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Pneumococcus

Oct 1, 2015
2015 / September 2015

Pneumococcal disease is the leading cause of serious illness throughout the world, caused by the Streptococcus pneumoniae bacterium. The bacterium spreads through contact with people who are ill or by healthy people who carry it in the back of their nose or throat. In developing countries, pneumococcus is linked to high infant and child mortality rates. Even in more industrialized countries, pneumococcal disease commonly occurs in adults and children. The World Health Organization estimates more than 1.6 million people — including 850,000 children younger than 5 years — die every year from pneumococcal infections. Nearly all these deaths occur in the poorest countries.

Anyone can get pneumococcal disease, but some people are at greater risk. Children at higher risk include those younger than 2 years of age; those in group childcare; and those with illnesses such as HIV, sickle cell disease and chronic heart or lung conditions. Some American Indian, Alaska Native and African-American children may be at increased risk.

Adults age 65 and older have a higher risk for pneumococcal disease. Some adults ages 19 through 64 are at risk due to chronic illnesses such as lung, heart, liver or kidney disease; asthma; diabetes; alcoholism; conditions weakening the immune system (HIV/AIDS, cancer or damaged or absent spleen); living in nursing homes or long-term care facilities; and having cochlear implants or cerebral spinal fluid leaks. Smokers are also at risk.

Pneumococcal bacteria spread from person to person by direct contact with respiratory secretions during coughing, sneezing and kissing. Many who carry the bacteria, especially children, are not ill. In some carriers, however, pneumococcus spreads outside the nose to ears, blood or lungs and causes illness.

Symptoms and complications depend on the part of the body infected. Most infections are mild. Some can be fatal or result in long-term problems such as brain damage or hearing loss.

Pneumococcal pneumonia is the most common form of lung disease. Symptoms include fever, chills, cough, rapid or difficult breathing and chest pain. Older adults may experience confusion or low alertness. Pneumococcal meningitis infects the covering of the brain and spinal cord, causing symptoms of stiff neck, fever, headache, pain when looking into lights and confusion. In babies, meningitis may cause poor eating and drinking, low alertness and vomiting. If the bacteria enter the bloodstream, they can cause pneumococcal bacteremia and sepsis. Symptoms include fever, chills and low alertness. Pneumococcal bacteria cause up to half of all middle ear infections. Symptoms include ear pain; a red, swollen ear drum; fever; and sleepiness.

Meningitis and sepsis are the most life-threatening pneumococcal diseases and require rapid diagnosis and treatment to prevent multiple system organ failure and death. Pneumococcal meningitis is the most severe form of the disease and one of the most fatal childhood illnesses, killing or disabling 40–70 percent of children with the disease in developing countries.

Diagnosis depends upon the infection site. Your doctor will perform a physical exam and health history and order blood, imaging or lab tests. Treatment is with antibiotics. Early diagnosis of pneumococcal infection and laboratory testing are crucial to receiving proper antibiotic treatment. Pneumococcal infections are becoming more difficult to treat as bacteria become resistant to commonly used antibiotics. Severe cases of pneumococcal infection require supportive care in a hospital with oxygen, intravenous fluids, surgical drainage and even life support in an intensive care unit.

New vaccines are safe and highly effective in preventing pneumococcal disease. Two vaccines are available, one for infants and young children, the other for adults at high risk. Since 2000, when U.S. infants began receiving routine vaccination against pneumococcal disease, the country has nearly eliminated childhood pneumococcal disease caused by serotypes (serologically distinguishable strains) and reduced the spread of the bacteria to adults. If you are at risk, vaccination is the safest, most effective protection.

Because there are more than 90 strains of known pneumococcal serotypes causing disease, a pneumococcal infection will not protect you from future infection; pneumococcal vaccines are still recommended for those who have had the disease. More than 95 percent of pneumococcal deaths in the United States occur in adults, yet about 70 percent of at-risk adults remain unvaccinated.

U.S. hospitals, primary care providers and specialty providers (pulmonologists, cardiologists and endocrinologists) are required to encourage patients to receive the pneumococcal and flu vaccines. The administration or refusal of the vaccines is documented in patients’ medical records. All hospitals are required to follow the immunization performance quality measure which offers the pneumococcal vaccine to all eligible patients prior to their discharge.

Pneumococcus prevention tactics:

  • Get vaccinated. Doctors recommend the polysaccharide pneumococcal vaccine (PVC23) for adults older than 65 years and anyone older than 2 years with chronic diseases, including spleenectomy.
  • Vaccinate your children. Doctors recommend the pneumococcal conjugate vaccine (PCV13) for children younger than 2 years, at-risk children ages 2 to 5 years and those attending a childcare center. Doctors recommend flu shots for children 6 months and older.
  • Protect against respiratory infections that can lead to pneumonia. Wash your hands regularly or use a hand sanitizer.
  • Strengthen your immune system with good sleep, exercise and a healthy diet.
  • Don’t smoke. Smoking damages your lungs’ natural defenses against infection.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.

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