PNEUMOCOCCAL
What is pneumococcal disease?
The term ‘pneumococcal disease’ is used to describe infections caused by the bacterium Streptococcus pneumoniae (the pneumococcus). This includes common and relatively minor conditions such as ear infection as well as more serious life threatening conditions such as pneumonia, meningitis or blood poisoning (septicaemia).
Who gets pneumococcal disease?
Anyone can get pneumococcal disease. However, some individuals are at particularly high risk: infants and young children, those aged 65 years and older, individuals with weakened immune systems (for example, those suffering from cancer, leukaemia, HIV infection), those with sickle cell disease or without a functioning spleen and individuals who have a chronic illness such as lung, heart, kidney disease or diabetes.1
How common is pneumococcal disease?
Rates of pneumococcal disease peak in children and the elderly . 2
Invasive pneumococcal disease (IPD) – including meningitis and septicaemia
Before the introduction of a pneumococcal immunisation programme for UK infants in 2006, more than 5000 invasive pneumococcal infections were reported every year from patients of all ages in England & Wales3 . Similarly, Health Protection Scotland received between 600-800 reports each year .4
Pneumonia
Before the introduction of the pneumococcal vaccine for infants, it was reported that 1 child in every 200 was admitted to hospital for pneumococcal pneumonia during their first five years of life5 . Amongst adults in the UK, there are up to half a million cases of pneumonia each year of which an estimated 42% are due to pneumococcal infection.6,7,8
1-Department of Health. Immunisation against infectious diseases – The Green Book
2-CDC Prevention of pneumococcal disease. Recommendations of the Advisory Committee on
Immunization Practices (ACIP) April 4 1997; Vol 46, No. RR-8
3-Miller et al., 2011, Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study, May 27, 2011 DOI:10.1016/S1473- 3099(11)70090-1
4-http://www.hps.scot.nhs.uk/resp/pneumococcaldisease.aspx
5-Djuretic T, Ryan MJ, Miller E et al. Hospital admissions in children due to pneumococcal pneumonia in England. J Infect 1998; 37:54-58
6-Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax doi:10.1136/thx.2009.129502
7-British Thoracic Society. Guidelines for the Management of Community Acquired Pneumonia in
Adults. Thorax 2009; 64 (Suppl III): 1-55
Ear infections
Almost 80% of children have at least one episode of acute otitis media by the age of three years9 . The pneumococcus is the most common bacterial cause of otitis media, responsible for over half of bacterial cases.5,10
Can pneumococcal disease be prevented?
Protection from pneumococcal disease is provided through vaccination. Although over 90 different types (serotypes) of pneumococcus have been identified, a subset of these are responsible for causing disease. Vaccines are available which help to protect against the majority of infections.
There are two types of pneumococcal vaccine currently available:
• Pneumococcal conjugate vaccine (PCV) is routinely available free of charge for all UK babies as part of the childhood immunisation programme. This vaccine is given as a 3 dose schedule at 2, 4 and around 13 months of age1. The vaccine covers 13 pneumococcal serotypes11 and was estimated to cover 74% of IPD cases in under 5’s at the time of introduction12 . Another conjugate vaccine, covering 10 serotypes, is also licensed in Europe13.
• Pneumococcal polysaccharide vaccine is recommended in individuals aged 2 years and over who have various underlying medical conditions, placing them at higher risk from infection 1,14. The vaccine covers 23 serotypes. Generally a single dose of this vaccine is given although some may need a repeat dose. It is not suitable for children under 2 years. The UK programme for use in the over 65’s is currently under review by the Department of Health (June 2011) 15
The impact of the pneumococcal conjugate vaccine
In the UK, the Department of Health estimated that in the first 30 months after the introduction of PCV covering 7 pneumococcal serotypes, up to 959 cases of serious illness and 53 deaths caused by the pneumococcus were prevented .16
Since the introduction of the 7 valent pneumococcal conjugate vaccine, there has been a 98% reduction in vaccine serotype pneumococcal disease in the under 2’s. The protective effect has spread into the older age groups, termed the ‘herd effect’ and vaccine serotype disease has decrease by 81% in those aged 65 years or older. 3
8-Office for National Statistics. Mid year Population Estimate 2009: Great Britain http://www.statistics.gov. uk/statbase/product.asp?vlnk=15106
9-Rovers MM. The burden of otitis media. Vaccine 2008 26(S7): G2-G4
10-Eskola J, Kilpi T, Palmu A et al. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. NEJM 2001; 344(6): 403-409
11-Prevnar 13 SmPC, http://www.medicines.org.uk/EMC/medicine/22689/SPC/Prevenar+13+suspension+for+injection/
12-Kaye et al., 2011.The impact of pneumococcal conjugate vaccination in children in England & Wales four years after the introduction of PCV7. Poster ESPID conference 2011.
13-Synflorix SmPC, http://www.medicines.org.uk/emc/medicine/22743/SPC/Synflorix+suspension+for+injection+in+pre-filled+syringe
14-Pneumococcal Polysaccharide Vaccine Pneumovax SPC; http://www.medicines.org.uk/EMC/medicine/1446/SPC/Pneumovax+II/
15-JCVI statement on discontinuation of the routine pneumococcal vaccination programme for adults aged 65 years and older (16 March 2011) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_125122.pdf
16-Department of Health. Report of the Director of Immunisation. April 2009
Where to find further information
• NHS guide to vaccinations: http://www.nhs.uk/Planners/vaccinations/Pages/Aboutvaccinationhub.aspx
• Patient groups providing support, education and increasing awareness of meningitis: Meningitis Trust (www.meningitis-trust.org/) and Meningitis Research Foundation (www.meningitis.org)
• Pneumococcal disease surveillance in the UK: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Pneumococcal
• Health Protection Scotland Immunisation & Vaccine Preventable Diseases: http://www.hps.scot.nhs.uk/immvax/index.aspx