Clinton diagnosis a reminder of risk factors, vaccine recommendations

Presidential candidates are famously visible, making frequent campaign stops during the course of many months. Along the way, they have perhaps thousands of interactions that place them at risk for illness.

According to William Schaffner, MD, professor of preventive medicine at Vanderbilt University and Infectious Disease News Editorial Board member, this may explain how Hillary Clinton contracted pneumonia.

William Schaffner

The CDC says good hygiene practices such as washing your hands can prevent pneumonia and other respiratory infections.

Clinton, the Democratic nominee for president, fell ill during a ceremony Sunday marking the 15th anniversary of 9/11, according to her campaign, and was later seen being helped into a van by several people. Clinton’s personal physician said she had been diagnosed with pneumonia 2 days earlier during a follow-up evaluation for a prolonged cough related to allergies.

The physician, Lisa R. Bardack, MD, director of internal medicine at CareMount Medical, said the former U.S. Secretary of State had been put on antibiotics and advised to “rest and modify” her schedule after being diagnosed with pneumonia. In a statement, Bardack said Clinton had become overheated and dehydrated during the 9/11 event but was “rehydrated and recovering nicely” later in the day.

“What likely happened here is that during the course of campaigning, she has had face-to-face contact with thousands of people, shaking their hands. This is an ideal way to acquire a viral infection,” Schaffner said in an interview.

A viral infection — such as one that might be contracted while on the campaign trail — can lead to bacterial pneumonia, according to Schaffner. Without evidence of severe infection — hospitalization, for instance — Schaffner said Clinton’s pneumonia is likely on the milder side, but could still be responsible for her apparent unsteadiness on her feet.

“You’re perspiring, and that evaporates, so you lose more fluid. Put that in the context of being out on a hot day, and there you go,” he said. “You’re more likely to have an episode where your blood pressure drops and you feel uncertain. But once you get hydrated, your feeling of well-being improves substantially.”

Major risk factors associated with pneumonia include age, smoking, underlying heart or lung disease, and diabetes, according to Schaffner. Common symptoms include fever, fatigue, loss of appetite, cough, sore throat and green or yellow sputum. More serious symptoms might consist of chest pain, shortness of breath and chills accompanied by a fever.

Patients who are more or less active in their daily lives but have an illness that includes fever, some cough and a loss of appetite, might have so-called “walking pneumonia,” which can be treated with rest, fluids and a course of antibiotics, according to Schaffner.

“As you get more of these symptoms, the illness is more severe,” he said.

The CDC recommends that persons aged 65 years and older receive two pneumococcal vaccines: the pneumococcal conjugate vaccine, then the pneumococcal polysaccharide vaccine 1 year later. The CDC also says the best way to prevent influenza is to get vaccinated every year.

Both of these recommendations would apply to Clinton, aged 68 years, and Republican opponent Donald J. Trump, aged 70 years.

“Our presidential candidates should take advantage of not only the pneumococcal vaccines, but also annual influenza vaccine, and they will set an excellent example for everyone in the country,” Schaffner said. – by Gerard Gallagher

Disclosure: Schaffner reports relationships with Dynavax, Genentech, Merck, Novavax, Pfizer, and Sanofi Pasteur.