Childhood Pneumococcal Disease

What is childhood pneumococcal disease?

Pneumococcal disease is the leading cause of serious illnesses in children worldwide. The disease covers a range of infections that are caused by the Streptococcus pneumoniae (S. pneumoniae) bacterium.

S. pneumoniae can cause serious, life-threatening diseases and permanent health damage to children. Those infected with S. pneumoniae suffer a range of childhood diseases, from the more serious meningitis (inflammation or swelling of the lining of the brain), pneumonia (inflammation of the lungs) and blood infection (bacteraemia) to the less severe but highly prevalent diseases such as otitis media (inflammatory infection of the middle ear), sinusitis (inflammation of the sinuses) and bronchitis (inflammation of the airways in the lungs). These more common diseases can also be very debilitating and distressing for children and their parents.

Invasive pneumococcal diseases

• Invasive pneumonia

Each year, 156 million cases of childhood pneumonia are treated worldwide, with children in developing countries accounting for more than 95% of all new cases worldwide

Pneumonia is the most common cause of pneumococcal deaths worldwide. Pneumococcal pneumonia is an extremely serious disease and fatalities rates are estimated to range from 10% to 20%, with the risk of death exceeding 50% for high-risk groups such as young children and the elderly. S. pneumoniae is the most important cause of severe pneumonia , which may help explain the high mortality rates

Symptoms typically include shaking, chills, high fever, sweating, shortness of breath, chest pain, muscle pain, fatigue and a cough that produces thick, greenish or yellow phlegm (mucus)

• Pneumococcal meningitis

Pneumococcal meningitis is most frequent in children aged less than two years old

The consequences of pneumococcal meningitis can be severe – 20% of sufferers will die (one in six children) , whilst approximately 25% of survivors (rising to half in children)9, may be left with severe and disabling after-effects such as hearing and sight loss, epilepsy, learning and behavioural problems (especially in babies and young children), memory problems, tiredness and persistent headaches

Meningitis symptoms can include high fever, severe headache, vomiting, a dislike of bright lights, stiff neck, muscle pain, drowsiness, difficultly to wake and a rash that does not fade under pressure

• Pneumococcal bacteraemia

Pneumococcal bacteraemia is an extremely serious condition which results in death in about 20% of cases

It is a common secondary condition of invasive pneumococcal pneumonia, occurring in approximately 25% of patients

Symptoms include fever, headache and muscular aches and pains

Non-invasive pneumococcal diseases

• Otitis media

Otitis media (OM) encompasses a range of potentially serious inflammatory middle ear infections

OM is one of the most frequent diseases of childhood. By the age of three years, it is estimated that 75% of all children will have had at least one episode and more than one third will have had repeated infections (defined as three or more episodes in one year)

Repeated infections can sometimes result in surgery with the insertion of a small metal ‘tunnel’ (called a grommet) through the eardrum to allow fluid to drain away

The symptoms include restlessness, pain, fever and generalised flu-like symptoms such as fever and a sore throat, temporary hearing loss and pus running out of the ear(s)

• Sinusitis

Sinusitis is an infection of the small, air-filled cavities inside the cheekbones and forehead. Acute sinusitis often develops quickly (over a few days) following a cold or influenza (flu)

Symptoms include pain and tenderness of sinuses, blocked or runny nose or a high temperature

• Bronchitis

Bronchitis is an infection of the main airways of the lungs (bronchi)

It is common in winter, and often develops following a cold, sore throat or influenza (flu). Anyone can be affected although smokers and those who work with substances that can irritate the lungs, such as grains or textiles, are more likely to get the condition

The main symptom of bronchitis is a cough which may bring up yellowy, grey mucous

Who is at risk?

Anyone can contract a pneumococcal disease, but some groups are more at risk than others. These include:

Young children and the elderly

Individuals with weak immune systems due to cancer, leukaemia, Hodgkin's disease or HIV (human immunodeficiency virus)

People suffering from a wide range of chronic conditions such as lung, heart and kidney disease, diabetes and alcoholism

How is pneumococcal disease spread?

The bacteria are spread through contact between people who are ill or who carry the bacteria in their throat. Bacteria are most commonly spread/transmitted through coughing or sneezing, or by touching objects which have bacteria on them, and then carrying the bacteria to the mouth or nose. It is common for people, especially children, to carry and spread pneumococcal bacteria without being ill from it.

How is pneumococcal disease treated?

Standard practice varies by country and by disease, but antibiotics are generally used for the treatment of pneumococcal infections.6 Penicillin is the drug of first choice in the treatment of invasive pneumococcal infections, but in recent years, resistance to penicillin and other antibiotics has emerged.

Vaccination against pneumococcal disease

S. pneumoniae is becoming increasingly resistant to antibiotics. As pneumococcal disease becomes harder to treat because of this resistance, its prevention by vaccination becomes more important. According to the World Health Organization (WHO), of all potential public health measures, vaccination is likely to have the most significant impact on the number of new cases of pneumococcal disease.

Pneumococcol disease is the leading vaccine-preventable disease in children under five years old.

Pneumococcal vaccines provide protection against infections caused by different strains of bacteria, called serotypes.

More than 90 different serotypes of S. pneumoniae bacterium have been identified

Globally, 10 to 15 serotypes account for 80-90% of all IPDs in young children

The S. pneumoniae serotypes 1, 5, and 7F are causing a significant proportion of IPDs, accounting for 5-25% of cases worldwide

Serotypes 1, 5 and 7F have been associated with high levels of invasive disease, and can frequently cause more serious or life-threatening conditions, such as complicated pneumonia or empyema

Serotypes 1, 5 and 7F are responsible for:

• 22% of childhood IPDs in Philippines, Malaysia, and Thailand

• 3% of childhood IPDs in the Asia Pacific Rim (Hong Kong, Japan, Korea, Singapore and Taiwan)

Serotypes 1 and 7F are responsible for up to 20% of childhood IPDs in Philippines and Taiwan

Serotype 5 accounts for up to 13% of IPDs in Philippines and Taiwan

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