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Pneumococcal

Pneumococcal

Streptococcus pneumoniae bacteria, or pneumococcus, are common inhabitants of the respiratory tract and can cause many types of illnesses. The major clinical syndromes of pneumococcal disease are pneumonia (infection in the lungs), bacteremia (blood stream infection) and meningitis (infection of the covering around the brain and spinal cord). Pneumococcus can cause other types of infections too, such as ear infections and sinus infections. Some of these infections are considered “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs. When this happens, disease is usually very severe, requiring treatment in a hospital and even causing death in some cases.

Pneumococcal pneumonia is the most common form of pneumococcal disease among adults, but can cause mild to severe illness in people of all ages. Symptoms usually include an abrupt onset of fever, chills, productive cough, shortness of breath, rapid breathing and heart rate, low oxygen level, malaise and weakness. Complications of pneumococcal pneumonia include infection of the space between membranes that surround the lungs (empyema), inflammation of the sac surrounding the heart (pericarditis), and blockage of the airway that allows air into the lungs (endobronchial obstruction), with lung collapse (atelectasis) and collection of pus (abscess) in the lungs. About 5-7 out of 100 people will die from it, but that rate may be much higher among elderly patients.

Bacteremia is a type of invasive pneumococcal disease that infects the blood. Bacteremia without a known site of infection is the most common form of pneumococcal infection among children 2 years of age and younger, accounting for 70% of invasive disease in this age group. In adults, more than 12,000 cases occur without pneumonia per year. The case fatality rate in this group is about 20% and may be as high as 60%.

Meningitis is the most severe type of invasive pneumococcal disease. Pneumococci cause over 50% of all cases of bacterial meningitis in the United States. Symptoms may include headache, lethargy, vomiting, irritability, fever, nuchal rigidity, seizures and coma. Of children younger than 5 years old who get pneumococcal meningitis, about 1 out of 15 dies of the infection and others may have long-term problems, such as hearing loss or developmental delay. The case fatality rate in adults is about 22%. Among survivors, long-term neurologic problems are common.

Pneumococcus is a common cause of acute otitis media (middle ear) infections. Middle ear infections in children account for 20 million office visits annually. Complications of pneumococcal otitis media include mastoiditis (infection of the bone behind the ear) and meningitis.

The CDC identifies many conditions that increase a person’s risk for invasive pneumococcal disease.

Children at increased risk for pneumococcal disease include those:

  • Younger than 2 years old
  • Who have certain illnesses (sickle cell disease, HIV infection, diabetes, immune compromising conditions, nephrotic syndrome, or chronic heart, lung, kidney, or liver disease)
  • With cochlear implants or cerebrospinal fluid (CSF) leaks (escape of the fluid that surrounds the brain and spinal cord)

Adults at risk for pneumococcal disease include:

  • Adults 65 years or older
  • Adults 19 through 64 years old:
  • With chronic illnesses (chronic heart, liver, kidney, or lung [including chronic obstructive lung disease, emphysema, and asthma] disease; diabetes; or alcoholism)
  • With conditions that weaken the immune system (HIV/AIDS, cancer, or damaged/absent spleen)
  • With cochlear implants or cerebrospinal fluid (CSF) leaks (escape of the fluid that surrounds the brain and spinal cord)
  • Who smoke cigarettes

The best way to prevent pneumococcal disease is by getting vaccinated.  There are two pneumococcal vaccines currently available in the United States: pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) and pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23®). These vaccines are good at preventing severe pneumococcal disease, which often requires treatment in the hospital and can be deadly. However, these vaccines will not prevent all infections.

CDC recommends PCV13 for:

  • All children younger than 2 years old
  • People 2 years or older with certain medical conditions
  • In addition, adults 65 years or older may discuss and decide, with their clinician, to receive PCV13.

CDC recommends PPSV23 for

  • All adults 65 years or older
  • People 2 through 64 years old with certain medical conditions
  • Adults 19 through 64 years old who smoke cigarettes

Click here for further information.

 

 

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