The Facts about Pneumococcal Infection

Streptococcus pneumoniae bacteria cause several serious illnesses including meningitis, pneumonia, and infections of the bloodstream, middle ear and sinuses.

Also known as pneumococci, the bacteria are usually spread by respiratory droplets from the nose or mouth of a person with a pneumococcal infection. (It's common for people, especially children, to carry the bacteria in their throats without being ill from it.)

Prevalence
Pneumococcal infections are the most common cause of invasive bacterial infection in American children; estimated to cause 200 deaths, 700 cases of meningitis, 17,000 cases of bacteremia and 4.9 million cases of otitis media (ear infections) annually in children under 5 years of age.

Meningitis is the most severe type of pneumococcal disease. About 5% of children under age 5 who contract pneumococcal meningitis will die of their infection; others can have long-term problems such as hearing loss. Many children with pneumococcal pneumonia or bloodstream infections (also called bacteremia) will need to be hospitalized.

Pneumococcal Infections and Symptoms
Meningitis: High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion and sleepiness.

In newborns and small infants, the classic symptoms of fever, headache and neck stiffness may be absent or difficult to detect; these children may be slow or inactive, irritable, feeding poorly or vomiting.

Pneumonia: In adults, pneumococcal pneumonia is often characterized by sudden onset of illness with symptoms including shaking chills, fever, shortness of breath or rapid breathing, pain in the chest that is worsened by breathing deeply, and a productive cough.

Signs and symptoms may be non-specific in infants and young children, but might include fever, cough, rapid breathing or grunting.

Otitis media: Children who have otitis media (middle ear infection) typically have a painful ear, and the eardrum is often red and swollen. Other symptoms that may accompany otitis media include sleeplessness, fever and irritability.

Bloodstream infections: Infants and young children with bloodstream infections (bacteremia) typically have non-specific symptoms such as fevers and irritability.

Risk Factors
Young children are much more likely than older children and adults to get pneumococcal disease. Children under age 2, children in group child care, and those who have certain illnesses (including sickle cell disease, HIV infection and chronic heart or lung conditions) are at higher risk. In addition, pneumococcal disease is more common among children of certain racial or ethnic groups, such as Alaska Natives, Native Americans and African-Americans.

Children without a spleen or who have problems with spleen function (including sickle cell disease), are also at increased risk of pneumococcal infections, as are those taking immunosuppressive chemotherapy, those with congenital and acquired immune deficiency (including HIV infections), those with chronic renal disease and healthy Native American, Alaskan Native, and African American children.

Treatment
Pneumococcal disease is treated with antibiotics. Over the last decade, many pneumococci have become resistant to some antibiotics; high levels of penicillin resistance are common.

Preventive Vaccines
Adults and Children: Pneumococcal vaccines to prevent disease among adults and children age 2 and older have been in use since 1977. People in the following groups should receive the pneumococcal vaccine:

• Those 65 years of age or older.
• Those with serious long-term health problems such as heart disease, sickle cell disease, alcoholism, leaks of cerebrospinal fluid, lung disease (not including asthma), diabetes or liver cirrhosis.
• Those with lowered resistance to infection due to Hodgkin's disease, multiple myeloma, cancer treatment with x-rays or drugs, treatment with long-term steroids, bone marrow or organ transplant, kidney failure or HIV/AIDS; people with lymphoma, leukemia or other cancers, nephrotic syndrome, damaged spleen or no spleen.
• Alaskan Native and some Native American populations.

Pregnant Women: In general, pregnant women should not receive the vaccine. Its safety during the first trimester of pregnancy has not been evaluated, although no adverse consequences have been reported among newborns whose mothers were vaccinated during pregnancy.

Infants and Toddlers: In 2000, the FDA licensed a new vaccine for preventing pneumococcal disease in children. Prevnar is the first pneumococcal vaccine that can be used in children under the age of 2 years.

Among 37,000 children in a California study, the vaccine was over 90% effective in preventing invasive disease. The children who received the new vaccine also had 7% fewer episodes of otitis media and a 20% decrease in the number of tympanostomy tubes (ear tubes) placed. In addition, the vaccine was shown to decrease the incidence of pneumonia.

This article includes information from the US Centers for Disease Control and Prevention and the National Immunization Program.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.