Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Invasive pneumococcal disease – meningitis or septicaemia
What is pneumococcal disease
Pneumococcal disease is caused by a bacterium called Streptococcus pneumoniae. This bacterium is the most
common bacterial cause of community-acquired pneumonia and a common cause of bacteraemia and meningitis in
children and adults. There are over 90 types of S. pneumoniae known (these are called serotypes).
What diseases does pneumococcus cause
The most common types of infections caused by S. pneumoniae include:
• Middle ear infections (acute otitis media), particularly common in children
• Pneumonia
• Bacteraemia (blood stream infection)
• Sinus infections and
• Meningitis
How common is pneumococcal disease
Pneumococcal infection is a leading cause of death worldwide. Mortality is highest in patients who develop
bacteraemia or meningitis. Pneumococcal pneumonia is estimated to affect 0.1% of the population every year.
Who is most at risk of pneumococcal disease
Individuals most at risk of pneumococcal infections are
• the very young or the very old
• people with a chronic illness such as diseases of heart, lung, kidneys or liver
• people without a spleen or with a damaged spleen
• people whose immune system is not working properly.
How do people get infected
People can get infected by person-to-person spread, usually through respiratory droplet spread, but may be by direct
oral contact or indirectly through articles contaminated with respiratory discharges. The bacteria is spread through
contact between persons who are ill or who carry the bacteria in their throat (often without being ill). It is extremely
rare for healthy people to catch the infection from a relative or a member of their household.
How is pneumococcal disease treated
Pneumococcal disease is treated with antibiotics. In recent years many pneumococci have become resistant to some
of the antibiotics used to treat pneumococcal infections; high levels of resistance to penicillin are uncommon.
How is pneumococcal disease prevented
The most common types of pneumococcal disease can be prevented by vaccination. Vaccination is recommended for
those most at risk of disease. Since 2008 all children are recommended the pneumococcal vaccine.
Pneumococcal vaccines
There are two different types of pneumococcal vaccine:
1. Pneumococcal Polysaccharide Vaccine (PPV23). This incorporates 23 of the most common strains of
pneumococcus. It is only suitable for use in those ≥2 years of age.
2. Pneumococcal Conjugate Vaccines are used in the childhood immunisation schedule at 2, 6, and 12 months. The
vaccine currently used protects against 13 strains. These vaccines are used in children because they are more suitable
for children than the polysaccharide vaccines.
Are close contacts ever offered antibiotics
If two or more cases of serious pneumococcal disease are identified in a closed setting (household, school or other
closed environment) there may be a slightly increased risk of developing the infection among the close contacts.
In these circumstances close contacts may be offered antibiotics and sometimes immunisation as a precautionary
measure if appropriate.
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