By Sujatha Rajagopal

Every year, pneumococcal disease (PD) causes serious illness in households across the world. It is also a leading cause of childhood death. Fortunately, a vaccine has now made the disease preventable. Sadly, not realising the urgency, many parents put off getting the vaccine, leaving their young children at great risk of succumbing to PD.

We can stop PD from snatching our children’s lives. Find out how now.

What is PD?
Pneumococcal disease is a group of illnesses caused by the bacteria Streptococcus pneumoniae, also known as pneumococcus. The bacteria can invade different parts of the body and cause different types of infections, such as:
• Pneumonia: infection in the lungs
• Meningitis: infection of the covering of the brain or spinal cord
• Bacteraemia: blood stream infection
• Sepsis: blood poisoning
• Otitis media: middle ear infection
• Sinusitis: infection of the sinuses

Pneumococcus is the most common cause of bacterial pneumonia, meningitis, bacteraemia and otitis media in young children.

How dangerous is PD?
According to the World Health Organization (WHO), annually, PD kills up to a million children aged below five in developing countries. In industrialized nations, PD affects as many as 160 per 100,000 children below two years of age. In Singapore, the figure is as high as 70 cases per 100,000 children.

Meningitis is the most severe form of PD. Apart from death and other complications, PD can also lead to hearing loss, learning disabilities, speech delays and paralysis.

Who is at higher risk?
PD has no age barrier but children under nine years have the most risk, especially:
• Infants and toddlers under two years (due to low levels of pneumococcal antibodies)
• Preschoolers who attend day-care (due to increased exposure in group settings)

How does PD spread?
PD spreads via airborne particles, such as when the infected person sneezes or coughs. Worse, it can be transmitted by someone who seems healthy. Many young children carry the bacteria in their nose and throat without even being sick.

Does PD have symptoms?
Symptoms vary by illness:
• Pneumonia: fever, cough, chills, chest congestion, rapid breathing and sudden shaking. Often, in young children, these symptoms can mimic that of the flu
• Meningitis: fever, severe headache, inability to look at bright lights, nausea, vomiting and stiff neck
• Bacteraemia: high fever and other non-specific symptoms
• Acute otitis media: earache, fever and in younger kids, frequent tugging at the earlobe
• Sinusitis: low-grade fever, runny nose and cough.

In very young children, symptoms can be difficult to detect. A pre-verbal child may at most, seem irritable and inactive. By the time treatment is sought, the disease may have already progressed.

When should we seek medical advice?
Symptoms can worsen very quickly so seek medical advice as early as possible. If a cold, flu or fever doesn’t clear in two days, see a doctor immediately. If symptoms persist after that, consult your doctor regularly. If your doctor suspects PD, a blood test and X-ray may be needed to confirm the diagnosis.

How is PD treated?
PD is treated with antibiotics like penicillin. Over the last decade, many of the pneumococcus serotypes have shown resistance towards commonly used antibiotics. Studies showed that a large number of the four most common pneumococcus serotypes to infect children in Singapore were penicillin-resistant. Some serotypes were also resistant to other drugs!

Children infected with antibiotic-resistant pneumococcus usually need a longer hospital stay and more expensive alternative medicines. They also experience greater discomfort.

Clearly, the best solution is to prevent the disease altogether.

How can PD be prevented?
The best protection is vaccination. According to the WHO, PD is the number one vaccine-preventable cause of death in children below the age of five.

The US FDA-licensed pneumococcal conjugate vaccine is highly effective in preventing PD in young children as well as kids up to nine years old. Another vaccine is available for older age groups.

How safe and effective is the vaccine?
The vaccine
• Can dramatically reduce incidence of childhood bacterial pneumonia, meningitis, bacteraemia and ear infections
• Covers 86.6% of the serotypes known to cause invasive PD in Singapore
• Can be safely given with other routine childhood vaccinations
• Is easily tolerated with mostly mild side effects such as irritation at the injection site and low-grade fever.

The vaccine is mandatory in the list of childhood immunizations in 16 countries, including the UK, the US, Australia, France, Germany, Switzerland and Norway.

Who should be vaccinated? How often?
Children from six weeks of age to nine years should be vaccinated as soon as possible. Up to four doses, given six weeks to two months apart, may be needed depending on the age group.

Speak to your doctor for the best course of action.

Do I have to foot the entire vaccine cost?
From 1 May 2007, the Singapore government’s Baby Bonus Scheme will cover a child’s medical and vaccination-related expenses. See www.babybonus.gov.sg for details.

Don’t wait!

PD can strike at anytime. Vaccination is obviously not a matter to procrastinate. That one little “ouch” moment can offer lifelong protection against the ravages of the deadly bacteria. Speak to your doctor today.