• Pneumococcal disease is caused by infection with Streptococcus pneumoniae (pneumococcus).
• It represents a significant burden on the National Health Service all year round.
• At any time of the year, harmful strains of these bacteria can be transmitted to any individual; these have the potential to infect various organs and systems in the body. The consequences can include lower respiratory tract infections (LRTIs) such as pneumonia, meningitis or blood poisoning (septicaemia).
• Many adult patients at high risk from influenza are also at risk from pneumococcal infection.
• Pneumococcal meningitis is most common in children under 2 years of age.
• Pneumonia is a common condition which can be life-threatening, particularly in debilitated patients. Bacterial or viral pneumonia may affect one or both lungs. Bacterial pneumonia is often more serious and the pneumococcus accounts for more cases of community-acquired pneumonia than any other bug in the UK.
• The symptoms of pneumonia include a productive cough with chest pain, high fever, breathing difficulties, weakness, confusion and loss of appetite.
• The treatment of pneumococcal disease involves antibiotics. Due to the high risk of complications with these infections the very young, elderly and chronically sick patients frequently require intensive medical care and, often, hospitalisation.

 

 

• Pneumococcal infections that lead to pneumonia, meningitis and septicaemia, are a significant cause of mortality. As many as 9,000 adults die due to pneumococcal infections each year.¹ In patients with community-acquired infections due to Streptococcus pneumoniae the mortality rate is as high as 21%.²
• Over 15% of children with pneumococcal meningitis will die⁴ and many survivors will suffer long term consequences such as deafness, brain damage, amputation and scarring³. It is estimated that 43 children (1 month to 4 years of age) die from invasive pneumococcal disease each year in England & Wales.⁴
• In the UK, up to 1 in 200 of children under 5 will be admitted to hospital with pneumococcal pneumonia.⁵
• Around 50,000 cases of adult pneumococcal pneumonia occur annually in the UK,⁶ with an associated mortality of up to 20%.⁶ In 1995, of the pneumonia deaths where the cause was known, 89% were due to the pneumococcus.⁷ Between 1993 and 1997, laboratory confirmed pneumococcal infections increased by 28%.⁸
• Up to 350,000 episodes of acute otitis media are caused by pneumococcus in children aged under 5 each year in the UK.⁹

 

• The burden of disease makes significant demands on the resources and budgets of the NHS. Up to 16% of GP consultations are for respiratory tract infections (RTIs)¹⁰ and as many as 95% of patients with community acquired pneumonia are managed by GPs. One third of pneumonia patients also require home visits.¹¹
• Significant demands are also made on hospital resources. Between 5-10% of patients admitted to hospital with community-acquired pneumonia are suffering from severe infection, which requires intensive care management, and comprise 10% of medical admissions to general ICU¹². Also, the median hospital stay for these patients is between 11-14 days compared with the average of only 5 days.^{12, 13}
• Empyema, a collection of pus in the chest cavity, is a serious consequence of severe bacterial pneumonia, requiring hospitalisation and often surgery.¹⁴
• Treatment with antibiotics is usually effective for most patients. However mortality is not reduced in the first 3 days of antibiotic therapy,¹⁵ and as many as 25% of patients with pneumonia die within 48 hours of admission to hospital. Drug-related costs are also significant with respiratory diseases accounting for 60% of all antibiotic prescribing by GPs.¹²
• An increasing worry is the development of antibiotic resistance to the pneumococcus. We can no longer assume that the commonly used antibiotics will be effective. In 2000, 7% of blood poisoning and meningitis isolates were resistant to penicillin and 13% were resistant to erythromycin.¹⁶

 

 

• Pneumococcal polysaccharide vaccine helps protect against more than 90%¹⁷ of the harmful pneumococcal strains in the UK, including most antibiotic resistant pneumococci.¹⁸
• The vaccine is effective and provides protection of between 65-84% in high-risk patient groups²⁰ including a reduction in pneumococcal bacteraemia of up to 70%.¹⁷
• A single vaccination provides protection for up to 5 years in most patients.
• Re-vaccination after 5 years is indicated in specific high-risk patients with low antibody levels e.g. patients with a non-functioning spleen or nephrotic syndrome.
• The vaccine can be given at the same time as influenza vaccine but at a different site.

 

 

• A conjugate pneumococcal vaccine is available for use in infants and children.
• The vaccine provides active immunisation against the 7 most common serotypes causing pneumococcal meningitis and septicaemia in the UK, including those most likely to be associated with antibiotic resistance throughout Europe.
• Using the same technology as Haemophilus influenzae type B (Hib) and meningococcal Serogroup C conjugate (Men C) vaccines, it is predicted that a primary vaccination course will provide effective, long-term protection for babies and young children against pneumococcal meningitis and septicaemia and other forms of pneumococcal infection.
• Currently the vaccine is recommended for those children at the highest risk of infection (see below).
• The Government will be considering this for inclusion in the childhood immunisation schedule, following expert advice from the Joint Committee on Vaccines and immunisation (JCVI).

 

 

According to the Department of Health recommendations,¹⁷ pneumococcal vaccine should be given to all patients in whom pneumococcal disease is likely to be more common and/or dangerous. High-risk groups are:

• All adults aged 65 and over
• Asplenia or dysfunction of the spleen
• Chronic respiratory disease
• Chronic heart disease
• Chronic renal disease
• Chronic liver disease
• Diabetes
• Immunosuppression
• Individuals with cochlear implants (it is important that immunisation does not delay the cochlear implantation)
• Individuals with the potential for cerebrospinal fluid leaks
• Children under 5 years of age who have previously had invasive pneumococcal disease

For more information regarding the conjugate and polysaccharide vaccines in children, please refer to the Department of Health guidelines http://www.immunisation.nhs.uk.

 

 

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8. Public Health Laboratory Service. Bacteraemia data, Gram Positive Bacteria. Laboratory reports for England and Wales 1993-1997. www.phls.co.uk. Last updated: September 1999.
9. Moxon R. Pneumococcal vaccination in children. In: The Clinical impact of Pneumoccocal Diseases and Strategies for its prevention. International Congress and Symposium Series 210. London: Royal Society of Medicine Press Limited 1995: 31-38.
10. Anderson H, Esmail A, Hollowell J et al. Lower respiratory disease report 16. Department of Public Health Policy March 1993.
11. MacFarlane J, Colville A, Guion A et al. Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community. Lancet 1993; 341:511-514. [101204]
12. MacFarlane J. International Congress and Symposium Series. Royal Society of Medicine Press 1995; 210: 9-16. [112516]
13. Office of Health Economics (1999). Compendium of Health Statistics, 11th Edition.
14. Tan T, Mason E, Barson W et al. Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillinnonsusceptible streptococcus pneumoniae. Ped 1998;102(6):1369-1375
15. Shann F. Modern vaccines: pneumococcus and influenza. Lancet April 1990; 898-901. [111690]
16. Invasive Pneumococcal Disease, England and Wales : 2000 CDR Weekly Vol. 13, No.21, 22 May 2003.
17. Department of Health, Welsh Office, Scottish Office Department of Health DHSS (Northern Ireland). Immunisation Against Infectious Disease Pneumococcal Updated Chapter 25. http://www.dh.gov.uk/assetRoot/04/07/31/28/04073128.pdf
18. Letter from the Chief Medical Officer : PL CMO (2005) 1: The Pneumococcal Immunisation Programme for Older People and Risk Groups, April 2005.
19. George R, Ball L, Cooper P. Antibiotic resistant pneumococci in the United Kingdom. CDR 1992; 2(4):37-43. [100746]
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