FACTS ABOUT PNEUMOCOCCAL DISEASE

What is pneumococcal disease?
Pneumococcal disease is a leading cause of serious illness in children and adults throughout the world. The disease is caused by a common bacterium, the pneumococcus, which can attack different parts of the body. When pneumococcal bacteria invade the lungs, they cause pneumonia; when they invade the bloodstream, they cause bacteremia; and when they invade the covering of the brain, they cause meningitis. Pneumococci may also cause otitis media (middle ear infection) and sinusitis. Currently there are more than 80 known pneumococcal types, but only a few types account for most of the invasive disease.

Who is at risk?
Anyone can get pneumococcal disease, but some groups are at particularly high risk for pneumococcal disease or its complications. These groups include persons aged 65 and older; adults and children with weak immune systems due to cancer, leukemia, Hodgkin's disease or human immunodeficiency virus (HIV); adults and children with sickle cell disease or without a functioning spleen (asplenia); those who have a chronic illness such as lung, heart, and kidney disease, diabetes and alcoholism; adults and children who are members of certain racial and ethnic groups such as Alaskan Natives, certain American Indian populations, and African-Americans, or those who live in special environments; residents of chronic or long-term care facilities; and children who attend day care.

How significant is pneumococcal disease?
Each year in the United States, pneumococcal disease accounts for an estimated 150,000 to 570,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of meningitis. According to the Centers for Disease Control and Prevention (CDC), pneumococcal disease causes about 12,000 deaths annually among hospitalized patients. The highest rates of death occur among the elderly and patients who have underlying medical conditions.

How is pneumococcal disease treated?
Pneumococcal disease is treated with antibiotics, such as penicillin, cephalosporins, and erythromycin. In recent years, pneumococcal strains resistant to one or more of these commonly used antibiotics have emerged. The impact of this resistance makes treatment difficult and may result in longer hospitalizations and more expensive alternative therapy. The emergence of these resistant strains places further emphasis on the need for preventing pneumococcal disease through vaccination.

Can pneumococcal disease be prevented?
The best way to protect against pneumococcal disease is through vaccination. There are two types of pneumococcal vaccine currently available: a polysaccharide vaccine and a conjugate vaccine. The polysaccharide vaccine is used in adults and children five years of age and older, and the conjugate vaccine is used in children under five years of age. The polysaccharide vaccine has been available in the United States for over 20 years. Yet in 1997 only 45.8 percent of those aged 65 and older, less than half of all older adults, reported receiving pneumococcal vaccination. The conjugate vaccine was licensed in February 2000.

When is the best time to get vaccinated?
In adults, pneumococcal vaccination with the polysaccharide vaccine, which is reimbursable by Medicare Part B, is appropriate at any time of the year. It can be administered at the same time as the influenza vaccine. In infants aged 2-23 months, the conjugate vaccine will be incorporated into the childhood immunization schedule.

What has been the experience with pneumococcal vaccines?
Pneumococcal vaccines are considered clinically effective and safe. Pneumococcal vaccination of adults with the polysaccharide vaccine has been shown to be effective in the prevention of invasive pneumococcal disease, offering protection against 23 of the most prevalent pneumococcal types. Those serotypes contained in the vaccine account for nearly 90 percent of pneumococcal disease.

In infants and children, studies have shown that the conjugate vaccine reduces the incidence of invasive pneumococcal disease, pneumococcal pneumonia, and otitis media.

In infants and children, studies have shown that the conjugate vaccine reduces the incidence of invasive pneumococcal disease, pneumococcal pneumonia, and otitis media.

How often is vaccination needed?
In most adults who are vaccinated at age 65 or older, vaccination is needed only once in a lifetime. However, for adults who are vaccinated before age 65 or for those at highest risk for serious disease, revaccination may be necessary.

In infants and children aged 11 months or younger, three or four doses of conjugate vaccine are required, depending upon the age the first dose is given. Children 12-23 months of age require two doses. Healthy children 24-59 months of age require one dose of conjugate vaccine, and those with sickle cell disease, asplenia, HIV, chronic diseases, or any condition that weakens the immune system, require two doses.

Who should be vaccinated?
Vaccination with polysaccharide vaccine is recommended for the approximately 31 million Americans who are 65 years of age and older. Vaccination is also recommended for all children between 2-23 months of age and children aged 24-59 months who are at increased risk for pneumococcal disease (e.g., children with sickle cell disease, asplenia, HIV, chronic diseases, or any condition that weakens the immune system).

Who should not be vaccinated?
Individuals who have had a previous allergic reaction to any component of the pneumococcal vaccine (e.g., hives, difficulty breathing) should avoid vaccination. The vaccine should also be avoided during radiation therapy or chemotherapy.

Healthcare providers can choose to delay vaccination of children with moderate to severe infection until the child has recovered.

###