Who is at risk?

Pneumococcal Disease can be a risk for:

• Children under 2 years of age^1,2
• Children who attend day care centres, crèches, or pre-school centres²
• Children who have had a recent ear infection²
• Children who have had a recent course of antibiotics²
• Children who have an underlying illness²
• Children who have poorly functioning immune systems¹
• If there is more than one child in a household³
• Children from deprived backgrounds^2,4
• If the mother doesn’t breastfeed²

Pneumococcal infections can occur at any time of the year but exhibit a distinct winter seasonality.¹²  All age groups are at risk.  However, infants under the age of two years are more likely to suffer from Pneumococcal infections compared to other children.^5,6

Children with certain underlying medical conditions that affect the proper functioning of their immune systems (i.e., immunosuppressive conditions, sickle cell disease, cancer, asplenia) are more at risk of invasive pneumococcal infection, but the vast majority of disease will actually occur in otherwise healthy youngsters.⁷

There is also an association of day-care attendance and lack of breastfeeding with risk of invasive pneumococcal disease in children.

The presence of the “pneumo bug” in the back of the nose or throat is very common. For example, a study in the UK showed that almost all families with young children carry it at any one time during the year.^8,9  In the majority of cases the bug will stay in the back of the nose or throat without causing any harm.

However, nearly all children will have had an ear infection by their third birthday and half of them will have another episode within two years.¹⁰

The “pneumo bug” is the most common cause of bacterial pneumonia and bacterial meningitis in children under 2 years of age.^11,13

Reference:
1. World Health Organization Pneumococcal vaccines. Weekly Epidemiological Record 2003;  78(14):  110 – 119.
2. 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.
3. 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.
4. Grant C.C.,  Harnden A.R., Jewell G., Knox K., Peto T. E., Crook D.W. Invasive pneumococcal disease in Oxford 1985 – 2001: a retrospective case series. Arch Dis Child 2003;  88:  712 – 714.
5. 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.
6. 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.
7. 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.
8. Hussain M., Melegaro A., Pebody R.G., George R., Edmunds W.J., Talukdar R. et al. A longitudinal household study of Streptococcus pneumoniae nasopharyngeal carriage in a UK setting. Epidemiol Infect 2005; 133: 891 – 898.
9. Giebink G.S. The Prevention of Pneumococcal Disease in Children. N Engl J Med 2001; 345(16): 1177 – 1183.
10. Rovers M.M., Schilder A.G.M., Zielhuis G.A., Rosenfeld R.M. Otitis media. The Lancet 2004; 363: 465 – 473.
11. 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.
12. Dowell S.F., Whitney C.G., Wright C., Rose C.E., Schuchat A. Seasonal patterns of invasive pneumococcal disease. Emerg Infect Dis 2003; 9(5): 573 – 9.
13. Swartz M.N. Bacterial Meningitis – A View of the Past 90 Years. N Engl J Med 2004; 351(18): 1826 – 8.