Mobile Health’s Clinical Corner:

by Anne M Dunne, RN-BC, MSCN

Sr. Vice President, Clinical Services

Pneumococcal disease is caused by the bacteria, Streptococcus pneumoniae. There are many subtypes. Most subtypes can cause disease, but only a few produce the majority of invasive pneumococ­cal infections.  The disease is spread from person to person by drop­lets in the air. Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined.

There are three major conditions caused by invasive pneumococcal disease. These conditions are caused by infection with the same bacteria, but have different symptoms:

·        pneumonia

·        bacteremia

·        meningitis

Pneumonia is the most common disease caused by pneumococcal bacteria. It is estimated that 175,000 hospitalizations due to pneumococcal pneumonia occur each year in the United States. The incubation period is short (1–3 days). Symptoms include abrupt onset of fever, shak­ing chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weak­ness. The fatality rate is 5%–7% and may be much higher in the elderly.

Bacteremia, a blood infection, occurs in about 25%–30% of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococ­cal bacteremia occur each year in the United States. The overall case-fatality rate for bacteremia is about 20% but may be as high as 60% among the elderly­

Pneumococci cause 13%–19% of all cases of bac­terial meningitis (infection of the covering of the brain or spinal cord) in the United States. There are 3,000–6,000 cases of pneumococcal meningitis each year. Symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma

Penicillin is the drug of choice for treatment of pneu­mococcal disease; however, resistance to penicillin and other antibiotics has been on the rise. Studies indicate that in some areas of the United States up to 40% of invasive pneumococci are resistant to common antibiotics. The increased difficulty of treating this serious bacte­rial infection makes prevention through vaccination even more important

In 1977, the first pneumococcal polysaccharide vaccine was licensed in the United States. In 1983, an improved pneumococcal polysaccharide vaccine was licensed.  It contains purified protein from 23 types of pneumococcal bacteria (the old formula­tion contained 14 types). This pneumococcal poly­saccharide vaccine is commonly known as PPSV23. The vaccine is made from inac­tivated (killed) bacteria The PPSV23 vaccine is licensed for use in adults with certain risk factors.  

The polysaccharide vaccine (PPSV23) can be given as an injection in either the muscle or the subcutaneous tissue of the arm or leg.   Most healthy adults who get the vaccine develop protection within 2 to 3 weeks.

The vaccine is recommended for:

·        All adults age 65 years or older

·        An adult with a long-term health problem such as cardiovascular dis­ease, sickle cell anemia, alcoholism, lung disease, diabetes, cirrhosis, or leaks of cerebrospinal fluid

·        Anyone who has or is getting a cochlear implant

·        An adult who has a disease or condition that lowers the body’s resistance to infection, such as Hodgkin’s disease, kidney fail­ure, nephrotic syndrome, lymphoma, leukemia, multiple myeloma, HIV infection or AIDS, dam­aged spleen or no spleen, or organ transplant  

·        An adult  who is taking any drug or treatment that lowers the body’s resistance to infection, such as long-term steroids, certain cancer drugs, or radiation therapy  

·        Adults ages 19–64 who have asthma  

·        Adults ages 19–64 who smoke cigarettes

Revaccination is not done routinely, but a single revaccination dose is recommended for groups of people at highest risk of serious infection. No one should receive more than two doses of PPSV 23.  Persons who received a first dose when they were younger than age 65 years should receive a second dose at age 65 years if at least five years have elapsed since the previous dose.  While there is no evidence that PPSV is harmful to either a pregnant woman or to her fetus, as a precaution, women with conditions that put them at risk for pneumococcal disease should be vaccinated before becoming pregnant, if possible.  About half of people who get PPSV have mild side effects, such as redness or pain at the injection site. Less than 1% develops a fever, muscle aches, or more severe local reaction

The Centers for Disease Control and Prevention, the American College of Obstetri­cians and Gynecologists, the American Academy of Family Physicians, and the American College of Phy­sicians all recommend the PPSV23 vaccine.

Please contact Mobile Health Medical Services at 212 695-5122 x 6003 to learn more about the pneumonia vaccine or to add it to your agency’s profile.

References:

http://www.vaccineinformation.org/pneumchild/qandavax.asp

 www.cdc.gov

 www.immunize.org

 www.vaccineinformation.org