Pneumococcal infections (caused by bacteria called Streptococcus pneumoniae) can cause a number of serious illnesses, including pneumonia (chest infection), bacteraemia (infection in the blood), meningitis (infection around the brain), sinusitis and otitis media (middle ear infection).

Pneumococcal infection is now the most common cause of meningitis in children under five years of age in Australia (as fewer children now get meningitis from Haemophilus influenza type B, thanks to the Hib vaccines).

There are 90 different types of pneumococcal bacteria, but most disease is caused by only a few types.

Who is affected?

• All children and adults can get pneumococcal disease, but in Australia it is most common in young children, especially Aboriginal and Torres Strait Islander children under 2 years of age, Aboriginal and Torres Strait Islander adults over 50 years, and all adults over 65 years of age.
• Australian Aboriginal and Torres Strait Islander children living in central Australia are much more likely to get pneumococcal disease than Aboriginal and Torres Strait Islander children in cities and large towns, and non-Aboriginal children.
• People with serious illnesses that weaken their immune system are also more likely to get pneumococcal disease. These include people with HIV infection, kidney disease, several forms of cancer and people who have had transplants.
• Smokers and people who drink a lot of alcohol also get pneumococcal disease more often.
• Pneumococcal bacteria are commonly carried in the back of the throat and nose in healthy children and adults.

Types of pneumococcal disease

Pneumococcal infections can cause ear infections, sinusitis, tonsillitis, bronchitis, pneumonia or rarely, meningitis. Each of these diseases are covered in more detail in other topics on this site.

• Children with pneumococcal disease may develop a fever, runny nose, sore ears or a cough.
• If a child is developing pneumonia he will also start breathing more rapidly, and breathing will be harder work than usual.
• If he is developing meningitis, he will also become irritable or more sleepy than usual, refuse feeds and may vomit, and develop a severe headache.
• Most children who have an illness with fever, runny nose, sore ears and cough will have a viral infection, but check with your doctor if your child is becoming more unwell.

How are pneumococcal infections caught?

• Although many healthy people carry the germs, they are mostly spread from people who are unwell.
• They can be spread by coughing or sneezing, sharing things that are put into the mouth (such as cups, spoons and toys), touching things which have the germs on them and then carrying the germs on the hands to the mouth or nose, and by handling used tissues.
• While pneumococcal disease can occur at any time, it seems to be more common in winter and spring.

How long does it take to develop?

• Infection can develop as quickly as 1 to 3 days after contact with an infected person.

How long is a person infectious?

• When an ill person gets treatment with an effective antibiotic, the person will stop being infectious within 24 to 48 hours, otherwise they will be infectious while they are unwell.
• There is no need to give antibiotics to people who carry the bacteria in their nose and throat, but are not ill.

Preventing the spread of pneumococcal disease

• Normal hygiene is important at home, in child care centres, and at pre-school, including washing hands, disposing carefully of tissues after use, not sharing cups, spoons, etc. and keeping toys clean and dry.
• Children should not go to childcare, pre-school or school when they are unwell. The child may return once she is well.
• There is no need to give antibiotics to contacts at home, child care or school if they are not ill.
• Vaccines have been developed to give protection against most pneumococcal infections, and in Australia free vaccines are now available for all children born since January 2003 and for some older children and some adults (see 'The immunisation program in Australia' below).

What parents can do

• Children who are unwell should not be sent to childcare or school. They can pass an infection to other children. Also, teachers or carers are not able to give a sick child the attention he needs.
• See the topic 'Feeling sick' for more information about caring for a sick child.

Treating pneumococcal disease

• Most illnesses caused by pneumococcal bacteria can be treated with penicillin, but some germs are becoming resistant to penicillin and some other commonly used antibiotics. This is one of the reasons why vaccines have been developed.
• If a child is unwell, with symptoms of a possible chest infection, ear infection, sinusitis, or meningitis, check with your doctor as soon as possible. See the topics 'Pneumonia', 'Sinusitis', 'Ear infections' and 'Meningitis' for more information.

The immunisation program in Australia

There are two different vaccines, one called Prevenar® for children under 5 years, and another, Pneumovax23®, for older children and adults. There are many strains (types) of pneumococcal bacteria, and different strains affect people at different ages.

• Pneumococcal vaccine for children is provided free to:
• all babies and children born since 1 January 2003
• all Aboriginal and Torres Strait Islander children in Central Australia up to 5 years of age
• children under 5 years with some other health problems
• all Aboriginal and Torres Strait Islander people over 50 years of age, and those with other risk factors
• all Australian adults over 65 years.
• Pneumococcal vaccination is also recommended for people who do not have a spleen, smokers, people with a damaged immune system, and people who have chronic illnesses such as heart, kidney or lung disease, diabetes, alcoholism and some blood disorders. The vaccine may be free for some of these people. They should talk to their doctor about vaccination.

Immunisation of young children

• The vaccine Prevenar® is being used for injections given at 2, 4 and 6 months and for 'catch-up' immunisation for children over 6 months old. It works well in babies and young children and covers the 7 types of pneumococcal bacteria that cause most disease in children.
• Children up to 6 months will need 3 doses
• Children between 7 and 17 months will need 2 doses
• Children between 18 and 23 months will need one dose
• As children get older, their immune system is better able to respond to the vaccine, so they need fewer doses to protect them.
• Doses should be given about 2 months apart.
• The vaccine should be given at the same time as the other vaccines due at 2, 4 and 6 months.
  • This will mean that the baby will need 3 injections at the same time (2 into one leg - or arm in a child over 12 months old - and one into the opposite leg or arm). The different vaccines cannot be mixed in the one syringe, to be given as one injection only. Polio vaccine is still given by mouth at the same time as the injections.
  • Giving several immunisations at the same time:
    - does not overload the immune system
    - does not increase the risk of serious side effects
    - works well to protect the baby.
• There may be some swelling, redness and soreness at the injection site(s). Some children may develop a low fever and be sleepy or restless and irritable. Severe reactions are rare. Your immunisation provider will be able to tell you more about possible side effects.
• Your child cannot get pneumococcal disease from the vaccine.