Pneumococcal Disease Immunisation

Pneumococcal disease refers to several clinical illnesses that can range from ear and sinus infections to pneumonia and blood stream infections and is caused by the Streptococcus pneumoniae bacterium (also called pneumococcus). This organism can be carried in the upper respiratory tracts of healthy people. The disease spreads from person to person through coughing and sneezing or touching contaminated surfaces. Most pneumococcal infections are mild, however some can develop into invasive pneumococcal disease (IPD) with long term complications or death. Vaccination against invasive pneumococcal disease is highly recommended for several risk groups, including young infants, adults aged >70 years and Indigenous people and Torres Strait Islanders, particularly young adults. 

What is Invasive Pneumococcal Disease?

When Streptococcus pneumoniae is found in a normally sterile site it is deemed invasive. This is most often in the blood, but it can also be found in pleural and cerebrospinal fluid. Invasive pneumococcal disease can cause meningitis, pneumonia with bacteraemia and bacteraemia without focus in many patients, causing serious complications. Pneumococcal pneumonia is the most common community-acquired pneumonia.

What are the symptoms of Pneumococcal Disease?

Symptoms of pneumococcal disease will also reflect where the infection is located: for pneumonia, there may be fever, chills, cough, rapid or difficulty in breathing and chest pain; in meningitis, a stiff neck, fever, photophobia, confusion and headaches. (Caveat: Older adults with pneumococcal pneumonia may experience confusion or low alertness rather than the more common symptoms listed above.)

Invasive pneumococcal diseases are far more serious than the common non-invasive types and occur in the blood or a major organ.

Examples of invasive pneumococcal disease include:

• Sepsis: When a person’s body responds to an infection in an extreme way, damaging its own tissues, it is known as sepsis, a potentially life-threatening condition. The symptoms include chills and fever, confusion, difficulty breathing, clammy skin, rapid heart rate and severe pain.
• Bacteraemia: This condition is caused by a bacterial infection which may be mild or even without symptoms, however if the body’s immune system is unable to remove the bacteria, the infection may progress rapidly and result in sepsis. Bacteraemia symptoms include reduced alertness, fever, chills, rapid heart rate and respirations.
• Pneumonia: This infection of the lungs can progress, spreading into the chest cavity or causing inflammation of the heart lining (pericardium). Symptoms can include breathing difficulties, chest pain, fever, cough and chills. Confusion or lowered acuity is more common in older adults with pneumococcal pneumonia.
• Meningitis: When the membranes that cover the brain and spinal cord (meninges) become inflamed, it is known as meningitis. Symptoms generally include headaches, neck stiffness, fever, confusion and light sensitivity, however some people present with different symptoms or they many may not be apparent.

Other infections that may occur:

• Osteomyelitis: This is an inflammation or swelling which occurs when an infection somewhere else in the body spreads to the bone.
• Septic arthritis: This condition is an infection in the joint tissues and the joint (synovial) fluid that can be caused by different types of bacteria, including pneumococci, fungi and viruses. Symptoms include fever, joint pain and aches, swelling, redness and warmth. Prompt treatment with antibiotics is needed to halt the risk of joint damage. 

Pneumococcal disease may also cause:

• Otitis media: Inflammation of the middle ear producing  earache, fluid in the middle ear and swelling of the eardrum. If the eardrum is perforated, pus can drain further into the ear canal.
• Bronchitis: Acute bronchitis is characterised by inflamed airways with a cough and mucous. The illness can last up to three weeks and it is more common in children aged under 5 years.
• Sinusitis: When the sinuses around the nasal cavity become inflamed it is known as sinusitis. Symptoms can include facial tenderness, pain, and swelling around the eyes, cheeks and forehead.

All invasive pneumococcal diseases require urgent medical treatment.

Where is Pneumococcal Disease found?

Anyone anywhere can become infected and develop pneumococcal disease, however, the risk of progressing to severe invasive pneumococcal disease (IPD) is highest in young infants and adults aged >70 years. Indigenous people and Torres Strait Islanders, particularly young adults, are disproportionately affected in Australia. 

Children at increased risk for pneumococcal disease include those:

• Younger than 5 years of age
• With certain medical conditions: sickle cell disease, congenital or acquired asplenia, HIV infection, diabetes, immunocompromising conditions, nephrotic syndrome, or chronic heart, lung, kidney, or liver disease
• With Cochlear Implants or cerebrospinal fluid leaks (escape of the fluid that surrounds the brain and spinal cord).

Adults at risk for pneumococcal disease are among:

• The elderly
• Aboriginal and Torres Strait Islanders of all ages but especially those >50 years
• Adults with certain underlying medical conditions: Chronic illnesses affecting the heart, liver, kidney, or lung (including chronic obstructive lung disease, emphysema, asthma), or with diabetes or alcoholism. Conditions that weaken the immune system: HIV/AIDS, cancer, or damaged/absent spleen
• Those with Cochlear Implants
• Smokers present and past.

Pneumococcal Disease Vaccination

Pneumococcal disease vaccination is available and there are two types of pneumococcal vaccines which offer protection against different types of pneumococcal disease – they are not available as a combination vaccine. The vaccine is given as an injection, generally in the upper arm.

Pneumococcal vaccines:

• 13-valent pneumococcal conjugate vaccine (13vPCV)
• 23-valent pneumococcal polysaccharide vaccine (23vPPV)

These are National Immunisation Program pneumococcal vaccines and the dosage schedule will depend on the person’s age and presenting medical conditions that put them at greater risk of contracting pneumococcal disease. Vaccination providers explain which vaccine is best for each individual. Serious reactions to pneumococcal vaccination are rare.

A recent update (May 11, 2023) to the Australian Immunisation Handbook advised: '

The optimal pneumococcal vaccination program for Australia is currently under review. At present Prevenar 13 (13vPCV) and Pneumovax 23 (23vPPV) are the pneumococcal vaccines funded under the National Immunisation Program (NIP) for eligible individuals. Updates to this chapter include interim recommendations for use of extended valency vaccines (Vaxneuvance [15vPCV] and Prevenar 20 [20vPCV]) in adults for whom they have recently been registered by the Therapeutic Goods Administration but are not currently NIP-funded.'