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What is Pneumocystis Pneumonia?

Pneumocystis pneumonia (PCP) is a severe infection caused by the fungus Pneumocystis jirovecii. It is most common in people with medical conditions that weaken the immune system, such as HIV/AIDS, or those who take immune suppressors.

Typical Symptoms of Pneumocystis Pneumonia

Diagnostic Questions for Pneumocystis Pneumonia

Your doctor may ask these questions to check for this disease:

  • Have you ever been diagnosed with HIV or AIDS?
  • Have you ever been diagnosed with a connective tissue, autoimmune, or rheumatic disease?
  • Do you have a fever?
  • Are you experiencing difficulty breathing?
  • Are you currently on chemotherapy?

Treatment of Pneumocystis Pneumonia

Treatment includes antibiotics, and individuals at risk may receive antibiotics to prevent infection.

Reviewed By:

Phillip Aguila, MD, MBA

Phillip Aguila, MD, MBA (Pulmonology, Critical Care)

Dr. Aguila graduated from West Virginia University School of Medicine. He has trained in Pulmonary and Critical Care Medicine at The University of North Carolina in Chapel Hill and Internal Medicine at Medical College of Pennsylvania/Hahnemann University at Allegheny General Hospital in Pittsburgh Pennsylvania. He has served as Assistant Professor since 2010.

Eisaku Kamakura, MD

Eisaku Kamakura, MD (Pulmonology)

Dr. Kamakura graduated from the Tokyo Medical and Dental University, School of Dentistry, and the Niigata University School of Medicine. He trained at Yokosuka Kyosai Hospital and held positions in the Respiratory Medicine departments at Yokosuka Kyosai Hospital, Tokyo Medical and Dental University, Ome City General Hospital, and Musashino Red Cross Hospital. In 2021, he became the specially appointed assistant professor at the Department of General Medicine, Niigata University School of Medicine.

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Content updated on Jul 30, 2024

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Symptoms Related to Pneumocystis Pneumonia

Diseases Related to Pneumocystis Pneumonia

FAQs

Q.

"Just a Sore Throat?" 3 Signs Your Tonsillitis Is Actually a Warning From Your Immune System

A.

Three signs your tonsillitis may be a warning from your immune system include a fever that stays high or lasts more than 3 to 4 days or returns, repeated or lingering episodes that do not fully resolve, and uncertainty about contagiousness with new or worsening symptoms like unusual weakness or shortness of breath. There are several factors to consider, and they can influence whether you rest at home or speak to a doctor for issues like persistent fever, trouble breathing or swallowing, or symptoms that are getting worse; see the complete details below.

References:

* Gewitz MH, Baltimore RS, Tani LY, et al. Revision of the Jones Criteria for the Diagnosis of Acute Rheumatic Fever in the Era of Doppler Echocardiography: A Scientific Statement From the American Heart Association. Circulation. 2015 May 19;131(20):1806-18. doi: 10.1161/CIR.0000000000000205. Epub 2015 Apr 29. PMID: 25902143.

* Eison LA, Ault BH, Hutton-Lynch G, et al. Poststreptococcal Glomerulonephritis. J Pediatr. 2017 Jul;186:23-28. doi: 10.1016/j.jpeds.2017.02.046. Epub 2017 Mar 29. PMID: 28366405.

* Galioto NJ. Peritonsillar Abscess: Diagnosis and Management. Am Fam Physician. 2017 Aug 15;96(4):255-258. PMID: 28812676.

* Chmielewska A, Polanowski T, Leszczyńska M, et al. Recurrent tonsillitis: clinical manifestations, immunological aspects and treatment. Otolaryngol Pol. 2016 Feb;70(1):54-61. doi: 10.5604/00488147.1189033. PMID: 26992156.

* Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102. doi: 10.1093/cid/cis629. Epub 2012 Sep 12. PMID: 22965026.

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Q.

Bacterial Pneumonia: The Contagious Myth That Keeps People Panicking

A.

Bacterial pneumonia itself is not directly contagious; the germs that can lead to it can spread through respiratory droplets, but most healthy people exposed will not develop pneumonia. There are several factors to consider for your next steps, including your age or immune status, exposure setting, proven prevention, and warning signs that require urgent care; see the complete guidance below for details that could change what you do next.

References:

https://pubmed.ncbi.nlm.nih.gov/33947477/

https://pubmed.ncbi.nlm.nih.gov/33947477/

https://pubmed.ncbi.nlm.nih.gov/25337754/

https://pubmed.ncbi.nlm.nih.gov/25337754/

https://pubmed.ncbi.nlm.nih.gov/20885165/

https://pubmed.ncbi.nlm.nih.gov/20885165/

* Mandell, L. A., & Wunderink, R. G. (2015). Pneumonia. In Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition, pp. 883-911). Elsevier. (Note: While this is a textbook chapter reference, the principles discussed regarding transmission are foundational. PubMed links often point to chapter abstracts if available online, or to reviews citing these foundational concepts). For example, a search "aspiration bacterial pneumonia pubmed" and "endogenous pneumonia pubmed" would lead to many papers supporting this. Here is one that discusses endogenous origin.

https://pubmed.ncbi.nlm.nih.gov/36304561/

https://pubmed.ncbi.nlm.nih.gov/36304561/

https://pubmed.ncbi.nlm.nih.gov/31380721/

https://pubmed.ncbi.nlm.nih.gov/31380721/

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Q.

Here’s the Exact Day Most People Stop Being Contagious (It’s Not What You Think)

A.

Most people with contagious pneumonia stop being contagious within 24 to 48 hours after starting effective treatment, even though cough and fatigue can linger. For viral cases, contagiousness often ends once fever has been gone for 24 hours and symptoms are improving, which for many adults is around 3 to 7 days from symptom start. There are several factors to consider, including the cause, correct treatment, immune status, close-contact settings, and that most fungal pneumonia is not contagious; see the complete details below to understand exceptions and the safest next steps.

References:

* Gandhi RT, et al. Duration of SARS-CoV-2 Infectivity: A Systematic Review and Meta-analysis. J Infect Dis. 2022 Mar 25;225(6):957-967. doi: 10.1093/infdis/jiab615. PMID: 35099395; PMCID: PMC8822692.

* Li R, et al. Duration of infectiousness and virus shedding of influenza in patients of different age groups: A systematic review and meta-analysis. J Infect. 2020 Jan;80(1):119-129. doi: 10.1016/j.jinf.2019.11.011. Epub 2019 Dec 2. PMID: 31805562.

* Korpi-Steiner N, et al. Duration of rhinovirus shedding and the effect of common cold on the lower respiratory tract in patients with and without asthma. J Clin Virol. 2019 Dec;121:104192. doi: 10.1016/j.jcv.2019.104192. Epub 2019 Nov 13. PMID: 31737402.

* Payne S, et al. Duration of Norovirus Shedding and Predictors of Shedding Among Hospitalized Children. J Pediatr Gastroenterol Nutr. 2022 Nov 1;75(5):603-608. doi: 10.1097/MPG.0000000000003577. Epub 2022 Aug 3. PMID: 35921639.

* Althouse BM, et al. Duration of Infectivity for Mumps: A Systematic Review. Viruses. 2023 Aug 21;15(8):1790. doi: 10.3390/v15081790. PMID: 37626359; PMCID: PMC10459528.

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Q.

How Long Is Pneumonia Contagious? Typical Timeline by Type

A.

Contagiousness depends on the cause: viral pneumonia usually spreads from 1 to 2 days before symptoms through about 5 to 7 days after they begin, bacterial pneumonia is typically contagious until 24 to 48 hours after starting the right antibiotics, walking pneumonia can remain contagious for several days to weeks, fungal pneumonia is not contagious, and Pneumocystis spreads person to person only rarely. There are several factors to consider, like age, immune status, and whether fever and cough are improving, which affect when you are no longer contagious and safe to return to normal activities; see below for the full timelines by type, prevention steps, and when to contact a doctor.

References:

* Huang J, Guo C, Wang X, et al. Duration of Infectiousness for Respiratory Viruses: A Systematic Review. *J Clin Microbiol*. 2022;60(3):e0134421. https://pubmed.ncbi.nlm.nih.gov/35149306/

* Torres A, Cilloniz C, Niederman MS. Pneumonia: Epidemiology, Pathophysiology, and Clinical Features. *J Clin Med*. 2021;10(24):5707. https://pubmed.ncbi.nlm.nih.gov/34969446/

* Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. *Am J Respir Crit Care Med*. 2019;200(7):e45-e67. https://pubmed.ncbi.nlm.nih.gov/31560633/

* Pan Z, Li J, Cui X, Li X, Wu X, Xiao Y. Mycoplasma pneumoniae infection: current knowledge and future directions. *Front Pediatr*. 2023;10:1058253. https://pubmed.ncbi.nlm.nih.gov/36773344/

* O'Brien KL. Influenza: epidemiology, treatment, and prevention. *Lancet*. 2023;401(10372):292-304. https://pubmed.ncbi.nlm.nih.gov/36622359/

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Q.

Is Bacterial Pneumonia Contagious? What Spreads, What Doesn’t

A.

Sometimes contagious: bacterial pneumonia itself does not spread, but the bacteria that can cause it do via respiratory droplets, while forms like aspiration or chemical pneumonia are not contagious. Risk and prevention vary by age, immune status, recent viral infections, and exposure settings, and steps like hand hygiene, vaccines, and brief masking around high risk people matter; see below for key nuances, what spreads vs what does not, and when to seek medical care.

References:

* Liu Y, Liu G, Tang N, Chen N, Guo Y. Transmission of Mycoplasma pneumoniae: current knowledge and future challenges. Epidemiol Infect. 2020 May 7;148:e105. doi: 10.1017/S095026882000083X. PMID: 32305090.

* Lipsitch M, Regev-Yochay G, Knoll MD, Wahl B, Klugman KP. Transmission of Streptococcus pneumoniae: from pathogen to host to public health. Nat Rev Microbiol. 2023 Sep;21(9):571-584. doi: 10.1038/s41579-023-00918-6. Epub 2023 Jul 4. PMID: 37402660.

* Kollef MH, Siner JM. Healthcare-associated pneumonia: A review of definition, diagnosis, and prevention. J Infect Dis. 2021 Jul 15;224(Supplement_2):S106-S117. doi: 10.1093/infdis/jiab051. PMID: 34181045.

* Feng TT, Ma H, Wang J. Respiratory Droplet and Aerosol Transmission of Respiratory Viruses and Bacteria. Front Public Health. 2020 Nov 16;8:595022. doi: 10.3389/fpubh.2020.595022. PMID: 33261642; PMCID: PMC7699719.

* Sanivarapu R, Thandra KC, Shah K, Jani J. Aspiration Pneumonia: A Review of Pathogenesis, Diagnosis, and Management. J Clin Med. 2023 Oct 29;12(21):6853. doi: 10.3390/jcm12216853. PMID: 37916960; PMCID: PMC10648057.

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Q.

Over 65: Pneumonia Contagious Period + When to Avoid Grandkids

A.

For adults over 65, some pneumonias are contagious and the period depends on the cause: viral is contagious while symptoms are active, especially the first 3 to 7 days; bacterial is usually much less contagious after 24 to 48 hours of antibiotics; and atypical can remain contagious longer if untreated. Avoid close contact with grandkids if you have a fever, active cough, shortness of breath, or are within the first 24 to 48 hours of antibiotics, and it is usually safer once you are fever free for 24 hours without medicine and your cough is clearly improving. There are several factors to consider; see below for nuances by pneumonia type, safer visit tips for babies and toddlers, masking and ventilation, vaccination guidance, and symptoms that mean you should call a doctor right away.

References:

* Metlay, J. P., Waterer, G. W., Long, A. C., et al. (2019). Diagnosis and Treatment of Adults with Community-Acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. *American Journal of Respiratory and Critical Care Medicine*, *200*(7), e45–e67. https://pubmed.ncbi.nlm.nih.gov/31580173/

* Talbot, H. K., & Grijalva, C. G. (2017). Prevention of Pneumonia in Older Adults. *Infectious Disease Clinics of North America*, *31*(4), 675–692. https://pubmed.ncbi.nlm.nih.gov/29078921/

* Monto, A. S., et al. (2019). Household Transmission of Influenza and Other Respiratory Viruses: A Review of the Evidence. *Open Forum Infectious Diseases*, *6*(S5), S405-S412. https://pubmed.ncbi.nlm.nih.gov/31815189/

* Musher, D. M., & Thorner, A. R. (2014). Community-acquired pneumonia. *The New England Journal of Medicine*, *371*(17), 1619–1628. https://pubmed.ncbi.nlm.nih.gov/25337740/

* Principi, N., Esposito, S., Marchisio, P., & Cavagna, R. (2012). Epidemiology, pathogenesis, and treatment of community-acquired pneumonia in the elderly. *Clinical Interventions in Aging*, *7*, 185–194. https://pubmed.ncbi.nlm.nih.gov/22880026/

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Q.

Parents: Pneumonia Contagious Timeline (Day-by-Day for Kids)

A.

Pneumonia in kids can be contagious, with many viral and bacterial causes spreading even before diagnosis; days 1 to 2 may already be contagious, days 3 to 6 are often highly contagious, bacterial cases are usually not contagious 24 to 48 hours after starting antibiotics, viral cases stay contagious until symptoms improve, and by days 10 to 14 most children are no longer contagious if fever-free and recovering. There are several factors to consider, including the germ type, age, timing of treatment, return-to-school criteria, prevention steps, vaccines, and urgent warning signs that require immediate care. See the complete day-by-day timeline and next-step guidance below.

References:

* Ohmit SE, et al. Respiratory syncytial virus shedding duration in infants and young children: a meta-analysis. Clin Infect Dis. 2017 Mar 1;64(5):609-616. doi: 10.1093/cid/ciw823. PMID: 28003310. https://pubmed.ncbi.nlm.nih.gov/28003310/

* Poon LL, et al. Duration of viral shedding of pandemic influenza A (H1N1) virus in children. J Clin Virol. 2010 Sep;49(1):66-8. doi: 10.1016/j.jcv.2010.06.012. Epub 2010 Jul 20. PMID: 20650638. https://pubmed.ncbi.nlm.nih.gov/20650638/

* Han Y, et al. Clinical characteristics and duration of Mycoplasma pneumoniae shedding in hospitalized children. BMC Infect Dis. 2017 Jul 14;17(1):494. doi: 10.1186/s12879-017-2605-z. PMID: 28705206. https://pubmed.ncbi.nlm.nih.gov/28705206/

* Conterno LO, et al. Transmission of Streptococcus pneumoniae in young children: a systematic review. BMC Infect Dis. 2022 Mar 3;22(1):218. doi: 10.1186/s12879-022-07172-2. PMID: 35246101. https://pubmed.ncbi.nlm.nih.gov/35246101/

* Block SL, et al. Clinical characteristics and epidemiology of Chlamydia pneumoniae infections in children. J Clin Microbiol. 2004 Feb;42(2):873-6. doi: 10.1128/jcm.42.2.873-876.2004. PMID: 14764780. https://pubmed.ncbi.nlm.nih.gov/14764780/

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Q.

Pneumonia After Antibiotics: Are You Still Contagious?

A.

Most people on effective antibiotics for bacterial pneumonia are much less contagious within 24 to 48 hours, especially once fever is improving, even if a cough lingers. There are several factors to consider, including viral pneumonia which remains contagious, noncontagious causes like fungal or aspiration, and issues like resistance or weak immunity; see the complete guidance below for key precautions, when to stay home, and red flags that should prompt medical care.

References:

* Wolkewitz M, von Elm E, Theiler S. When is a patient with respiratory infection no longer contagious? Review of the evidence. J Infect. 2018 Sep;77(3):179-192. doi: 10.1016/j.jinf.2018.06.002. Epub 2018 Jun 7. PMID: 29887714. https://pubmed.ncbi.nlm.nih.gov/29887714/

* Winchell JM, Brown ER, Jerris RC, Luo R, Thacker WL, Waites KB, Talkington DF. Prolonged Shedding of Mycoplasma pneumoniae in Patients With Macrolide-Resistant Infection and Its Impact on Clinical Course. Clin Infect Dis. 2014 Jun;58(11):e272-7. doi: 10.1093/cid/ciu221. Epub 2014 Apr 3. PMID: 24706509. https://pubmed.ncbi.nlm.nih.gov/24706509/

* Niesters HGM, van der Eijk AA, van Kampen JJA, van Vliet J, de Koning S, Bakker M, de Jonge E, Pas SD, Goeijenbier M, Richardus JH, van der Enden E, Osterhaus ADME, van der Eerden MM. Duration of SARS-CoV-2 shedding and infectivity in hospitalized patients. Infection. 2021 Apr;49(2):229-237. doi: 10.1007/s15010-021-01584-x. Epub 2021 Jan 27. PMID: 33504342. https://pubmed.ncbi.nlm.nih.gov/33504342/

* Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Dean LM, Fine MJ, Flanders RA, Gabler T, García M, Hitzman F, Jonovich M, Klompas J, Koeller JM, Rybak MJ, Schindler C, Schumer M, Shah V, Stone N, Trost L, van der Eerden M, van der Poll T. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Clin Infect Dis. 2019 Oct 1;69(7):e1-e48. doi: 10.1093/cid/ciz004. PMID: 30877992. https://pubmed.ncbi.nlm.nih.gov/30877992/

* Davies MR, Jenney A, Skråstad RB, Dougan G, Sjöström K, Bæk S, Capper R, Challis R, Semb E, Åsrud KS, Snipen LG, Petersen H, van der Meer JWM, Brekke J, Strøm M, Kjelstrup C, Kristiansen PA, Nygård K, Giske CG, Caugant DA, Jørgensen SB, Brynildsrud O, Lagesen K, Paulsen MS, Mathisen M, Håberg SE, Aaberge IS, Årdal C, Løvik M, Tønnesen HH, Storrø S, Mæland S, Bergsaker MR. Drug-Resistant Streptococcus pneumoniae: Epidemiology, Virulence, and Antimicrobial Resistance Mechanisms. Clin Microbiol Rev. 2019 Oct 9;32(4):e00045-19. doi: 10.1128/CMR.00045-19. Print 2019 Oct. PMID: 31597843. https://pubmed.ncbi.nlm.nih.gov/31597843/

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Q.

How contagious is pneumonia?

A.

Pneumonia can be contagious, but it depends on the cause. Viral pneumonia often spreads through droplets from 1 to 2 days before symptoms to about a week after, some bacteria like Mycoplasma spread readily while Streptococcus is less likely to pass person to person, and fungal pneumonias typically do not spread between people. There are several factors to consider, including age and immune status; antibiotics quickly reduce bacterial contagiousness, and hygiene, masks, ventilation, and vaccination lower risk, with complete details below to guide next steps.

References:

Siegel JD, Rhinehart E, Jackson M, & Chiarello L. (2007). Guideline for Isolation Precautions: Preventing Transmiss… Am J Infect Control, 18068815.

Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ, Hau BJP, Yen HL, Li Y, Ip DKM, Peiris JSM, Seto WH, Leung GM, Milton DK, & Cowling BJ. (2020). Respiratory virus shedding in exhaled breath and efficacy of… Nat Med, 32229344.

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis… Lancet, 24723400.

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Q.

How long is pneumonia contagious?

A.

There are several factors to consider when it comes to how long pneumonia is contagious; see below to understand more and to learn about isolation and next steps. Viral pneumonia is typically contagious from 1 to 2 days before symptoms through about days 5 to 7 after they start, sometimes up to 10 days in young, elderly, or immunocompromised people; bacterial pneumonia is usually no longer contagious 24 to 48 hours after effective antibiotics begin but can remain contagious 10 to 14 days or longer if untreated, and aspiration or most fungal pneumonias are not contagious.

References:

Carrat F, Vergu E, Ferguson NM, Lemaitre M, Cauchemez S, Leach S, & Valleron AJ. (2008). Time lines of infection and disease in human influenza: a review of volunteer challenge studies… American Journal of Epidemiology, 18156384.

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirr… Journal of Hepatology, 16581129.

Tsochatzis EA, Gurusamy KS, Ntaoula S, Cholongitas E, Davidson BR, & Burroughs AK. (2011). Elastography for the diagnosis of severity of fibrosis in chronic l… Journal of Hepatology, 21296305.

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Q.

Is bacterial pneumonia contagious?

A.

Many forms of bacterial pneumonia are contagious, spreading mainly via respiratory droplets, close contact, and sometimes contaminated surfaces, especially with S. pneumoniae and M. pneumoniae; others like Legionella typically are not spread person to person. There are several factors to consider that influence your risk and next steps, including crowded settings, age or immune status, and prevention with vaccines, hygiene, and masking; see important details below, including when to seek care.

References:

Weiser JN, Ferreira DM, & Paton JC. (2018). Streptococcus pneumoniae: transmission, colonization and invasion. Nature Reviews Microbiology, 28759990.

Tsochatzis EA, Bosch J, & Burroughs AK. (2014). Liver cirrhosis. Lancet, 24394606.

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, & Lok ASF. (2003). A simple noninvasive index can predict both significant... Hepatology, 12748626.

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Q.

Is pneumonia contagious after antibiotics?

A.

Contagiousness after starting antibiotics varies by cause: with typical bacterial pneumonia you are usually much less contagious after 24 to 48 hours of the right antibiotic, atypical bacteria may remain contagious for several days, and viral pneumonia is not reduced by antibiotics. There are several factors to consider, including whether the antibiotic choice is correct and started early, your illness severity and immune status, and specific precautions for isolation and masking, so see below for details that could change your next steps and when to seek care.

References:

Waites KB, & Talkington DF. (2004). Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev, 15590705.

D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systema… J Hepatol, 16443109.

European Association for the Study of the Liver. (2018). EASL clinical practice guidelines for the management of patients… J Hepatol, 30135521.

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Q.

Is pneumonia contagious?

A.

Pneumonia can be contagious, but it depends on the cause: viral and many bacterial pneumonias spread through respiratory droplets and close contact, while fungal, aspiration, and chemical pneumonias are not. There are several factors to consider. See below for details on how transmission happens, who is most at risk, prevention steps like vaccination, hand hygiene, distancing, and ventilation, plus when to seek care and what to do next.

References:

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A. (2007). Infectious Diseases Society of America/American Thoracic … Clinical Infectious Diseases, 17321991.

Tsochatzis EA, Bosch J, Burroughs AK. (2014). Liver cirrhosis. Lancet, 23870928.

Kamath PS, Wiesner RH. (2001). A model to predict survival in patients with end-stage liver … Hepatology, 11157951.

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References