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Pneumo IQ

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Pneumococcal disease in focus

Pneumococcal disease is the term used to describe a variety of conditions caused by a bacterium, Streptococcus pneumoniae or the “pneumo bug”.
These include:
Meningitis (infection of the protective membranes of the brain and spinal cord)
Septicaemia and bacteraemia (blood infection)
Pneumonia, acute bronchitis, and chest infections (infection of the lung)
Otitis media (middle ear infection)
Sinusitis1

Pneumococcal disease can affect any age group. However, the greatest incidence of disease is in infants and young children under the age of 2 years, and also the elderly.5

Risk Factors for children

Although children with poorly functioning immune systems are at greatest risk of contracting pneumococcal infection, the vast majority of disease occurs in otherwise healthy youngsters.19 Children under the age of 2 years are especially vulnerable.2 It is generally acknowledged that the majority of infants and children succumbing to pneumococcal meningitis or septicaemia have no identified risk factors.

Day-care centres or attendance at a nursery school also puts infants and young children at greatest risk.20,21,26  A recent study suggested that being in day-care or attending a nursery school may double the risk of invasive pneumococcal diseases, such as meningitis, bacteraemia, sepsis, and severe pneumonia.22,23 Additional risk factors in all children include the number of siblings, frequent otitis media (middle ear infections), and antibiotic usage.20,22,26  It has also been observed that there is an increased risk of invasive pneumococcal disease in children from deprived backgrounds. While the association between risk of infection and social deprivation is not new, it provides a timely reminder about health impact of social inequality.27


  1. Prakash P.M.  The burden of Pneumococcal disease in children – advances in the fight of this epidemic.  Professional Nursing Today 2007; 11(3): 25 – 28.
  2. Department of Health.  Pneumococcal vaccine added to the childhood immunization programme; more protection against meningitis and septicaemia.  8 February 2006.  http://www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/
    DH_4128036
  3. NICD.  Surveillance Bulletin 2007; 5(1): 1 – 20.
  4. Giebink G.S. The Prevention of Pneumococcal Disease in Children.  N Engl J Med 2001; 345(16): 1177 – 1183.
  5. World Health Organization Pneumococcal conjugate vaccine for childhood immunization – WHO position paper.  Weekly Epidemiological Record 2007;  82(12):  93 – 104.
  6. Ispahani P., Slack R.C.B., Donald F.E., Weston V.C., Rutter N.  Twenty years surveillance of invasive pneumococcal disease in Nottingham:  serogroups responsible and implications for immunization.  Arch Dis Child 2004;  89:  757 – 762.
  7. Baraff L.J., Lee S.I., Schriger D.L.  Outcomes of bacterial meningitis in children:  a meta-analysis.  Paed Infect Dis J 1993;  12(5):  389 – 394.
  8. Drummond P., Clark J., Wheeler J., Galloway A., Freeman R., Cant A.  Community acquired pneumonia – a prospective UK study.  Arch Dis Child 2000;  83:  408 – 412.
  9. Djuretic T., Ryan M.J., Miller E., Fairley C.K., Goldblatt D.  Hospital Admissions in Children due to Pneumococcal Pneumonia in England.  J of Inf 1998; 37:  54 – 58.
  10. Bradshaw D., Bourne D., Nannan N.  What are the leading causes of death among South Africa children?  MRC Policy Brief 2003; 3.  (Unpublished data).
  11. Bedford H., de Louvois J., Halket S., Peckham C., Hurley R., Harvey D.  Meningitis in infancy in England and Wales:  follow up at age 5 years.  BMJ 2001;  323:  1 – 5.
  12. Karstaedt A.S., Khoosal M., Crewe-Brown H.H.  Pneumococcal bacteremia during a decade in children in Soweto, South Africa.  Pediatr Infect Dis J 2000;  19(5):  454 – 457.
  13. Merck Manual Professional.  http://www.merck.com/mmpe/print/sec14/ch167/ch167g.html
  14. Eskola J., Kilpi T., Palmu A., et al.  Efficacy of a pneumococcal conjugate vaccine against acute otitis media.  N Engl J Med 2001;  344(6):  403 – 409.
  15. Fireman B., Black S.B., Shinefield H.R., Lee J., Lewis E., Ray P.  Impact of the pneumococcal conjugate vaccine on oitits media.  Pediatr Infect Dis J 2003;  22(1):  10 – 16.
  16. Rovers M.M., Schilder A.G.M., Zielhuis G.A., Rosenfeld R.M. Otitis media. The Lancet 2004; 363: 465 – 473.
  17. Department of Health, Chief Medical Officer.  Preventing meningitis.  7 December 2006.http://www.dh.gov.uk/  (Accessed:  12 October 2007)
  18. Subcommittee on Management of Sinusitis and Committee on Quality Improvement.  Clinical Practice
    Guideline:  Management of Sinusitis.  Pediatrics 2001; 108(3):  798 – 808.
  19. McIntosh E.D.G.  How many episodes of hospital care might be prevented by widespread uptake of 7-valent pneumococcal conjugate vaccine?  Arch Dis Child 2003;  88:  859 – 861.
  20. Kornelisse R.F., Westerbeek C.M.L., Spoor A.B., et al.  Pneumococcal Meningitis in Children:  Prognostic Indicators and Outcome.  Clin Inf Dis 1995;  21:  1390 – 1397.
  21. Dagan R., O’Brien K.L. Modeling the Association between Pneumococcal Carriage and Child-Care Center Attendance. CID 2005; 40: 1223 – 1226.
  22. Givon-Lavi N., Fraser D., Porat N., Dagan R.  Spread of Streptococcus pneumoniae and Antibiotic-Resistant S. pneumoniae from Day-Care Centre Attendees to Their Younger Siblings.  JID 2002; 186: 1608-14.
  23. Dagan R., Sikuler-Cohen M., Zamir O., Janco J., Givon-Lavi N., Fraser D. Effect of a conjugate Pneumococcal vaccine on the occurrence of respiratory infections and antibiotic use in day-care center attendees. Pediatr Infect Dis J 2001; 20: 951 – 958.
  24. Hussain M., Melegaro A., Pebody R.G., George R., Edmunds W.J., Talukdar R. et al. A longitudinal household study of Streptococcus pneumoniae nasopharyngeal carriage in a UK setting. Epidemiol Infect 2005; 133: 891 – 898.
  25. Sáez-Llorens X., McCracken G.H. Bacterial meningitis in children. Lancet 2003; 361: 2139 – 2148
  26. Levine O.S., Farley M., Harrison L.H.,  Lefkowitz L., McGeer A., Schwartz B.  Risk Factors for Invasive Pneumococcal Disease in Children:  A Population-based Case-Control Study in North America.  Pediatrics 1999;  103(3):  28 – 33.
  27. Grant C.C.,  Harnden A.R., Jewell G., Knox K., Peto T. E., Crook D.W.  Invasive pneumococcal disease in Oxford 1985 – 2001:  a retrospective case series.  Arch Dis Child 2003;  88:  712 – 714.
  28. Wikipedia, the free encyclopedia
  29. Miller E., Waight P., Efstratiou A., Brisson M., Johnson A., George R.  Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996 – 1998.  Acta Paed Suppl 2000;  435:  11 – 16.
  30. Toddlers – Meningitis Research Foundation.  http://www.meningitis.org/symptoms/toddlers