BY: Nur Umirra Mohd Sahad

IT is highly contagious, and at times, can be deadly. For children under five years of age, exposure to the Streptococcus pneumoniae bacteria will cause them to suffer from a myriad of illnesses, and in some cases, result in death.

A simple vaccination will reduce the heartache, and financial costs.

Unfortunately, many parents are unaware that they can get their children vaccinated against the bacteria which can cause meningitis, pneumonia, blood infection as well as infection in the middle ear - which are all under the pneumococcal disease.

Consultant paediatrician Datuk Dr Zulkifli Ismail says that there is a vaccine available to protect their children from this bacteria which is found in the nose and throat of up to 60 per cent of children.

"A sneeze or cough can transmit this bacteria from one child to another and if infected, the child will suffer from any one of the cluster of diseases," says Dr Zulkifli.

He says that in Malaysia, it is found that 31 per cent of parents are aware of the existence of pneumococcal disease.

Pneumococcal disease is the number one vaccine-preventable cause of death in children below five years, worldwide. It is responsible for 800,000 deaths annually in this age group.

There are two types of pneumococcal disease - invasive and non-invasive. Pneumonia, sinusitis and otitis media are non-invasive while blood infection or bacteraemia, meningitis and bacteraemic pneumonia are invasive.

"In Malaysia, incidence of invasive pneumococcal disease can affect the very young and the very old. Of this, meningitis is the most common illness caused by this bacteria."

If left untreated at an early stage, invasive pneumococcal disease may cause long-term debilitating complications in the form of speech delay, paralysis, deafness and mental retardation, which may be irreversible.

In Malaysia, there are 500,000 cases annually of otitis media in children below the ages of two. Of this figure, 250,000 will progress to chronic otorrhea or discharge of infected pus into ear canal with the possibility of developing hearing loss.

There are 4,000 cases annually of childhood acute respiratory infections, 200 of which result in death, and 750 cases of pneumococcal bacteraemia (blood infection) that could lead to between 15 and 20 deaths.

Early vaccination - preferably before the child turns five - is important to prevent them from being infected. Studies found that the 7-valent pneumococcal conjugate vaccine (PCV7) can prevent between 57 and 91 per cent of invasive pneumococcal disease in children below the age of two. It can also reduce pneumonic hospitalisation by 39 per cent.

Consultant paediatrician and neonatologist Datuk Dr Musa Mohd Nordin says children who are immunised are not only protected from the disease, they also cannot transmit the bacteria to other people.

"If enough children are vaccinated against a disease then the disease cannot spread into the community. This is called 'herd immunity'. If you target between 80 and 90 per cent of the children to be immunised, then you have covered the entire population," said Dr Musa.

"We can never stress enough on the serious risks and consequences of pneumococcal disease in infants- and children- lives as well as in adults. People who are 65 years and above are also at risks of being infected with the bacteria. It is also important that they get vaccinated."

Children should get at least three doses of the vaccine at two, four, six and 12 months. For children aged between one and two years, they should get at least two doses of the vaccine. For those under two years, they need one dose.

What it does

The streptococcus pneumoniae bacteria is present in the nose and throat of most healthy children below two years old. The bacteria spreads when the child coughs or sneezes.

Who are at risk of pneumococcal disease?

* Children attending childcare centres or kindergartens

* Children below five years.

* Those who have poor immunity

* Those who have an history of middle ear infection

* Those exposed to secondhand cigarette smoke

* Those suffering from chronic illnesses such as diabetes, heart, lung or kidney disease

Diseases caused by the bacteria

There are three major conditions caused by invasive pneumococcal disease: pneumonia, bacteraemia, and meningitis. They are all caused by infection by the same bacteria, but have different symptoms.

* Pneumococcal pneumonia (lung disease) is the most common disease caused by the pneumococcal bacteria. Symptoms include abrupt onset of fever, shivering, chest pain, cough, shortness of breath, rapid breathing and heart rate, and feeling weak. The fatality rate is between five and seven per cent and may be much higher in the elderly.

* Pneumococcal bacteraemia (blood infection) occurs in about 30 per cent of patients with pneumococcal pneumonia. Bacteraemia is the most common clinical presentation among children below the ages of two, accounting for 70 per cent of the invasive disease in this group.

* Pneumococci cause about 19 per cent of all cases of bacterial meningitis or infection of the covering of the brain or spinal cord. Symptoms may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Infants have the highest rate of pneumococcal meningitis, approximately 10 cases per 100,000 population. The fatality rate is also high. Pneumococci are also a common cause of acute otitis media (middle ear infection).

Pneumococcal disease burden

According to World Health Organisation, pneumococcal pneumonia and meningitis are responsible for 800,000 to one million child deaths each year. In developing countries, more than 90 per cent of pneumococcal pneumonia deaths in children occur while pneumococcal meningitis kills or disables between 40 and 75 per cent of children.

Can pneumococcal be prevented?

Yes, by getting vaccinated. There are two different vaccines - one for adults and one for children. The vaccine for adults has been available for many years and is called the pneumococcal polysaccharide vaccine (Pneumovax or Pnu-Imune). It is effective in preventing the most serious complications of pneumococcal infection. The paediatric vaccine is called the pneumococal conjugate vaccine (Prevnar) and is only for use in children under five years of age.

Who should get the vaccine?

Pneumococcal polysaccharide vaccine is recommended for:

* Toddlers aged two years and above with chronic medical conditions such as diabetes, chronic lung (except asthma), heart, kidney or liver disease.

* Those whose immune systems have been weakened by conditions such as cancer or HIV.

* People without a functioning spleen and those with sickle cell disease.

* Residents of chronic care or long-term care facilities.