What is pneumococcal disease?

• Pneumococcal disease describes a group of illnesses caused by the bacterium Streptococcus pneumoniae, also known as pneumococcus.¹
• Streptococcus pneumoniae can cause meningitis (infection of the lining of the brain), pneumonia (infection of the lung), bacteraemia (blood infection), sinusitis as well as otitis media (infection of the middle ear).^1,2
• It is estimated that more than 1 million children under the age of five die from pneumococcal disease every year.¹

pneumococcal_meningitis

Definition

Meningitis is the inflammation of the protective membranes (meninges) covering the brain and spinal cord¹²

Signs and Symptom

• Headache¹²
• Neck stiffness¹²
• Fever ¹²
• Photophobia (inability to tolerate bright light)¹²
• Irritability¹² 
• Seizures¹²
• Swelling of the fontanelle (soft spot on a newborn baby’s skull)¹²

How Serious is Meningitis?

Meningitis is the 10th leading cause of death in South African children under five³ and one out of every five children who contract pneumococcal_meningitis will die⁴, while almost 50% of those who survive will be left with disabilities ranging from deafness to brain damage.^5,20

pneumococcal_meningitis is the leading cause of bacterial meningitis in the USA and South Africa²¹ and the second most common form of bacterial meningitis in the UK.^4,7 It is among the most destructive in terms of death and permanent disability.^5,8,20

pneumococcal_pneumonia

Definition

Pneumonia is an infection of the lung, in which the alveoli (microscopic air filled sacs of the lung) become inflamed and flooded with fluid.¹²

Signs and Symptoms - Main Symptoms

• Cough producing greenish or yellow sputum, sometimes tinged with blood¹²
• Fever¹²
• Shaking chills¹²
• Shortness of breath¹²
• Chest pain¹²

Additional Symptoms

• Headaches¹²
• Sweaty and clammy skin¹²
• Loss of appetite¹²
• Fatigue¹²
• Blueness of the skin¹²
• Nausea and vomiting¹²
• Joint pains or muscle aches¹²

How Serious is Pneumonia?

One out of every 200 children in the UK were hospitalised before their 5th birthday due to pneumococcal_pneumonia¹³.  pneumococcal_pneumonia is the most common bacterial form of pneumonia in children under 2 years of age, and the commonest form of pneumonia requiring hospitalisation in children.^14,15

Pnumococcal Bacteraemia

Definition
Bacteraemia is the presence of bacteria in the bloodstream.²²

Signs and Symptoms

• Fever²²

How Serious is Bacteraemia?

A South African study monitored the incidence of pneumococcal_bacteraemia in children in Soweto during a decade and assessed the influence of HIV infection on any changes.  Children in Soweto had a high incidence of pneumococcal_bacteraemia which doubled during the decade mainly as a result of the impact of the HIV epidemic.¹⁶

Bacteraemia may be transient and cause no sequelae, or it may cause systemic consequences.  Development of symptoms such as abnormally fast breathing, shaking chills, persistent fever, altered sensorium, low blood pressure, abdominal pain, nausea, vomiting, and diarrhoea, suggests sepsis or septic shock.  Septic shock develops in 25% to 40% of patients with significant bacteraemia.²²

pneumococcal_sinusitis

Definition

Sinusitis is an inflammation of the paranasal sinuses.  It is usually caused by infection, but can also be caused by allergic reactions.²²

Signs and Symptoms

• A dull ache or pressure across the midface, especially between or deep into the eyes22
  Headache²²
• Nasal congestion or obstruction²²
• Postnasal drip²²
• Fever²²
• Raspy voice²² 
• Pus-like nasal discharge²²
• Loss of sense of smell²²
• Facial pain that is sometimes aggravated when bending over²²

How Serious is Sinusitis?

Bacterial infections of the paranasal sinuses do not usually involve the nose.  When the patient with bacterial infection of the paranasal sinuses has a thick, coloured, nasal drainage, the site of infection is the sinuses;  the nose is simply acting as a conduit for secretions produced in the sinuses.¹⁷

Children have 6 – 8 viral upper respiratory infections each year;  it is estimated that between 5% and 13% of these infections may be complicated by a secondary bacterial infection of the sinuses.¹⁷

Pneumococcal Otitis Media

Definition

Otitis media is inflammation of the middle ear (the cavity between the eardrum and the inner ear)²³

Signs and Symptoms

• Sudden, severe earache²³
• Hearing loss²³
• Ringing or buzzing in the ear²³
• Sense of fullness in the ear²³
• Irritability²³
• Tugging or rubbing the ear²³
• Unwillingness to lie down²³
• Fever²³
• Headache²³
• Change in appetite or sleeping patterns²³
• Fluid leaking from the ear²³
• Nausea²³
• Occasionally, the eardrum can burst, which causes a discharge of pus and relief of pain²³

How Serious is Otitis Media?

Acute otitis media in children accounts for 20 million office visits per year in the Unites States. Up to 1.2 million of the 20 million yearly episodes of acute otitis media in the US could theoretically be prevented if the pneumococcal vaccine were widely used. Tympanostomy tubes (grommets) accounted for 30% – 50% of all surgical operations in children in the US.  The estimated annual cost associated with otitis media is $2 billion - $5 billion in the US. Streptococcus pneumoniae is the most commonly reported bacterial cause of acute otitis media, accounting for 28% to 55% of cases.^18,19

Reference:
1. 1. World Health Organization Pneumococcal vaccines.  Weekly Epidemiological Record 2003;  78(14):  110 – 119.
2. Prevenar package insert.
3. Bradshaw D., Bourne D., Nannan N.  What are the leading causes of death among South Africa children?  MRC Policy Brief 2003; 3.  (Unpublished data).
4. Department of Health, Chief Medical Officer. Preventing meningitis. 7 December 2006.  http://www.dh.gov.uk/en/Aboutus/Ministersand
   DepartmentLeaders/ChiefMedicalOfficer/
   ProgressOnPolicy/ProgressBrowsableDocument/
   DH_4102788 (Accessed:  20 September 2007)
5. Bedford H., de Louvois J., Halket S., Peckham C., Hurley R., Harvey D.  Meningitis in infancy in England and Wales:  follow up at age 5 years.  BMJ 2001;  323:  1 – 5.
6. Levine O.S., Farley M., Harrison L.H.,  Lefkowitz L., McGeer A., Schwartz B.  Risk Factors for Invasive Pneumococcal Disease in Children:  A Population-based Case-Control Study in North America.  Pediatrics 1999; 103(3): 28 – 33.
7. Ispahani P., Slack R.C.B., Donald F.E., Weston V.C., Rutter N.  Twenty years surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implications for immunization. Arch Dis Child 2004; 89: 757 – 762.
8. Baraff L.J., Lee S.I., Schriger D.L. Outcomes of bacterial meningitis in children: a meta-analysis.  Paed Infect Dis J 1993; 12(5): 389 – 394.
9. McIntosh E.D.G. How many episodes of hospital care might be prevented by widespread uptake of 7-valent pneumococcal conjugate vaccine? Arch Dis Child 2003;  88:  859 – 861.
10. Givon-Lavi N., Fraser D., Porat N., Dagan R. Spread of Streptococcus pneumoniae and Antibiotic-Resistant S. pneumoniae from Day-Care Centre Attendees to Their Younger Siblings. JID 2002; 186: 1608-14.
11. Grant C.C.,  Harnden A.R., Jewell G., Knox K., Peto T. E., Crook D.W.  nvasive pneumococcal disease in Oxford 1985 – 2001: a retrospective case series. Arch Dis Child 2003;  88:  712 – 714.
12. Wikipedia, the free encyclopedia
13. Djuretic T., Ryan M.J., Miller E., Fairley C.K., Goldblatt D. Hospital Admissions in Children due to pneumococcal_pneumonia in England. J of Inf 1998; 37:  54 – 58.
14. Miller E., Waight P., Efstratiou A., Brisson M., Johnson A., George R. Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996 – 1998. Acta Paed Suppl 2000;  435:  11 – 16.
15. Drummond P., Clark J., Wheeler J., Galloway A., Freeman R., Cant A. Community acquired pneumonia – a prospective UK study. Arch Dis Child 2000; 83:  408 – 412.
16. Karstaedt A.S., Khoosal M., Crewe-Brown H.H.  Pneumococcal bacteremia during a decade in children in Soweto, South Africa. Pediatr Infect Dis J 2000;  19(5): 454 – 457.
17. Subcommittee on Management of Sinusitis and Committee on Quality Improvement. Clinical Practice Guideline:  Management of Sinusitis. Pediatrics 2001; 108(3): 798 – 808.
18. Eskola J., Kilpi T., Palmu A., et al.  Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N Engl J Med 2001; 344(6): 403 – 409.
19. Fireman B., Black S.B., Shinefield H.R., Lee J., Lewis E., Ray P. Impact of the pneumococcal conjugate vaccine on oitits media. Pediatr Infect Dis J 2003;  22(1):  10 – 16.
20. Kornelisse R.F., Westerbeek C.M.L., Spoor A.B., et al. pneumococcal_meningitis in Children:  Prognostic Indicators and Outcome. Clin Inf Dis 1995;  21: 1390 – 1397.
21. Von Gottberg A. Respiratory and meningitis pathogens surveillance, South Africa, 2006. Comm Dis Surveillance Bull 2007; 5(1): 10 – 14.
22. Merck Manual Professional. http://www.merck.com/mmpe/print/sec14/ch167/ch167g.html  
23. Health Encyclopedia – Diseases and Conditions. 
    http://www.healthscout.com/ency/68/611/main.html