Feature Article: Babies, Grandparents and Pneumococcus

What do older grandparents and babies have in common? They both may need a pneumococcal vaccine. Pneumococcus is a bacterium commonly found in the throat and nose. In fact, about 25 of every 100 people are colonized with pneumococcal bacteria at any time. Pneumococcal infections can cause meningitis (an infection of the lining of the brain and spinal cord), sepsis (bloodstream infections) and, most commonly, pneumonia (an infection of the lungs).

Pneumococcus is an opportunistic infection. This means that the bacteria can live in the respiratory tract of people and not cause disease. However, if the respiratory tract has been compromised, such as by a common infection like influenza, the bacteria may get past the damaged tissues and into the bloodstream where they can cause severe infections in the blood, lungs, or brain and spinal cord.

Babies and pneumococcus

Because pneumococcus is a common bacterium, many children will come in contact with it sometime during their first two years of life. Most children who first come into contact with pneumococcus do not have a problem. However, some babies and children with a pneumococcal infection will experience pneumonia and high fever, cough and rapid, difficult breathing. Pus can form inside the lungs. Sometimes the pus can accumulate not only inside the lungs, but also between the lungs and the chest wall, a condition known as empyema. Sepsis and meningitis are also sometimes caused by infection with pneumococcus and both can be dangerous for babies and young children.

Since most adults have immunity, mothers typically transfer antibodies to the baby prior to birth, but those maternal antibodies diminish after a few months, leaving the baby vulnerable. For this reason, infants are recommended to get four doses of pneumococcal vaccine — at 2 months, 4 months, 6 months, and again between 12 and 15 months of age. The vaccine used in infants is referred to as the pneumococcal conjugate vaccine. The vaccine includes sugars (polysaccharides) from the 13 strains of pneumococcus that cause the most serious disease in that age group. However, because infants do not develop an adequate immune response to the sugar coating alone, the sugars are linked to a harmless protein that enhances the development of an immune response. Children younger than 5 years who are not up to date on their vaccines should also be immunized with the guidance of a physician. In addition, children with high-risk conditions, such as chronic heart or liver disease, diabetes, some cancers, and HIV among others, may also be recommended to get a second pneumococcal vaccine that protects against additional types of the bacteria.

Grandparents and pneumococcus

In addition to children younger than 5 years of age, pneumococcus disproportionately affects adults 65 years of age and older. Most often older adults infected with pneumococcus suffer bouts of pneumonia. Pneumonia can be lethal for older adults because it spreads rapidly and can turn an underlying condition like heart disease into a life-threatening situation.

The Centers for Disease Control and Prevention (CDC) recommends that adults 65 years or older receive two doses of pneumococcal vaccine. They are recommended to receive the vaccine that is typically recommended for children, which protects against 13 types of pneumococcus (this vaccine is often referred to as PCV13). PCV13 should then be followed up at least one year later with a dose of the pneumococcal vaccine that protects against 23 types of pneumococcus, commonly referred to as PPSV23. If you are older than 65 and have received one dose of either vaccine, check with your healthcare provider about getting the other version.

What about mom and dad?

Most adults do not need a pneumococcal vaccine until they turn 65. However, some adults at higher risk of being infected with pneumococcus are recommended to be vaccinated. If you have one of the following conditions, check with your doctor about whether you have had a pneumococcal vaccine or if you need to get one:

• Adults with heart or lung disease, liver disease, asthma, diabetes or cancer
• Adults without a functioning spleen
• Adults who received an organ transplant
• Adults who are immune compromised by disease, chemotherapy or steroids
• Individuals who are HIV positive
• Adults who smoke   or suffer from alcoholism

Globally, nearly 1 million children younger than 5 years of age die every year from pneumonia. In the U.S., about 1 million people each year are hospitalized with pneumonia and about 50,000, mostly older adults, die. Many pneumonia-related deaths are caused by pneumococcal infections. So make sure your youngest family members and your oldest family members share the common experience of having received pneumococcal vaccination.