What is pneumococcal disease?

Pneumococcal disease is caused by Streptococcus pneumoniae bacteria. One-hundred types of the bacteria produce a range of symptoms from relatively minor to very serious. Some types are more likely to cause infection in particular parts of the body than others, such as the sinuses (sinusitis), the ear (otitis media/middle ear infection), or the lungs (pneumonia).

Invasive pneumococcal disease is the most serious type of pneumococcal disease and occurs when the bacteria pass into the blood (bacteraemia), inflame the membranes around the brain (meningitis), infect the heart muscle, or infect other sites in the body such as joints or the gut (abdomen).

How do you catch it?

Pneumococcal bacteria are carried in the nose and throat and are easily passed from person to person by coughing, sneezing and close contact. Not everyone who catches or carries pneumococcal bacteria gets sick from them.

Who is at risk?

In New Zealand, the highest number of pneumococcal disease cases occur in babies and children aged under 2 years, and adults aged 65 years or older. Those with the highest risk of serious disease are babies aged under 1 year, Māori, Pacific Peoples, and older adults.

The risk of serious pneumococcal disease for Mäori is just over three times and for Pacific Peoples almost four times higher than the risk for New Zealand Europeans.

Being exposed to tobacco smoke, living in crowded conditions, having another respiratory infection present,

e.g. influenza, or a medical condition like diabetes or chronic lung or kidney problem, and/or having a weakened immune system, e.g. from HIV infection, cancer treatments or the person’s spleen has been removed, can also increase the risk of pneumococcal disease.

How serious is pneumococcal disease?

Pneumococcal pneumonia can become life threatening.

Pneumococcal blood infection (bacteraemia) and inflammation of the membranes around the brain (meningitis) are very serious, progress quickly (within hours), and can cause death. Pneumococcal infections can be difficult to treat particularly as some bacteria are resistant to antibiotics.

Pneumococcal bacteria can also cause ear infections that are painful and affect hearing. Long term hearing problems from chronic ear infections can cause speech and learning difficulties during childhood.

What are the symptoms of pneumococcal disease?

This depends on what disease it is causing. Pneumococcal pneumonia can start with a fever and shaking chills, chest pain, shortness of breath, cough and rapid breathing or grunting. As the infection worsens the heart rate increases and a lack of oxygen (hypoxia) may occur.

A baby or young child with bacteraemia may only have a fever and be irritable, but an adult may have influenza-like general aches, pains and fever.

A baby with meningitis may have a fever, be irritable, have an unusual cry, refuse feeds, vomit, have a blank expression, look pale, and/or be sleepy or difficult to wake. Children and adults with meningitis may have a fever, joint pain, stiff neck, vomiting, headache, dislike of bright light, and/or be confused or sleepy.

How do you prevent infection?

It is extremely difficult to avoid coming into contact with the bacteria but good hygiene practices, covering coughs and sneezes, hand washing, and avoiding smoking and contact with smokers may help.

It is important for babies to receive immunisation on time because they are particularly vulnerable to this infection from a very early age. Without immunisation, babies and young children cannot develop their own effective protection against pneumococcal bacteria until they are around 2 years old.

Which vaccines protect against pneumococcal disease?

Routine Immunisation Schedule

Prevenar13 is the free pneumococcal vaccine on the routine Immunisation Schedule at the 6 weeks, 5 months and 12 months of age immunisation visits. Prevenar13 will also be used to catch-up missed immunisation doses up to 5 years of age.

Special groups

Prevenar13 and Pneumovax23 are pneumococcal vaccines on the ‘special groups’ Schedule, for children and adults

with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule. Children with an eligible medical condition will be given  Prevenar13 at the 6 weeks, 3 months, 5 months and 12 months of age immunisation visits instead of Synflorix.

• Prevenar13 includes thirteen bacterial pneumococcal types.

• Pneumovax23 includes 23 pneumococcal types. It works in a different way to Prevenar13 and can add protection against additional pneumococcal types that are not covered by Prevenar13

Other pneumococcal vaccine recommendations

Doctors may recommend Prevenar13 and/or Pneumovax23 for people with a medical condition that is not listed on the Pharmaceutical Schedule, but the vaccines will not be free.

Prevenar13 and Pneumovax23 can be purchased from Healthcare Logistics for ineligible individuals.

How protective are the pneumococcal vaccines?

The pneumococcal conjugate vaccine, Prevenar13, significantly reduces the risk of pneumococcal pneumonia and invasive pneumococcal disease caused by serotypes directly or indirectly covered by the vaccines. This was particularly evident in children and somewhat evident in older adults who had received pneumococcal immunisations.

Immunising children also has a protective effect for the rest of the community. Community protection occurs because immunised children are less likely to carry and spread the pneumococcal bacteria.

How safe are the pneumococcal vaccines?

Large international studies and years of monitoring adverse events reported after immunisation with pneumococcal vaccines have shown they have an excellent safety profile and they are well tolerated.

The most serious response that can occur after any immunisation is a severe allergic reaction (anaphylaxis). The risk of this occurring after pneumococcal vaccination is less than once in one million doses.

Common vaccine responses include temporary redness, swelling and/or pain at the site of injection, irritability or drowsiness, and decreased appetite.

A fever is likely to occur in children who receive Prevenar13 at the same visit as other immunisations on the Schedule. However, it is recommended that Prevenar13® is administered at the same visit as other Schedule vaccines, such as rotavirus, diphtheria, tetanus, pertussis, polio, hepatitis B, Hib, measles, mumps, rubella, and varicella vaccines.

Children who receive Prevenar13 and the flu vaccine at the same visit have an increased risk of fever. Both vaccines can be given at the same visit. However, if parents are concerned about their child having a fever, these two vaccines could be given with two days or more between them.

Other considerations

There is a possibility of blunting (immune interference) of some PCV serotype antibody responses when PCV13 series is given at the same time as MenACWY-D (Menactra), due to both vaccines containing diptheria-derived proteins as conjugates. The clinical significance of this blunting is unknown and the affected serotypes (4, 6B, 18C) are currently rare in New Zealand.

Ideally, to reduce the risk of interference, each dose of Menactra should be given at least four weeks before or after PCV13, however, they can be given together or at any interval for pragmatic reasons, or if an accelerated schedule is required.

Who should not have the pneumococcal vaccines?

Anyone with severe allergy (anaphylaxis) to a previous dose of the vaccine or any component of the vaccine should not receive the vaccine.

Immunisation should be postponed in subjects suffering an acute illness or high fever. The presence of a minor infection is not a reason to delay immunisation.