Frequently asked questions
Why is pneumococcal meningitis considered to be worse than some other forms of meningitis?
Although less common than meningitis B, pneumococcal meningitis is significantly more life threatening. Before the pneumococcal vaccine became available in the routine childhood immunisation schedule, one in five children diagnosed with pneumococcal meningitis died1,2, twice the rate associated with meningococcal meningitis3. Furthermore, for children who survive pneumococcal meningitis, the risk of suffering long-term and severe neurological complications (brain damage) is higher than with survivors of meningitis caused by other bacteria3,4. One in six children who survive pneumococcal meningitis suffer mental retardation; one in seven develop epilepsy or other seizure disorders; while one in four become deaf (half of these profoundly so)3. Overall, more than half the survivors of pneumococcal meningitis will be left with some level of disability5. In addition, pneumococcal meningitis is not often associated with the non-blanching rash that characterises meningococcal septicaemia, the blood poisoning form of the disease that often accompanies meningococcal meningitis. As a result, diagnosis of pneumococcal meningitis is sometimes more difficult to make. This makes prevention an even more logical solution to the problem.
Should I be worried about ear infections?
Ear infections in young children are extremely common, with nearly all children having experienced an episode of otitis media (middle ear infection) by their third birthday6. Whilst many of these will be viral, up to half of the cases that are bacterial in origin are the result of pneumococcal infection7. Children who suffer severe and recurrent ear infections have been shown to be more likely to get "glue ear" and perforations of the eardrum, which can lead to hearing loss resulting in delays in speech, language and cognitive development6,8. Severe and recurrent otitis media has been shown to be more likely caused by the pneumo bug than by other organisms
Will vaccination with the pneumococcal conjugate vaccine (or 'the conjugate vaccine') protect my baby against all types of pneumococcal disease?
Although the conjugate vaccine is highly effective at protecting infants and children against serious disease caused by the bacterial strains covered by the vaccine9,10, it is not yet possible to create an effective vaccine that covers all the strains of the pneumo bug and offers 100% protection. There are over 90 different types of pneumococcal bacteria and the conjugate vaccine protects against seven of these. However, these seven types account for about 80% of the serious, life-threatening pneumococcal diseases that affect children between the age of two and twenty four months in the UK11. Furthermore, the conjugate vaccine has significantly reduced the rates of pneumococcal disease in the USA where it has been on the National Immunisation Programme since 200010. Vaccinating children in the US has also shown to be associated with a reduction in disease in other age groups, such as those of parents and grandparents10. It is thought that this is because children are not passing the pneumo bug onto their friends and relatives. The conjugate vaccine is licensed for the prevention of pneumococcal diseases such as meningitis, septicaemia, pneumonia and middle ear infection (otitis media)7,9.
How safe is the conjugate vaccine?
All medicines and vaccines are routinely monitored for safety following their introduction. The safety profile of the conjugate vaccine has been demonstrated in clinical trials in the US and across Europe. There were almost 40,000 children involved in these trials and all the results showed that the conjugate vaccine is well tolerated7,9,12. The most common side effects observed were local injection site reactions such as redness and swelling. These were reported as being mild and transient9. The safety profile of the conjugate vaccine is confirmed by experience in the United States9. The conjugate vaccine is recommended for all American children under 2 years of age and, in addition, to other children up to the age of 5 years considered to be at increased risk. The conjugate vaccine does not contain thiomersal or any other mercury-based preservative.
If a child has had pneumococcal meningitis or any other pneumococcal disease (IPD), can they have it again and should they be vaccinated?
Any episode of meningitis is quite rare so it is even more rare for a child to have it twice whatever the cause, however it is known to have happened in the past. There are many different pneumococcal strains and it may not be clear which caused the disease - the child could have had a completely different type of meningitis. If the child was under the age of two when they contracted pneumococcal meningitis, they may not have developed adequate natural protection and may still be vulnerable to infection even with the same bug. This is especially true if the child suffers from one of the conditions that cause their immune system to be inefficient, such as a missing or defective spleen, chronic heart, liver, kidney or respiratory disease, immunosuppression, and diabetes. All infants and children under two years of age are at a higher risk of pneumococcal meningitis than older children14.
What do other countries do about pneumococcal vaccination?
In the US, the pneumococcal conjugate vaccine (or 'the conjugate vaccine') has been available since 2000. It is recommended by the US Advisory Committee on Immunization Practices (ACIP) for routine use in all children up to the age of two years and for certain groups of other high-risk children up to the age of five years. It is being made available through both private medical health insurance schemes and through the federal government's Vaccines for Children programme. In Australia, the conjugate vaccine received a fully funded national universal recommendation in 2004. In EU countries, the conjugate vaccine has been licensed since February 2001. As in the UK, it is recommended in childhood immunisation schedules in Belgium, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Kuwait and Spain. It is also recommended in the childhood immunisation schedules in Norway and Switzerland. In Canada, the conjugate vaccine is now being introduced on a routine basis in most of the provinces.
