What is pneumococcal disease?

Pneumococcal disease (PD) is a group of illnesses caused by the streptococcus pneumoniae (R) bug. It can result in dangerous infections such as meningitis (infection of the lining of the brain and spinal cord), pneumonia (lung infection), bacteremia (blood infection) and sinusitis (infection of the sinuses). These infections can also lead to hearing loss, learning disabilities, brain damage, paralysis and sometimes, even death.

What causes it?

The pneumococcus bug is transmitted from person-to-person via respiratory droplets from the nose and mouth through sneezing, coughing or close contact. It is very common for people, especially children, to carry the bacteria in their throats (carriers) without being sick from it. But as children's immune systems are not well developed, they are constantly at risk of infection.

Who is at risk of contracting this disease? How severe is the threat posed by PD?

Young children up to nine years old, especially infants from birth to 24 months, are particularly susceptible to PD because their immune systems are not fully developed. Children who attend childcare centres or play in groups of more than three children are more likely to get infected. This is because many preschool children are carriers of pneumococcus - up to 60% of children carry the pneumococcus virus in their throat and nose. PD is one of the most common bacterial infections that we see in clinical practice among children below 5 years old. According to the Health Promotion Board, 26 out of every 100,000 children younger than 5 years were infected with invasive PD in 2006. Invasive PD is the severe form of PD that results in conditions like bacteremia, meningitis and pneumonia.

Is it easily diagnosed? Also, could one get PD without even realising it?

Pneumococcal disease is often difficult to diagnose, hard to treat and progresses very quickly. It can be difficult to diagnose PD symptoms as they are similar to those of the common cold, such as fever, cough, and runny nose.

However, the symptoms vary accordingly to each condition:

- Pneumonia: fever, cough, chills, chest congestion and rapid breathing. Often, in young children, these symptoms can mimic symptoms of the common cold

- Meningitis: fever, severe headache, inability to look at bright lights, nausea, vomiting and stiff neck

- Bacteraemia: high fever associated with other non-specific symptoms such as fever and headache

- Acute otitis media (middle ear infections): earache, fever and muffled hearing. Younger kids may also tug their earlobe frequently

What are the treatment methods?

PD infection is usually treated with antibiotics. However, according to the "Epidemiological News Bulletin" by Ministry of Health, published earlier this year, the resistance of streptococcus pneumoniae strains to penicillin has increased from 25% in 1997 to 63% in 1999. With growing antibiotic resistance, treatment of pneumococcal illnesses is increasingly difficult.

How can PD be prevented?

Vaccination is recognised as the most effective and practical means of protecting children against PD. According to the World Health Organisation, PD is the number one vaccine-preventable cause of death in children less than five years of age worldwide. In fact, 17 countries worldwide including Australia, Switzerland, the UK, the US, Canada, Greece and Mexico have already made it mandatory for all young children to be vaccinated against pneumococcal disease. The pneumococcal disease vaccine is effective in infants and children up to nine years of age. In Singapore, pneumococcal immunisation is not under the recommended list of immunisations under the National Childhood Immunisation Programme

Answers from Dr Low Kah Tzay, Consultant Paediatrician, Anson International Paediatric & Child Development Clinic