Frequently Asked Questions

Pneumococcal disease is the term used to describe a variety of conditions caused by the bacterium, Streptococcus pneumoniae or the pneumo bug. These include:

• Meningitis
• Septicaemia and bacteraemia
• Pneumonia
• Common childhood infections:
  • Acute bronchitis and chest infections
  • Middle ear infections (otitis media)
  • Sinusitis

It was estimated that 50 children under five years of age die each year in the UK from serious pneumococcal diseases, such as meningitis, septicaemia and pneumonia¹, prior to the introduction of the pneumococcal conjugate vaccine into the routine childhood immunisation schedule.

Pneumococcal meningitis and septicaemia

Pneumococcal meningitis is one of the most common forms of bacterial meningitis in the UK^2,3 and is amongst the most destructive in terms of death and permanent disability^4,8. One child out of every five who contracts the disease will die while half of those who survive will be left with some level of permanent disability ranging from brain damage to deafness⁴.

Pneumococcal pneumonia

Pneumococcal disease is the leading cause of severe pneumonia in infants and young children under 2 years of age and the commonest form of pneumonia requiring hospitalisation in all children⁵. It has been estimated that 1 in every 200 children is hospitalised in the UK as a result of pneumococcal pneumonia in their first five years of life⁶.

Common childhood infections

Pneumococcal infection is a major cause of many common, less severe childhood illnesses. These can cause considerable suffering, and impose a major burden on the NHS in terms of GP visits and admissions to hospital^6,7. They include:

• Less severe cases of pneumonia (chest infections)
  Less severe cases of pneumonia are often diagnosed as a 'chest infection' and treated in the community. As the leading cause of pneumonia in infants and young children under 2 years of age, the pneumococcal bug is responsible for a large proportion of these infections⁵.
• Otitis media
  Otitis media, inflammation of the middle ear, is often the result of viral or bacterial infection of the upper respiratory tract. It is estimated that as much as half of all acute bacterial otitis media is caused by pneumococcal infection⁹. Furthermore, pneumococcal disease is more likely to be responsible for the more severe and recurrent episodes of otitis media that children suffer¹⁰. Common complications include 'glue ear' and perforation of the eardrum which can lead to hearing loss, resulting in delays in speech, language and cognitive development, and associated behavioural problems^11,12.
• Sinusitis
  Pneumococcal infection is one of the most frequent bacterial causes of sinusitis (inflammation of the sinuses)^13,14.

Pneumococcal disease can affect any age group. However, the greatest incidence of disease is in infants and young children under the age of 2 years, and also in the elderly⁷.

In infants and young children, it is responsible for disabling and potentially life-threatening pneumococcal diseases, such as meningitis, septicaemia (the blood poisoning form of the disease), and pneumonia. It is also a leading cause of common childhood illnesses, such as middle ear infections (otitis media), chest infections, and sinusitis.

Although children with poorly functioning immune systems are at greatest risk of contracting pneumococcal diseases and children with underlying medical conditions are more vulnerable to the effects of pneumococcal infection, the vast majority of disease occurs in otherwise healthy youngsters¹⁵. Children under the age of two years are especially vulnerable⁷. It is generally acknowledged that the majority of infants and children succumbing to pneumococcal meningitis or septicaemia have no identified risk factors.

Day-care or attendance at a nursery also puts infants and young children at increased risk^16,17. A recent study suggested that being in day-care or attending a nursery may double the risk of invasive pneumococcal diseases, such as meningitis, bacteraemia, sepsis, and severe pneumonia^17,18. Additional risk factors in all children include the number of siblings, frequent otitis media (middle ear infections), and antibiotic usage^16,17,18,19.

It has also been observed that there is an increased risk of invasive pneumococcal disease in children from deprived backgrounds. While the association between the risk of infection and social deprivation is not new, it provides a timely reminder about the health impact of social inequality²⁰.

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^21,22.

However, most children will have had an ear infection by their third birthday¹¹ and a significant proportion of those that are severe or recurrent will have been caused by pneumococcal infection⁹.

Pneumococcal disease is the most common cause of bacterial pneumonia in children under two years of age⁵.

Meningitis of any type is rare. However, when it occurs, it can strike with frightening speed and with devastating consequences.

Pneumococcal meningitis is one of the most common bacterial forms of the disease. Based on reported figures, before the inclusion of the pneumococcal conjugate vaccine in the routine immunisation schedule, there were about 170 cases of pneumococcal meningitis and about 450 cases of pneumococcal bacteraemia reported in children under the age of 5 years in the UK each year²³.

However, this is widely accepted to be an underestimate of the true number of cases. One of the reasons for this is that, in the face of suspected meningitis or septicaemia, antibiotic treatment is likely to be started immediately without waiting for the specific organism to be identified. Once the patient begins treatment with antibiotics, this will affect the ability of conventional microbiological techniques to culture the responsible bacterium. However, more sensitive DNA-based tests have now been developed and are becoming more widely used. This may help lead to improved identification of infectious agents.

Pneumoccocal meningitis, septicaemia and pneumonia are life-threatening infections. Yet in their early stages, they can share signs and symptoms with many less serious conditions, delaying diagnosis and treatment. In particular, diagnosis of pneumococcal meningitis may be difficult as, compared with other forms of bacterial meningitis, it is less likely to be accompanied by septicaemia, so does not always have the well-publicised 'tell-tale' rash.

The consequences of delayed treatment can be profound, increasing the risk of complications and a poor outcome. Consequently, despite new and effective antibiotic therapies, and prior to the inclusion of the pneumococcal conjugate vaccine in the routine childhood immunisation schedule, there has been no improvement in mortality rates associated with pneumococcal diseases over the last two decades²⁴.

Prevention of pneumococcal infections by immunisation therefore remains the most rational approach to disease management. The need for routine infant pneumococcal vaccination is widely accepted amongst experts in childhood infectious disease, and is reflected in the official recommendation by the Joint Committee on Vaccination and Immunisation (JCVI), an advisory body to the Department of Health, that pneumococcal vaccination should become part of the routine childhood immunisation programme in the UK²⁵. The Department of Health introduced the pneumococcal conjugate vaccine to the routine immunisation schedule in September 2006²⁶.

A similar policy decision has already been implemented in respect of pneumococcal vaccination for the other most vulnerable group - the elderly. From April 2005, everyone over the age of 65 became eligible to have routine pneumococcal vaccination. The programme uses the polysaccharide vaccine licensed for use in adults and children over two years of age²⁷.

If you would like more information on how to spot the signs and symptoms of meningitis, contact any of the following organisations that provide excellent backup in this area:

Meningitis Trust - www.meningitis-trust.org.uk

Meningitis Research Foundation - www.meningitis.org

Meningitis Association Scotland - telephone 0141 427 6698