Pneumococcal disease is an infection caused by the bacterium
Streptococcus pneumoniae. It can lead to
pneumonia, bacteremia (infection of the blood),
middle ear infection, or
meningitis.
Streptococcus pneumoniae
is spread through contact with a person who has pneumococcal disease or who carries the bacteria in his or her throat. This most often occurs through respiratory droplets from the nose or mouth of someone with the infection.
This infection is most common in infants and young children, specifically, children under the age of two, and those in group childcare. It also occurs in those who have certain illnesses (eg,
sickle cell disease,
HIV infection, and chronic heart or lung conditions). These people are at higher risk of getting pneumococcal disease. Also, Alaskan Natives, Native Americans, and African Americans are more likely than other ethnic groups to get the infection.
It is estimated that
Streptococcus pneumoniae
is the annual cause, in children under five years of age, of 200 deaths, 700 cases of meningitis, 17,000 cases of bacteremia, and 4.9 million cases of middle ear infections.
Symptoms of meningitis include:
- High fever
- Headache
- Stiff and sore neck
- Nausea and vomiting
- Difficulty looking into bright lights
- Confusion
- Sleepiness
- In infants, slowness or inactivity, irritability, vomiting, and/or poor feeding
Symptoms of pneumonia include:
- Chills
- Fever
- Shortness of breath
- Chest pain worsened by breathing deeply
- Productive cough
- In infants and young children, fever, cough, rapid breathing, and/or grunting
Symptoms of middle ear infection include:
- Pain in the ear
- Red, swollen eardrum
- Sleepiness
- Fever
- Irritability
Symptoms of bacteremia include:
- Nonspecific symptoms, including fevers and irritability
Pneumococcal disease is treated with antibiotics.
There are two types of pneumococcal vaccines: the pneumococcal polysaccharide vaccine (PPV) and the pneumococcal conjugate vaccine (PCV). PPV is recommended for older children and adults, while PCV is approved for infants and toddlers.
These vaccines are made from pieces of
Streptococcus pneumoniae
bacteria. They are given by injection under the skin or into the muscle, usually in the arm or thigh. They must be stored in a refrigerator prior to administration.
PPV is recommended for all adults 65 years of age or older. It is also recommended for people over the age of two who have certain health problems (eg, heart or lung disease, sickle cell disease,
diabetes,
alcoholism,
cirrhosis, cerebrospinal fluid leakage,
Hodgkin's disease,
lymphoma,
leukemia, kidney failure,
multiple myeloma, nephritic syndrome, HIV infection or AIDS, damaged spleen, no spleen, and organ transplant). In addition, people over the age of two who are taking medications that lower the body's resistance to infection, including long-term steroids,
certain cancer drugs, and
radiation therapy, are advised to get PPV. Finally, Alaskan Natives and certain Native American populations should receive the vaccine.
PCV is recommended for children under two years of age. It is taken in four doses, at two, four, six, and 12-15 months. PCV, in one dose, is also recommended for children between 24-59 months who have not completed or started the vaccine series. PPV is recommedned to children more than 2 years old with underlying medical conditions*. Children at high risk include those who take medications that affect the immune system or have sickle cell disease; damaged spleen or no spleen; HIV infection or AIDS; diabetes; cancer; or liver, lung, or heart disease.
Finally, PCV should be considered for children who are under three years of age, who are of Alaskan Native, American Indian, or African American descent, or who attend group daycare. The number of doses for these children depends on their age.
PPV is a very safe vaccine. Half of the people who get the vaccine have mild side effects, such as redness or pain near the injection site. Less than 1% will develop a fever, muscle aches, or more severe local reactions. In rare cases, there have been reports of severe allergic reactions and other serious problems, even death. However, developing pneumococcal disease is much more likely to cause serious problems than getting the vaccine.
For PCV, studies have shown that about 25% of infants have redness, tenderness, or swelling around the injection site. About a third have a fever over 100.4 ºF, and one in 50 has a higher fever (over 102.2 ºF). There have also been reports of drowsiness and a loss of appetite. While there have been no reports of serious reactions from PCV, all vaccines are associated with a very small risk of serious problems, including severe allergic reactions that may result in death.
Because the safety of PPV in pregnant women has not been studied, pregnant women should consult their doctor before being vaccinated.
Also, certain children should not get PCV. These include those who have had a life-threatening allergic reaction to a previous dose of PCV, or those who have a severe allergy to one of the vaccine's components.
Children who have minor illnesses (eg, a
cold) can be vaccinated, but those who are moderately or severely ill should wait until they recover to get the vaccine.
Avoiding close contact with people who have infections can prevent pneumococcal disease. Also, washing your hands regularly can reduce your risk of infection.
In the event of a pneumococcal disease outbreak, all people who are eligible for a vaccine should receive it. The key to preventing outbreaks is for everyone who is at risk for developing severe pneumococcal disease to receive a vaccination.
