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Pneumococcal Disease

by in Diseases & Vaccines January 12, 2014

Dr Green Mom- Pneumococcal Disease and Vaccine

What is Pneumococcal Disease

  • Streptococcus (S.) pneumoniae is a bacteria (we will call pneumococcus) that may cause a range of problems from very minor to very severe- common cold symptoms, ear infections, pneumonia and meningitis.
  • There over 90 strains of pneumococcus. [2]
  • Pneumococcus is spread through respiratory droplets and is considered a normal inhabitant of the lining of the pharynx and oral cavity.
  • Pneumococcal infections are more common in winter and early spring.

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Pneumococcal Disease Symptoms

Mild

  • cough
  • common cold symptoms

Moderate

  • otitis media (children)

Severe

  • pneumonia (elderly)
  • meningitis (children younger than 1 yr of age but older than 6 months due to maternal antibodies – 10 cases per 100,000)-
    • An elevated body temperature (fever)
    • Headache.
    • Nausea.
    • Vomiting.
    • Sleepiness.
    • Irritability.
    • Stiff neck.
    • Seizures.
  • bacteremia (blood infection)
  • death

Groups at Increased Risk for Pneumococcal Complications

  • Asplenia (under functioning spleen) especially sickle cell
  • Those infected with HIV
  • Alaska Natives
  • American Indians
  • African Americans
  • Those in childcare
  • Those with a cochlear implant
  • Decreased immune function
  • Cigarette smoking/Secondhand smoke (51% of all disease)
  • Chronic heart, liver, pulmonary or renal disease
  • Cerebrospinal fluid (CSF) leak [1]

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Conventional Treatment for Pneumococcal Disease

“Empiric therapy depends on the syndrome. Many strains are resistant to penicillin, cephalosporins, and macrolides, so definitive treatment should be targeted on the basis of antimicrobial susceptibility results. In the United States and other countries where β-lactam resistance is common, the initial regimen for pneumococcal meningitis might include vancomycin or a fluoroquinolone, plus a third-generation cephalosporin.” ~CDC [12]

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When is the Pneumococcal Vaccine Given

Four Doses: 2 months, 4 months, 6 months, 15 months of age According to the CDC, unvaccinated children 7 months of age and older do not require a full series of four doses. The number of doses a child needs to complete the series depends on the child’s current age.

  • Unvaccinated children aged 7 through 11 months should receive two doses of vaccine at least 4 weeks apart, followed by a booster dose at age 12 through 15 months.
  • Unvaccinated children aged 12 through 23 months should receive two doses of vaccine, at least 8 weeks apart.
  • Previously unvaccinated healthy children 24 through 59 months of age should receive a single dose of PCV13.
  • Unvaccinated children 24 through 71 months of age with certain chronic medical conditions should receive 2 doses of PCV13 separated by at least 8 weeks. These conditions include chronic heart and lung disease, diabetes, cerebrospinal fluid leak, cochlear implant, sickle cell disease and other hemoglobinopathies, functional or anatomic asplenia, HIV infection, or immunocompromising conditions resulting from disease or treatment of a disease. [1]

For more information:

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Efficacy of the Pneumococcal Vaccine

  • Possible protection against 13 of over 90 strains of Streptococcus pneumoniae.
  • Prevention of invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F.
  • May not protect against the above in some individuals. [1]

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How Long Does Pneumococcal Vaccine Protection Last

  • The duration of protection from pneumococcal immunization is not known (some sources state approximately 4-5 years). [14,15]

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Ingredients in the Pneumococcal Vaccine

PREVNAR 13 (PCV13)-

  • Pc sugar/ diphtheria toxoid complex (PCV7 plus serotypes 1, 3, 5, 6A, 7F and 19A)
  • Aluminum— 125 micrograms
  • Polysorbate 80 Succinate (buffer to prevent acidity)

If you would like specific information regarding each ingredient, including studies:

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Pneumococcal Vaccine FDA Package Inserts

(Please read the “Contraindications/Warnings/Precautions/Adverse Reactions” VERY carefully inside each FDA Package Insert)

  • Pneumovax 23 (PPSV23) (Merck)  Pneumovax 23 FDA Package Insert (for use in persons 50 years of age or older and persons aged ≥2 years who are at increased risk for pneumococcal disease)
  • Prevnar (Wyeth)  Prevnar FDA Package Insert (for use in children under 2 years of age, includes 7 strains- not used much anymore due increased prevalence of other strains)
  • Prevnar 13 (PCV13) (Wyeth) Prevnar 13 FDA Package Insert (for use in children under 2 years of age, covers 13 strains including strains 3, 7F, and 19A)

See more information regarding the new Prevnar 13 vaccine:

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Controversy and the Pneumococcal Vaccine

  • The pneumococcal vaccine was introduced in the USA in 1977.
  • In 1983, the pneumovax 23 was introduced for high risk populations over the age of 2.
  • A new Prevnar 7 was introduced in 2000 to cover 7 of the over 90 strains of the pneumococci.
  • Prevnar 13 was introduced just 10 years later to cover 13 strains.
  • Prevnar 13 was introduced because the strains that were not common back in 2000 are common today. This leads me to wonder why rare strains are now considered common in only 10 years?
  • Paul Offit, MD states:

“An ounce of prevention is worth a pound of cure- In the 1940s all of the strains of pneumococcus were sensitive to the antibiotic, penicillin. However, over time many strains of pneumococcus have become resistant not only to penicillin, but also to the broader-spectrum antibiotics developed to combat bacterial infections. Strains of pneumococcus have now been identified that are highly resistant to most antibiotics. Our reliance on and overuse of antibiotics have led to this resistance, backing us into a corner when treating infections caused by these and other types of bacteria. Unfortunately, we have taken our first steps into a post-antibiotic era. This makes the use of vaccines all the more important.”   [2]

  • Regarding the above statement by Paul Offit, MD: I am not very interested in continuing to be a science guinea pig…. So, my interpretation of what Dr. Offit, MD is saying is that since antibiotics have “failed us,” let’s try vaccines!  Antibiotics have NOT failed us.  What has failed us is the way science and the medical system have overused  the privilege of antibiotics for much of the last century.  I believe this to be true about vaccines as well.  The overuse of vaccines over the next century may wreak havoc in much the same way that antibiotic resistant strains of disease are wreaking havoc today.
  • During clinical trials: There were 3 (0.063%) deaths among Prevnar 13 recipients, and 1 (0.036%) death in Prevnar recipients, all as a result of sudden infant death syndrome (SIDS). These SIDS rates are consistent with published age specific background rates of SIDS from the year 2000. [10]

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Pneumococcal Vaccine Reactions

PREVNAR 13 (PCV13)-

Signs to look for include:  

  • 50% of those vaccinated report pain, swelling, or erythema at the site of injection. These reactions usually persist for less than 48 hours.
  • Local reactions are reported more frequently after the fourth dose. [1]

Known Severe Reactions:

  • 8% of those vaccinated have severe local reactions that inhibit limb movement.
  • In clinical trials of PCV13, fever (higher than 100.4°F [38°C]) within 7 days of any dose of the primary series was reported for 24%–35% of children. [1]

Postmarketing Surveillance:

(this means the adverse reactions that have been reported by the public since the introduction of the vaccine)

The following additional adverse events, regardless of causality, have been reported during post-marketing use of PCV13:

  • Administration site conditions: Vaccination-site dermatitis, vaccination-site pruritus, vaccination-site urticaria
  • Blood and lymphatic system disorders: Lymphadenopathy localized to the region of the injection site
  • Cardiac Disorders: Cyanosis
  • Immune system disorders: Anaphylactic/anaphylactoid reaction including shock Nervous System Disorders: Hypotonia
  • Skin and subcutaneous tissue disorders: Angioneurotic edema, erythema multiforme
  • Respiratory: Apnea
  • Vascular Disorders: Pallor [10]

PNEUMOVAX 23 (PPSV23)- 

Signs to look for include: 

  • 30-50% of those vaccinated report pain, swelling, or erythema at the site of injection. These reactions usually persist for less than 48 hours.
  • Local reactions are reported more frequently following a second dose of PPSV23 vaccine than following the first dose. [1]

Known Severe Reactions:

  • Systemic reactions (such as fever and myalgia) are not common (fewer than 1% of vaccinees), and more severe systemic adverse reactions are rare.
  • A transient increase in HIV replication has been reported following PPSV23 vaccine. [1]

Postmarketing Surveillance:

(this means the adverse reactions that have been reported by the public since the introduction of the vaccine)

The following additional adverse events, regardless of causality, have been reported during post-marketing use of PPSV23:

  • General disorders and administration site conditions: Cellulitis, Malaise, Fever (>102°F), Warmth at the injection site, Decreased limb mobility, Peripheral edema in the injected extremity
  • Digestive System: Nausea, Vomiting
  • Hematologic/Lymphatic: Lymphadenitis, Lymphadenopathy, Thrombocytopenia in patients with stabilized idiopathic thrombocytopenic purport, Hemolytic anemia in patients who have had other hematologic disorders, Leukocytosis
  • Hypersensitivity reactions: Anaphylactoid reactions, Serum Sickness, Angioneurotic edema
  • Musculoskeletal System: Arthralgia, Arthritis
  • Nervous System: Paresthesia, Radiculoneuropathy, Guillain-Barré syndrome, Febrile convulsion
  • Skin: Rash, Urticaria, Cellulitis-like reactions, Erythema multiforme
  • Investigations: Increased serum C-reactive protein [11]

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The Bottom Line and the Pneumococcal Vaccine

  • Pneumococcal Vaccine–   Current number of claims filed, number compensated: Vaccine Injury Compensation Program (“vaccine court”) [16]
  • According to Paul Offit, MD, the pneumococcal vaccine (prevnar 13) will prevent 7 of every 100 ear infections and 20 of every 100 severe ear infections requiring tubes. [2]
  • The CDC Pink Book states that those at highest risk for potential complications with pneumococcal disease are asplenia (under functioning spleen) especially sickle cell, those infected with HIV, Alaska natives, American Indians, African Americans, those in childcare, and those with a cochlear implant. [1]
  • According to Dr. Sears, if you plan on nursing for at least 2 years and your infant/toddler is not in childcare, your child is much less likely to suffer from pneumococcal disease. [4]
  • The CDC Pink Book States that children in daycare have a 2-3 fold increase risk for pneumococcal disease (anything from common cold symptoms and ear infections to pneumonia or meningitis. [1]
  • Prevnar 7 (the earlier form of the vaccine covering 7 strains and now only accounts for 2% of the severe pneumococcal cases) may have caused other strains of pneumococcus to become more common- hence now there is a prevnar 13 that covers 13 strains.
  • 39% of severe pneumococcal cases are caused by strains NOT covered in the pneumococcal vaccine, prevnar 13. [1]

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References

  1. Epidemiology and Prevention of Vaccine-Preventable Diseases, 12th Edition (The Pink Book) (CDC) (web version)
  2. Children’s Hospital of Philadelphia (Paul A. Offit, MD)
  3. What Your Doctor May Not Tell You About(TM) Children’s Vaccinations
  4. The Vaccine Book: Making the Right Decision for Your Child (Sears Parenting Library)
  5. Make an Informed Vaccine Decision for the Health of Your Child: A Parent’s Guide to Childhood Shots
  6. Vaccinations: A Thoughtful Parent’s Guide: How to Make Safe, Sensible Decisions about the Risks, Benefits, and Alternatives
  7. Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children
  8. How to Raise a Healthy Child in Spite of Your Doctor
  9. Vaccine Ingredient Summary (CDC)
  10. Prevnar 13 FDA Package Insert
  11. Pneumovax 23 FDA Package Insert
  12. www.cdc.gov
  13. www.fda.gov
  14. www.immunize.org
  15. drugs.com
  16. Federal Vaccine Compensation Statistics (US Department of Health and Human Services)

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Resources

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Reviewed/Updated: 09/14
Content Created: 07/14

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