Vaccines and Preventable Diseases:
Pneumococcal Disease - Q&A
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Pneumococcal disease is defined as infections that are caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus. The most common types of pneumococcal infections include middle ear infections, sinus infections, lung infections (pneumonia), blood stream infections (bacteremia), and meningitis. Some of these infections are considered to be "invasive." Invasive disease means that germs invade parts of the body that are normally free from germs. For example, pneumococcal bacteria can invade the bloodstream, causing bacteremia, and/or the tissues and fluids surrounding the brain and spinal cord, causing meningitis. When this happens, disease is usually very severe, causing hospitalization or even death.
Young children are much more likely than older children and young adults to get pneumococcal disease. Children younger than 2 years of age, children in group child care, and children who have certain illnesses (for example, sickle cell disease, HIV infection, and chronic heart or lung conditions) are at higher risk than other children to get pneumococcal disease. Children with cochlear implants or cerebrospinal (CSF) fluid leaks are more likely to get pneumococcal meningitis. In addition, pneumococcal disease is more common among children of certain racial or ethnic groups, such as Alaska Natives, American Indians living in certain communities, and African-Americans, than among other groups.
Each year in the US pneumococcus causes about 4000 cases of blood stream infections (bacteremia), meningitis, or other invasive disease in children younger than 5 years of age. Children under 2 years of age average more than 1 middle ear infection each year, many of which are caused by pneumococcus. Pneumococcus is the most common cause of bacteremia, pneumonia, meningitis and otitis media (middle ear infections) in young children.
Children at increased risk of pneumococcal infections include those with anatomic or functional asplenia (including sickle cell disease), patients taking immunosuppressive drugs, those with congenital and acquired immune deficiency (including HIV infections), children with cochlear implants, and those with chronic renal disease. Some American Indian, Alaska Native and African American children may also be at increased risk. Children younger than 5 years of age in out-of-home day care are at increased risk (approximately 2 fold higher) of experiencing invasive pneumococcal infections than other children.
High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and young infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect; infants may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly.
In adults, pneumococcal pneumonia is often characterized by sudden onset of illness with symptoms including shaking chills, fever, shortness of breath or rapid breathing, pain in the chest that is worsened by breathing deeply, and a productive cough. In infants and young children, signs and symptoms may not be specific, and may include fever, cough, rapid breathing or grunting.
Children who have otitis media (middle ear infection) typically have a painful ear, and the eardrum is often red and swollen. Other symptoms that may accompany otitis media include sleeplessness, fever and irritability.
Blood stream infections:
Infants and young children with blood stream infections – also known as bacteremia – typically have non-specific symptoms including fevers and irritability.
Invasive pneumococcal disease may be a very serious illness in young children. Meningitis is the most severe type of pneumococcal disease. Of children younger than 5 years of age with pneumococcal meningitis, about 5% will die of their infection and others may have long-term problems such as blindness or hearing loss. Many children with pneumococcal pneumonia or blood stream infections will be ill enough to be hospitalized. About 1% of children with blood stream infections or pneumonia with a blood stream infection will die of their illness. Sinus infections and ear infections are usually mild and are much more common than serious forms of pneumococcal disease. Some children, however, develop recurrent ear infections and may need tympanostomy tubes (ear tubes).
The bacteria that cause pneumococcal disease are spread through contact with persons who are ill or healthy persons who carry the bacteria in the back of the nose. Transmission is mostly through the spread of respiratory droplets from the nose or mouth of a person with a pneumococcal infection. It is common for people, especially children, to carry the bacteria in their throats without being ill from it.
Pneumococcal disease is treated with antibiotics. Before the introduction of pneumococcal conjugate vaccine (PCV) to prevent infection, many types of pneumococcal bacteria were becoming resistant to some of the antibiotics used to treat pneumococcal infections. Antibiotic-resistant pneumococcal infections have significantly declined, but remain a concern in some populations. Appropriate use of antibiotics may also slow or reverse emerging drug resistance found among pneumococcal infections.
The pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) protects against 13 types of pneumococci (the bacteria that cause pneumococcal disease). It is recommended for use in infants and young children. The vaccine should be given to all infants at 2, 4, and 6 months of age, followed by a booster dose at 12 through 15 months of age. Previously unvaccinated, healthy children 24 months through 4 years of age only need to receive one dose of this vaccine. Additional doses of PCV13 may be recommended, depending on the child’s age and health status. For more information, please consult the ACIP recommendations or your child’s health care provider.
The pneumococcal polysaccharide vaccine (PPSV), Pneumovax®, is a 23-valent polysaccharide vaccine that is currently recommended for use in all adults who are 65 years and older and for persons who are 2 years and older and at high risk for disease such as persons with sickle cell disease, HIV infection, or other immunocompromising conditions. It is also recommended for use in adults 19 through 64 years of age who smoke cigarettes or who have asthma and adults living in nursing homes or long-term care facilities.
Yes. Studies done on 7-valent pneumococcal conjugate vaccine (PCV7), which was licensed by FDA in late 2000, showed the vaccine to be highly effective in preventing invasive pneumococcal disease in young children. The 13-valent pneumococcal conjugate vaccine, also known as Prevnar 13® or PCV13, which was licensed by FDA in February 2010, will provide protection against infections caused by a greater variety of pneumococcal serotypes (“strains”). PCV13 is similar to PCV7 but includes 6 additional serotypes. This means that it will provide protection against infections caused by a greater variety of pneumococcal serotypes. Studies have shown that PCV13 causes the body’s immune system to create protective antibodies, which help fight the pneumococcal bacteria, similar to PCV7. Like PCV7, PCV13 will be further studied for its effectiveness.
In a study including 37,000 infants in California, PCV7 was over 90% effective in preventing invasive disease. The children who received the vaccine also had 7% fewer episodes of otitis media and a 20% decrease in the number of tympanostomy tubes (ear tubes) placed. The vaccine was also shown to decrease the number of episodes of pneumonia.
CDC conducted a study soon after PCV7 was licensed and found that the vaccine was 96% effective against pneumococcal disease in healthy children who received one dose or more and 81% effective in children with medical conditions that put them at risk of pneumococcal disease. The vaccine was also highly effective at preventing pneumococcal disease caused by antibiotic-resistant serotypes.
Since routine vaccine introduction in the US, rates of invasive pneumococcal disease caused by the seven serotypes included in the vaccine have declined by 99%. Rates of invasive pneumococcal disease caused by some serotypes not in the PCV7 vaccine have increased since PCV7 vaccine introduction. However, these increases have been small compared to the decreases in vaccine type serotypes. Also, the main serotypes causing the increases will be covered by PCV13.
Pneumovax®, the pneumococcal polysaccharide vaccine that includes 23 serotypes, has been shown to be 50-85% effective in preventing invasive disease caused by those 23 serotypes in adults with healthy immune systems.
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Content last reviewed on April 1, 2011
Content Source: National Center for Immunization and Respiratory Diseases