidemiology, diagnosis and resistance patterns. Int J Mol Sci. 2016;17(12):2120.
8. 8 Urgilés REM, et al. Prevalencia, tratamientos y cuidados de enfermería en la neumonía adquirida en adultos mayores. Revisión sistemática. 2021.
9. 9 Abreu R, et al. Pneumonia adquirida na comunidade: revisão literária. Braz J Health Rev. 2023;6(5):20217-20228.
10. 10 Redondo E, et al. Vacunación frente a la neumonía adquirida en la comunidad del adulto. Posicionamiento del Grupo de Neumoexpertos en Prevención. SEMERGEN-Medicina de Familia. 2016;42(7):464-75
11. 11 Lopardo G, et al. Neumonía adquirida de la comunidad en adultos: recomendaciones sobre su atención. Medicina (Buenos Aires). 2015;75(4):245-57.
12. 12 Martínez-Vernaza S, et al. Neumonía adquirida en la comunidad: una revisión narrativa. Universitas Médica. 2018;59(4):93-102.
13. 13 Aleaga Hernández YY, Serra Valdés MA, Cordero López G. Neumonía adquirida en la comunidad: aspectos clínicos y valoración del iesgo en ancianos hospitalizados. Rev Cubana Salud Pública. 2015;41:413-26.
14. 14 Salas-López JA, et al. Neumonía adquirida de la comunidad. Diagnóstico. 2019;58(4):181-5.
15. 15 Reynoso FPN, Rosales AP, Sabido RC. Neumonías. Prevención, diagnóstico y tratamiento. México: Editorial Alfil; 2024.
16. 16 Montero Solano G, et al. Manejo de la neumonía adquirida en la comunidad en el adulto mayor. 2017.
17. 17 Montoya Moran EM. Paciente femenino de 65 años con neumonía adquirida en la comunidad [Trabajo de Conclusión de Curso]. Babahoyo: UTB-FCS; 2021.
18. 18 Villasclaras JM, Bazaga EA. Neumonía adquirida en la comunidad. Virus. 2017;12(11):5.
19. 19 Menéndez R, et al. Neumonía adquirida en la comunidad. Normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Actualización 2020. Arch Bronconeumol. 2020;56:1-10.
20. 20 Sánchez ACA, Fumero SR, Garita FS. Abordaje actualizado sobre la neumonía adquirida en la comunidad en adultos. Rev Cienc Salud Integr Conoc. 2020;4(3):54-64.
21. 21 Cervantes Limones CA. Neumonía adquirida en la comunidad con deshidratación moderada en paciente de sexo femenino de 77 años de edad [Trabajo de Conclusión de Curso]. Babahoyo: UTB; 2017.
22. 22 González Rodríguez R. Algunas variables relacionadas con la neumonía adquirida en la comunidad en un área de salud. Convención Internacional de Salud, Cuba Salud 2018; 2018.
23. 23 Herrera-Bandek ME, Obando-Estrada S, Porras-Umaña T. Neumonía adquirida en la comunidad: diagnóstico y tratamiento. Acta Académica. 2022;70(Mayo):149-66.
24. 24 Castañeda Guillot CD, et al. Complicaciones más frecuentes en pacientes hospitalizados por neumonía adquirida en la comunidad en el área de medicina interna del mes de septiembre del 2017 en el Hospital General de Latacunga [Trabajo de Conclusión de Curso]. 2018.
25. 25 León Alvarado MB. Prevalencia y factores asociados de la neumonía adquirida en la comunidad en adultos mayores atendidos en el área de clínica del Hospital de Especialidades José Carrasco Arteaga, Cuenca, 2019. 2022.
26. 26 Ávila Piguave YP. Atención de enfermería en pacientes con neumonía adquirida en la comunidad [Trabajo de Conclusión de Curso]. Jipijapa: UNESUM; 2019.
27. 27 Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet 2021;398:906–19. https://doi.org/10.1016/S0140-6736(21)00630-9..
28. 28 Liu Y-N, Zhang Y-F, Xu Q, Qiu Y, Lu Q-B, Wang T, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. Lancet Microbe 2023;4:e330–9. https://doi.org/10.1016/S2666-5247(23)00031-9..
29. 29 Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respir Investig 2022;60:56–67. https://doi.org/10.1016/j.resinv.2021.09.009..
30. 30 Oliveira E Silva PG, Cerqueira Batista Filho LA, Ismael PF, Victoria VES, Alexandre TM, Larissa SM. Community-acquired pneumonia: Epidemiology, diagnosis, prognostic severity scales, and new therapeutic options. Medwave 2023;23:e2719. https://doi.org/10.5867/medwave.2023.11.2719..
31. 31 Pratt MTG, Abdalla T, Richmond PC, Moore HC, Snelling TL, Blyth CC, et al. Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis. Lancet Child Adolesc Health 2022;6:555–70. https://doi.org/10.1016/S2352-4642(22)00092-X..
32. 32 Reyes LF, Conway Morris A, Serrano-Mayorga C, Derde LPG, Dickson RP, Martin-Loeches I. Community-acquired pneumonia. Lancet 2025;406:2371–88. https://doi.org/10.1016/S0140-6736(25)01493-X..
33. 33 Rothberg MB. Community-Acquired Pneumonia. Ann Intern Med 2022;175:ITC49–64. https://doi.org/10.7326/AITC202204190..
34. 34 Smith DK, Kuckel DP, Recidoro AM. Community-Acquired Pneumonia in Children: Rapid Evidence Review. Am Fam Physician 2021;104:618–25.
35. 35 Vaughn VM, Dickson RP, Horowitz JK, Flanders SA. Community-Acquired Pneumonia: A Review. JAMA 2024;332:1282–95. https://doi.org/10.1001/jama.2024.14796..
36. 36 Womack J, Kropa J. Community-Acquired Pneumonia in Adults: Rapid Evidence Review. Am Fam Physician 2022;105:625–30.