Pneumococcal disease is the leading infectious cause of death of children and adults worldwide. It kills more than 1.6 million people annually of which a vast majority are children. According to the World Health Organisation (WHO), at least one child dies from pneumococcal disease every minute in the world.
Pneumococcal disease can strike quickly, infecting adults and children alike. It is caused by a bacterium called Streptococcus pneumoniae. There are more than 90 subtypes of this bacterium.
Streptococcus pneumoniae causes several serious diseases including pneumonia, bacteraemia, septicaemia and meningitis. In addition, pneumococcal disease can cause permanent disability or death. Pneumococcal disease is a significant cause of morbidity and mortality worldwide but Streptococcus pneumoniae remains the number one vaccine-preventable killer in the world.
In Malaysia, we are fortunate to have pneumococcal vaccines that are able to protect children and adults from this killer disease. It is up to us to arm ourselves with the right information in order to make an informed decision to vaccinate ourselves and children against pneumococcal disease.
The Many Faces Of Pneumococcal Disease
Streptococcus pneumoniae can attack different parts of the body and lead to serious infection of the following systems:
Non-invasive pneumococcal diseases
- Middle ear (otitis media).
- Lungs (pneumonia)
Invasive pneumococcal diseases
- Blood (bacteraemia/septicaemia).
- Coverings of the brain and spinal cord (meningitis).
Pneumococcal otitis media is the most common type of pneumococcal disease. Though usually mild, otitis media may result in hearing impairment which may in turn cause speech delay in young children
Pneumococcal disease is a leading cause of pneumonia or lung infection. Complications of pneumococcal pneumonia include a collection of fluid (effusion) or pus ( empyema) in the space between membranes that surround the lungs and chest cavity inflammation of the sac surrounding the heart (pericarditis), and blockage of the airway that allows air into the lungs (endobronchial obstruction). It is also associated with lung collapse (atelectasis) and collection of pus (abscess) in the lungs. According to the Centres for Disease Control (CDC), about 5 out of 100 people with non-invasive pneumococcal pneumonia will die from it but this rate may be higher among young children and elderly patients.
Bacteraemia, or presence of bacteria in the blood, is one of the invasive pneumococcal disease. In Malaysia, it is estimated that pneumococcal bacteraemia occurs in 30 out of 100,000 children under five, with at least 750 cases and 20 deaths per year. The chance of death increases among elderly patients. Bacteraemia can develop into septicaemia when the bacterium begins to replicate in the bloodstream and spread to other organs. This can lead to septic shock which in turn leads to multi organ failure and death if not treated in time.
Pneumococcal meningitis is a severe manifestation of invasive pneumococcal disease. The mortality rate is 10% in children under the age of 5 years with survivors experiencing long term consequences such as hearing loss, developmental delay, learning and neurological disability. Mortality is also high amongst the elderly.
Are You At Risk Of Pneumococcal Disease?
Anyone can get pneumococcal disease. But some are particularly at high-risk for the disease such as children under the age of 2 year, adults aged 65 years or older and individuals with chronic medical illnesses or weakened immune systems.
The risk of pneumococcal disease in adults aged 65 and older also is high because it is more common for this age group to have pre-existing health conditions such as chronic heart, lung (including COPD and asthma), renal or liver disease, cancer, diabetes, or other risk factors such as smoking, alcoholism.
Signs and symptoms can be typically seen within 1-3 days of infection and vary based on the systems affected.
- Pneumonia presents with fever, chills, cough, chest pain and rapid breathing.
- Acute otitis media presents with ear pain, swollen drums, sleepiness and fever.
- Bacteraemia/septicaemia presents with high fever along with chills and low alertness.
- Meningitis presents with fever from severe headache, vomiting, nausea, photophobia (avoidance of bright light due to pain) and/or stiffness of neck. Infants often have fever and poor eating and drinking, low alertness, and vomiting.
Streptococcus pneumoniae is spread from person to person through direct contact or via droplets from an infected person when he or she coughs or sneezes. It can also be spread indirectly through contaminated surfaces and fomites.
However not everyone who is exposed to the bacterium will develop the disease. It is common for people, especially children, to carry Streptococcus pneumoniae in their nose and throat without exhibiting any signs or symptoms and/or developing any complications. Sometimes the bacteria can spread from the nose and throat into the blood, lungs, ears or sinus and cause complications. At the same time, these carriers can spread the bacteria to others.
Prevention Is Better Than Cure
Despite advances in medicine, pneumococcal disease continues to cause death and disability. Therefore preventive measures such as immunisation are important in ensuring you or those you love are not affected. The availability of the pneumococcal conjugate vaccines allow for babies from as young as 6 weeks to be vaccinated against this potentially deadly disease. In Malaysia, two types of conjugate vaccines are available; the 10- and 13-valent. While the 10-valent vaccine is licensed for babies from 6 weeks to 2 years, the 13-valent vaccine is licensed from 6 weeks to 5 years as well for those over the age of 50 years.
Both vaccines are available at most private clinics and hospitals. Do talk to your doctor regarding the number of doses required and which vaccine is more suitable for you or your child
Pneumococcal Disease And The Aging Population Of Malaysia
Pneumococcal disease does not only affect the young; the older population is also at risk. In the local context, this has taken a special significance as more grandparents take on the role of child-minders for their grandchildren in the absence of a live-in maid. The bacteria, which lives in the nasal cavities, can be transmitted from grandparent to grandchild and vice versa through close contact such as hugs and kisses. Affected children may then go on to spread the bacteria to their classmates in day-cares and schools.
As life expectancy in Malaysia increases so will the number of cases of pneumococcal disease among the elderly. The pneumococcal conjugate vaccine can protect young and old alike. Protection is conferred on multiple levels, the young can protect themselves and also help protect the old and vice versa.