Vaccines and Preventable Diseases:

Pneumococcal Disease in Children - Q&A

What is pneumococcal disease?

Pneumococcal disease is defined as infections that are caused by the bacteria Streptococcus pneumoniae, also known as pneumococcus. The most common types of infections caused by these bacteria include middle ear infections, pneumonia, blood stream infections (bacteremia), sinus infections, and meningitis. Some of these infections are considered to be "invasive." Invasive disease means that germs invade parts of the body that are normally free from germs, like blood or spinal fluid. When this happens, disease is usually very severe, causing hospitalization or even death. When pneumococcal bacteria invade the lungs, they can cause pneumonia. They can also invade the bloodstream, causing bacteremia, and/or the tissues and fluids surrounding the brain and spinal cord, causing meningitis.

Which children are most likely to get pneumococcal disease?

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

How common is pneumococcal disease?

Each year in the U.S. Streptococcus pneumoniae (pneumococcus) causes approximately 4,500 cases of blood stream infections (bacteremia), meningitis, or other invasive disease in children younger than 5 years of age. Children under 2 years of age average more than 1 middle ear infection each year, many of which are caused by pneumococcal infections. Streptococcus pneumoniae is the most common cause of bacteremia, pneumonia, meningitis and otitis media (middle ear infections) in young children.

Who is at most serious risk?

Children at increased risk of pneumococcal infections include those with anatomic or functional asplenia (including sickle cell disease), patients taking immunosuppressive chemotherapy, those with congenital and acquired immune deficiency (including HIV infections), those with chronic renal disease and healthy Native American, Alaska Native, and African American children. Children younger than 5 years of age in out-of-home day care are at increased risk (2-3 fold higher) of experiencing invasive pneumococcal infections than children in home care.

What are the symptoms of pneumococcal disease?

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 young infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly.


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. In infants and young children, signs and symptoms may not be specific, and may 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.

Blood stream infections: 
Infants and young children with blood stream infections-also known as bacteremia-typically have non-specific symptoms including fevers and irritability.

How serious is pneumococcal disease?

Pneumococcal disease is a very serious illness in young children. Pneumococcus is a major cause of invasive bacterial infections in U. S. children. In the United States it is estimated that pneumococcal infections cause around 50 deaths and more than 4,000 cases of bacteremia, meningitis, or other invasive disease, and 3.1 million cases of otitis media annually in children younger than 5 years of age.

Meningitis is the most severe type of pneumococcal disease. Of children younger than 5 years of age with pneumococcal meningitis, about 5% will die of their infection and others may have long-term problems such as hearing loss. Many children with pneumococcal pneumonia or blood stream infections will be ill enough to be hospitalized; about 1% of children with blood stream infections or pneumonia with a blood stream infection will die of their illness. Nearly all children with ear infections recover, although children with recurrent infections can suffer hearing loss.

How is pneumococcal disease spread?

The bacteria are spread through contact between persons who are ill or who carry the bacteria in their throat. Transmission is mostly through the spread of respiratory droplets from the nose or mouth of a person with a pneumococcal infection. It is common for people, especially children, to carry the bacteria in their throats without being ill from it.

How is pneumococcal disease treated/cured?

Pneumococcal disease is treated with antibiotics. Over the last decade, many strains of pneumococcal bacteria have become resistant to some of the antibiotics used to treat pneumococcal infections. High levels of resistance to penicillin are common.

Can pneumococcal disease in children be prevented?

In late 2000, the FDA licensed a new vaccine for the prevention of pneumococcal disease in children. The pneumococcal vaccine, Prevnar® (manufactured by Wyeth-Lederle Vaccines, now part of Pfizer, Inc.), is a vaccine in which the seven serotypes, which caused the majority of pneumococcal infections in young children, are conjugated (or linked) to a protein. This pneumococcal conjugate vaccine has been shown to be highly effective in preventing invasive pneumococcal disease in young children. In a study of this vaccine among 37,000 infants in California, the vaccine was over 90% effective in preventing invasive disease among the children studied. The children who received the vaccine also had 7% fewer episodes of otitis media and a 20% decrease in the number of tympanostomy tubes (ear tubes) placed. The vaccine was also shown to decrease the number of episodes of pneumonia.

CDC conducted a study soon after the vaccine was licensed and found that the vaccine was highly effective in preventing disease in children younger than 5 years of age. The investigators found that the vaccine was 96% effective against pneumococcal disease in healthy children who received one dose or more and 81% effective in children with medical conditions that put them at risk of pneumococcal disease. The vaccine was also highly effective at preventing pneumococcal disease caused by antibiotic-resistant strains.

Prevnar® is indicated for use in infants and toddlers. The vaccine should be given to all infants younger than 24 months of age at 2, 4, and 6 months of age, followed by a booster dose at 12 through 15 months of age. Children who are unvaccinated and are 7 through 11 months of age should be given a total of 3 doses (2 months apart) and children age 12 through 23 months should be given a total of 2 doses at least two months apart. Healthy children 24 months of age or older only need to receive one dose of this vaccine.

The Advisory Committee on Immunization Practices (ACIP) also recommends that children 24 through 59 months of age at highest risk of infection, including those with certain illnesses (sickle cell anemia, HIV infection, chronic lung or heart disease) should receive 2 doses of this vaccine (8 weeks apart) if they have previously received less than 3 doses. Vaccine should be considered for all children 24 through 59 months of age with a priority for those at higher risk, which includes Alaska Natives, American Indians, or African Americans and those children who attend out-of-home day care for more than 4 hours per week.

Prevnar® is the first pneumococcal vaccine that can be used in children under 2 years of age. However, pneumococcal vaccines for the prevention of disease among children and adults who are 2 years and older have been in use since 1977. Pneumovax® and Pnu-Immune® are 23-valent polysaccharide vaccines that are currently recommended for use in all adults who are older than 65 years of age and for persons who are 2 years and older and at high risk for disease such as persons with sickle cell disease, HIV infection, or other immunocompromising conditions.

The new 13-valent pneumococcal conjugate vaccine (Pfizer, Inc) which will be introduced in the U.S. in 2010 should provide protection against infections caused by a greater variety of pneumococcal strains. In addition, campaigns for judicious use of antibiotics may also slow or reverse emerging drug resistance found among pneumococcal infection.

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