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Pneumococcal

Pneumococcal Disease Media Backgrounder

Pneumococcal disease is a leading cause of serious illness in adults, particularly those 65 years of age and older, and children throughout the world. The disease is caused by a common bacterium, the pneumococcus (Streptococcus pneumoniae), which can attack different parts of the body.

When bacteria invade the lungs, they cause the most common form of community-acquired bacterial pneumonia; when bacteria invade the bloodstream, they cause bacteremia; and when they invade the covering of the brain, they cause meningitis. Pneumococci may also cause otitis media (middle ear infection) and sinusitis. Currently there are 90 known pneumococcal types; the 10 most common types account for approximately 62 percent of invasive disease worldwide.

Each year in the United States, there are an estimated 175,000 hospitalized cases of pneumococcal pneumonia, 34,500 cases of bacteremia and 2,200 cases of meningitis. Invasive disease (bacteremia and meningitis) are responsible for the highest rates of death among the elderly and patients who have underlying medical conditions. Children under age 2 fall into the highest general risk group for invasive pneumococcal infections.

According to the U.S. Centers for Disease Control and Prevention (CDC), invasive pneumococcal disease causes about 4,800 deaths annually. More than half of these cases and nearly all deaths occur in adults for whom vaccination against pneumococcal disease is recommended.

Pneumococcal Disease Symptoms

The symptoms of pneumococcal disease vary depending on the illness caused by the bacteria:

  • Symptoms of pneumonia in adults include sudden onset of illness characterized by shaking chills, fever, shortness of breath or rapid breathing, chest pain 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.
  • Meningitis is characterized by high fever, headache and stiff neck. The symptoms can develop over several hours or could take one to two days to appear. Others symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion and sleepiness.
  • Children with otitis media 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, also known as bacteremia, typically have non-specific symptoms including fever and irritability.

Anyone can get pneumococcal disease, but some groups are at particularly high risk for the disease or its complications. These groups include persons aged 65 and older; children under 2 years of age; individuals with weak immune systems due to cancer, leukemia, Hodgkin's disease or human immunodeficiency virus (HIV); persons with sickle cell disease or without a functioning spleen; individuals who have a chronic illness such as lung, heart and kidney disease, diabetes or alcoholism; persons living in special environments or communities, such as Alaskan Natives and certain American Indian populations; and residents of chronic or long-term care facilities.

Pneumococcal disease is spread through contact between persons who are ill or who carry the bacteria in their throat. 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.

Protection through Vaccination

The best way to protect against pneumococcal disease is through vaccination.

Vaccination against pneumococcal disease is recommended for:

  • Persons who are 65 years of age and older.
  • Everyone 2 years of age and older with chronic medical conditions such as diabetes; heart, kidney, liver or chronic lung disease (excluding asthma*); or alcoholism.
  • Those whose immune systems have been weakened by such conditions as cancer or HIV infection.
  • People without a functioning spleen and those with sickle cell disease.
  • Residents of chronic care or long-term care facilities.
  • Children at 2, 4 and 6 months of age, followed by a booster dose at 12-15 months.

* While people with asthma can safely receive a pneumococcal vaccine, asthma alone is not a high-risk indication for pneumococcal vaccination.

There are two types of pneumococcal vaccine currently available: a conjugate vaccine for children under 2 years of age and a polysaccharide vaccine for use in everyone 65 years of age and older and certain persons 2 to 64 years of age with underlying medical conditions. These pneumococcal vaccines are safe and effective.

Vaccination with the polysaccharide vaccine protects against 23 of the most prevalent Streptococcus pneumoniae strains. Serotypes contained in the vaccine account for nearly 90 percent of pneumococcal disease. The polysaccharide vaccine is not recommended for infants and young children under 2 years of age, as this age group does not respond to polysaccharide vaccines. These children should be vaccinated routinely with the conjugate vaccine, which is effective in protecting against more than 80 percent of the pneumococcal bacteria responsible for meningitis and bacteremia in young children.

A study published in the medical journal Clinical Infectious Diseases found that hospital patients who received the pneumococcal vaccine were 40 to 70 percent less likely to die than unvaccinated patients. In the study, vaccinated patients had a lower risk of respiratory failure, kidney failure, heart attack and other complications. Vaccinated patients in the study also spent an average of two fewer days in the hospital.

In most adults who are vaccinated at age 65 years or older, vaccination is needed only once in a lifetime. However, for adults who are vaccinated before age 65, or for those at highest risk for serious disease, revaccination may be necessary. Pneumococcal vaccination is reimbursable by Medicare Part B and is appropriate at any time of the year. It can be administered in the other arm at the same time as the influenza vaccine.

The polysaccharide vaccine has been available in the United States for more than 20 years and is recommended for routine vaccination of all persons 65 years and older. Yet only 64.5 percent of those 65 years of age and older reported ever receiving it, according to the CDC's Behavioral Risk Factor Surveillance System. This falls short of the Healthy People 2010 goal of vaccinating 90 percent of adults 65 years of age and older against pneumococcal disease.

The pneumococcal conjugate vaccine is recommended for all children 2 to 23 months of age and protects against seven strains of the Streptococcus pneumoniae bacterium. In infants and children, studies have shown that the conjugate vaccine reduces the incidence of invasive pneumococcal disease, pneumonia and otitis media.

The conjugate vaccine has been incorporated into the routine childhood immunization schedule. In infants and children 11 months of age or younger, three or four doses of conjugate vaccine are required, depending upon the age the first dose is given. Children 12 to 23 months of age require two doses. Healthy children 24 to 59 months of age require one dose of conjugate vaccine and those with certain chronic diseases require two doses.

The vaccine may cause some local reaction or soreness around the site of the injection; however, these reactions are usually minor and subside within a few days. In children, the conjugate vaccine may cause mild fever, fussiness and decreased appetite.

Individuals who have had a previous allergic reaction (e.g., hives, difficulty breathing) to the pneumococcal vaccine should avoid vaccination. The vaccine should also be avoided during radiation therapy or chemotherapy.

Health care providers can choose to delay vaccination of children with moderate to severe infection until the child has recovered. However, vaccination can proceed during minor illness, with or without fever, particularly among children with mild upper respiratory tract infections or hay fever.

Treating Pneumococcal Disease

Pneumococcal disease traditionally has been treated primarily with penicillin. In recent years, pneumococcal strains resistant to penicillin and other commonly used antibiotics have emerged. This resistance makes treatment difficult and may result in longer hospitalizations, more expensive alternative therapy using alternative antibiotics, and increased illness and death. The emergence of resistant strains places further emphasis on the need for preventing pneumococcal disease through vaccination.