Pneumococcal meningitis is the most common bacterial meningitis in South Africa.  One in five children diagnosed with pneumococcal meningitis will die,^1,2 twice the rate associated with meningococcal meningitis.^2,3

Furthermore, for children who survive pneumococcal meningitis, the risk of suffering long-term and severe neurological complications (brain damage) is higher than with survivors of meningococcal meningitis.^3,4  One in six children who survive pneumococcal meningitis suffer mental retardation; one in seven develop epilepsy or other seizure disorders; while one in four become deaf (half of these profoundly so).³  Overall, half the survivors of pneumococcal meningitis will be left with some level of disability.⁴

In addition, pneumococcal meningitis is not often associated with the non-blanching rash that characterises meningococcal septicaemia, the blood-infection form of the disease that often accompanies meningococcal meningitis.  As a result, diagnosis of pneumococcal meningitis is sometimes more difficult to make.  This makes prevention an even more logical solution to the problem.⁵

Suspected meningitis or septicaemia is a medical emergency and you should seek medical assistance immediately.

If you would like more information on how to recognise the signs and symptoms of any form of meningitis, contact any of the following organisations that provide excellent backup or contact your healthcare professional.
Meningitis Research Foundation – www.meningitis.org
National Meningitis Association – www.nmaus.org

Ear infections in young children are extremely common, with nearly all children having experienced an episode of otitis media (middle ear infection) by their third birthday.⁶  Whilst many of these will be viral, up to half of the cases that are bacterial in origin are the result of pneumococcal infection.⁷

Children who suffer severe and recurrent ear infections have been shown to be more likely to get “glue ear” and perforations of the eardrum, which can lead to hearing loss resulting in delays in speech, language and cognitive development.⁶  Severe and recurrent otitis media has been shown to be caused  more likely by the “pneumo bug” than by other organisms.⁸

Although the conjugate vaccine is highly effective at protecting infants and children against serious disease caused by the bacterial strains covered by the vaccine.^8,9 An effective vaccine that covers all the strains of the “pneumo bug” and offers 100% protection, is not yet available.  There are over 90 different types of pneumococcal bacteria and the conjugate vaccine protects against seven of these.  However, in South Africa, these seven types and cross protection of one other type, account for more than 70% of the serious, life-threatening pneumococcal diseases that affect children under the age of five.¹⁰  Furthermore, the conjugate vaccine has significantly reduced the rates of invasive pneumococcal disease in the USA where it has been on the National Immunisation Programme since 2000.⁹

Vaccinating children in the US has also shown to be associated with a reduction in pneumococcal disease in other age groups, such as those of parents and grandparents.⁹  It is thought that this is because children are not passing the “pneumo bug” onto their friends and relatives.

The conjugate vaccine is approved only for the prevention of serious, life-threatening (invasive) pneumococcal diseases, such as meningitis, bacteraemia and severe pneumonia, although it is recognised that there will be an additional benefit in helping reduce the number of infants and young children suffering from middle ear infections (otitis media) as a result of pneumococcal infection.^7,8

All medicines and vaccines are routinely monitored for safety following their introduction.  The safety profile of the conjugate vaccine has been demonstrated in clinical trials in the US and across Europe.  There were almost 40 000 children involved in these trials and all the results showed that the conjugate vaccine is well tolerated.^7,8

The most common side effects observed were local injection site reactions such as redness and swelling.  Systemic reactions were generally mild and transient and the most commonly reported systemic events included fever, vomiting, diarrhoea, drowsiness and restless sleep.⁸  The safety profile of the conjugate vaccine is confirmed by experience in the United States.⁸  The conjugate vaccine is recommended for all American children under 2 years of age and, in addition, to other children up to the age of 5 years  considered to be at increased risk.²⁰

After 2 years of routine use in the US, the majority of side effects that were reported were those previously identified in clinical trials.¹²

Vaccination schedule for infants and toddlers:¹³

Vaccination schedule for previously unvaccinated children from 7 months to 9 years:¹³

Late Starters
Previously unvaccinated infants from 7 to 11 months should receive 2 doses at least 1 month apart  followed by a booster dose after the  1-year birthday. The interval between the 2nd dose and booster should be at least 2 months.

Children from 12 to 23 months of age, previously unvaccinated, should receive 2 doses at least 2 months apart. Children >_ 24 months of age should receive a single dose.

Clinical trials have shown that the conjugate vaccine is well tolerated when administered with other routine childhood vaccines.¹⁴  Different injectable vaccines should always be given at different sites.¹⁵

It is quite rare for a child to have meningitis twice, whatever the cause.  However it is known to have happened in the past.  There are many different pneumococcal strains and it may not be clear which caused the disease – the children could have had a completely different type of meningitis.

If the child was under the age of two when they contracted pneumococcal meningitis, they may not have developed adequate natural protection and may still be vulnerable to infection even with the same bug.  This is especially true if the child suffers from one of the conditions that cause their immune system to be inefficient, such as a missing or defective spleen, chronic heart, liver, kidney or respiratory disease, immunosuppression, and diabetes.¹³  All infants and children under two years of age are at a higher risk of pneumococcal meningitis than older children.⁶

The conjugate vaccine is an inactivated vaccine and cannot cause even a mild form of pneumococcal disease.¹⁶

The conjugate vaccine is free of preservatives, including thiomersal or any other mercury based preservative.¹⁶

No.  Antibiotics are not used in the manufacture of the conjugate vaccine, neither are they added to the final vaccine.¹⁶

No.  The conjugate vaccine is grown up on a soya medium.  No eggs or chicken derived materials are used in its manufacture.  No egg or chicken derived material is added to the final vaccine.¹⁶

The conjugate vaccine does not contain latex, neither is latex used in the manufacture of thereof, however, the bung used in the vaccine packaging does contain latex.  Although not a specific contra-indication to the conjugate vaccine, it may not be suitable for use in a patient with a latex allergy. ¹⁶

The conjugate vaccine does not contain lactose, neither is lactose used in its manufacture.

Casamino acids, derived from casein, which is a milk protein and is taken from cow’s milk, are used in a very early stage in the production of the diphtheria toxoid.  No trace of the casamino acid should appear in the final vaccine.

The conjugate vaccine is suitable to be given to a patient with an intolerance to lactose. ¹⁶

No nuts or nut oils are used in the manufacture of the vaccine.  Neither are nuts or nut oils used to lubricate any of the equipment used in the manufacture of the conjugate vaccine. ¹⁶

No – every day of their life, babies are exposed to far more immune challenges from the environment around them than from all of the vaccines contained in the routine immunisation schedule added together.  They are able to deal with these immune challenges just as they are able to deal with the vaccinations we give them. ¹⁶

Within hours of birth, a baby’s gastrointestinal and respiratory tracts are heavily colonised with bacteria. ¹⁷

A baby’s immune system has an enormous capacity to fight the thousands of bacteria, viruses and other pathogens that it is bombarded with every day – a baby could, in theory, respond to around 10 000 vaccines at any one time.  If, for example, 11 vaccines were given to a baby at once, this might only occupy about a 1 000th of the immune system.  But, since the cells of the immune system replenish themselves at such a tremendous rate, a vaccine can never “use up” part of the immune system.¹⁷

Many of the vaccines on the SA vaccine schedule are not actually new but are improved formulations.  Rigorous clinical trials have ensured these are safe to give to babies. ¹⁶

Many vaccines given to babies and young children have been around for decades.  What is fairly new is our ability to take these older vaccines, link them to proteins (which themselves have been around for many years) and make conjugate vaccines.  By doing this we can protect the younger age groups that are so vulnerable to these diseases. ¹⁶

Babies need protection early – their greatest risk of getting various deadly diseases is in the first 12 months of life.  To delay vaccination is to put them at risk. ¹⁶

Babies get their immunity in two ways:  through the passive or active route.

Passive immunity is obtained from immunoglobulin or naturally, by being passed from mother to baby. ¹⁶

Mothers pass antibodies to their babies in two ways.  The first is via the placenta, mainly during the 3rd trimester of pregnancy.  This is why premature babies have lower levels of immunity than full term babies.  The second way babies get passive immunity is through breast milk.  Breast milk and colostrum mainly provide a class of antibody called IgA22, which guards mucosal surfaces – important because it helps protect against gastrointestinal and respiratory bugs.¹⁹  This provides limited protection against invasive infections.  Therefore whilst breast-feeding has a great many health benefits, it is not a replacement for immunisation.¹⁸

Active immunity is obtained through natural infection or immunisation.

Natural infection is less reliable than vaccination for providing protective immunity.  If the child survives an infection, they will develop immunity to the strains of organisms they were protected against.  In the case of pneumococcal infection, there are 90 different strains of the bacterium and consequently many more chances of infection. ¹⁶

But the child may not survive, especially as pneumococcal infection is associated with high rates of mortality.1  For up to half of those who survive, the outcome may be a severe disability. ⁴

For serious, life-threatening childhood illnesses, acquiring active immunity through vaccination is a much safer way to protect babies and children than risking exposure to the diseases.^1,4

You can have your child vaccinated at your clinic – the same place all other vaccinations are given.  Alternatively some doctors and paediatricians offer a vaccination service, and some pharmacies have clinics, which do the same.