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Every newborn born in Poland on or after 1 January 2017 will be vaccinated against pneumococci for free. Until now, a vaccine that protects against the bacterium that causes, among others, otitis media, sinusitis, and pneumonia was optional and paid for most children. Premature babies were vaccinated for free.
Children born before 37 weeks gestation and those with a birth weight less than 2,5 kg, as well as those under the age of five but suffering from chronic heart disease, diabetes and asthma, had a chance of receiving this vaccination. The parents of the other children had to buy the vaccines themselves (if they wanted their child vaccinated, of course).
From January, pneumococcal vaccination will be compulsory for everyone and will be financed by the state budget.
What are pneumococci?
Streptococcus pneumoniae, popularly known as pneumococcus or pneumoniae, are bacteria belonging to the common type of bacteria, streptococci. These bacteria belong to gram-positive bacteria with a characteristic granular shape and often arrange themselves in pairs in the microscopic image, hence the name of pneumonia.
A characteristic feature of pneumococci is the ability to produce a shell consisting of various types of polysaccharides. This feature is important in the pathogenicity of these bacteria, because it allows us to avoid the attack of our immune system, and additionally, due to the large diversity of envelopes in different strains, it is possible to re-infect. Taking into account the composition of the capsule, there are about 90 different serotypes among pneumococci.
Under natural conditions, pneumococci live on the mucous membranes of the upper respiratory tract, both in humans and animals. It is believed that approx. 10% of adults and approx. 20-40% of children are carriers of these bacteria. The frequency of pneumococcal carriage is highest among children, especially in nursery and kindergarten children, and decreases with age.
The main route of pneumococcal infection is the droplet route – during sneezing or coughing, while less often direct contact is considered, e.g. contact with objects contaminated with respiratory secretions. The most common source of bacteria is a sick person or a healthy carrier. It is very often observed that children are the source of pneumococci for the elderly; contact of grandparents with grandchildren.
The highest number of pneuomococcal infections is observed in the winter months and early spring, which is explained by the fact that then we suffer more often from viral infections of the upper respiratory tract, and these then favor bacterial infections, including pneumococcal infections.
The main forms of pneumococcal infection
These are the most common:
- localized infections:
- otitis media – it is believed that almost every child under the age of 5 has a history of pneumococcal inflammation
- sinusitis of the nose
- pneumonia – the contributing factors are chronic lung diseases, smoking and as a complication of influenza
- conjunctivitis
- invasive infections:
- pneumonia with bacteremia (presence of bacteria in the blood) – bacteremia occurs in about 25-30% of pneumonia cases
- meningitis – pneumococcal meningitis. they cause permanent complications much more often, and recurrent meningitis is more common.
- sepsis = sepsis – most are from severe pneumonia; however, it may develop as the underlying disease without a prior focus of inflammation in a particular location; mortality in pneumococcal sepsis is 17-25%
- endocarditis
- peritonitis
- osteomyelitis
- arthritis
Who are pneumococci dangerous for?
Pneumococcal infection can affect anyone, but most often it affects children from 2 months to 2 years of age and the elderly over 65 years of age. In these age groups, infections may be severe, invasive, and have a higher mortality rate.
High-risk groups include people with congenital and acquired immune disorders, spleen deficiency, cancer, diabetes, kidney failure, chronic lung or heart diseases, after cochlear implantation.
In developing countries, pneumococcus is one of the leading causes of mortality in children under the age of 5, nearly 20% of deaths in this age group. However, in the group of elderly patients with pneumococcal bacteremia, mortality is as high as 60%.
In December, the Ministry of Health announced the end of the tender for the purchase of pneumococcal vaccines. Children who are compulsorily vaccinated will receive Synflorix PCV10. The ministry also bought Prevenar PCV13, which can be given to immunocompromised children if the doctor decides to do so.
One of the most common forms of pneumococcal infection is otitis media. “It is believed that almost every child under the age of 5 has a history of pneumococcal otitis media” – indicates the Ministry of Health. Pneumococcal can also cause sinusitis, conjunctivitis, and pneumonia (especially in the case of complications from influenza and in people with chronic lung disease).
The most severe form of pneumococcal infection is the so-called invasive pneumococcal disease (IPD). This concept includes meningitis, sepsis, and pneumonia with bacteremia. According to the data of the National Institute of Public Health – National Institute of Hygiene, the incidence rate of invasive pneumococcal disease in Poland in 2014 increased almost threefold compared to 2007.
How to recognize pneumococcal infection?
The basic examination allowing to diagnose pneumococcal infection is bacteriological examination. The cultivation of pneumococci from blood, cerebrospinal fluid or secretions from the lower respiratory tract provides the basis for the diagnosis. On the other hand, frequently performed tests, such as swabs from the nose or throat, allow to determine the possible carrier of pneumococci, or in the case of clinical symptoms, I can indirectly suggest the participation of pneumococci in the infection.
Performing a microbiological test is very important as it will additionally determine the sensitivity of pneumococci to antibiotics. And it is with them that pneumococcal infection is treated. The basic antibiotics used in therapy include penicillin derivatives, cephalosporins, macrolides and fluoroquinolones.
Currently, a big problem in the treatment of pneumococcal infections is the increasing occurrence of strains of these bacteria that show resistance to the above-mentioned antibiotics. That is why it is so important to determine susceptibility in a bacteriological test.
The use of antibiotics in viral infections of the upper respiratory tract (colds) and the treatment of pneumococcal carrier promote the formation of resistant strains. The mere finding of pneumococci on the mucous membranes of the upper respiratory tract (in a nasal or pharyngeal swab) in the absence of clinical symptoms should not be the basis for the administration of an antibiotic.
The Ministry of Health argues that vaccination is a very effective method of preventing pneumococcal diseases. He cites research showing that one pneumococcal vaccine reduces community-acquired pneumonia by 16 percent. in children up to 15 years of age, and by 32 percent. in children under two years of age.
The ministry adds that research conducted in Norway also shows an increase in immunity in all age groups after the introduction of field vaccination. – This indicates a high effectiveness of vaccination also in unvaccinated groups as part of an indirect effect, i.e. environmental resistance – explains the resort.
A similar effect was confirmed by research conducted in Poland. After the introduction of population vaccinations in Kielce in 2006, in 2005–2012 in children under two years of age by 96,5%. the incidence of pneumococcal pneumonia decreased. At the same time, as a result of environmental immunity, the incidence of this disease in people between 50 and 64 years old decreased by 30,8%, and in people over 65 – by 56,8%. The incidence of penicillin-resistant pneumococcal strains in children under 5 years of age also decreased.