Every year, numerous deaths are recorded worldwide as a result of pneumococcal infections. More than half of those affected are children under the age of five. Children of this age are particularly at risk because their immune systems are not yet fully developed. However, pneumococcal infections are also often fatal for people over 60 years of age and for people with chronic diseases. The most effective protection against pneumococcal infection is vaccination.
What is pneumococcus?
Pneumococci are bacteria that belong to the large group of cocci (spherical bacteria). Depending on the type of connection, different subgroups are distinguished: chain-shaped cocci are called streptococci, while a cluster of four cocci is called tetracocci. Pneumococci belong to the subgroup of diplococci – their bacteria are stored in pairs. Pneumococci can be the trigger of severe infections. Diseases caused by pneumococci include pneumonia, meningitis, otitis media, sinusitis, and keratitis. If the bacteria enter the bloodstream, blood poisoning (sepsis) can also occur. In total, there are more than 90 different pneumococcal species – although 23 species are responsible for more than 90 percent of illnesses.
Typical symptoms of pneumococcal disease
Because pneumococci can cause many different diseases, there are no typical symptoms of pneumococcal disease. However, many pneumococcal infections are accompanied by high fever and chills. Below are the most common diseases caused by pneumococcus and their typical symptoms.
- Pneumonia: pneumonia usually develops from an upper respiratory tract infection. It is accompanied by symptoms such as high fever, cough and purulent sputum, and chills. In older people, however, the typical symptoms such as fever are sometimes absent.
- Meningitis: Meningitis is also mostly preceded by a disease of the upper respiratory tract. Typical symptoms are headache, neck stiffness, as well as fever, nausea and loss of consciousness up to unconsciousness. In addition, those affected are often sensitive to light or sound. If a characteristic rash appears at the same time, this indicates that the infection was caused by meningococci and not pneumococci.
- Middle ear infection: Middle ear infections cause severe, pulsating ear pain, as well as fever, nausea and vomiting. Sufferers often also report hearing loss. In the case of a middle ear infection caused by bacteria such as pneumococci, it can also come to a rupture of the eardrum – however, this can usually be prevented by the timely administration of antibiotics.
- Sinusitis: typical symptoms of sinusitis are fever, headache, as well as suppurated sinuses. In most cases, however, a sinusitis is not caused by bacteria, but by viruses.
- Corneal inflammation: In a corneal inflammation of the eye, there is a redness of the eye, a foreign body sensation, a deterioration of vision, as well as severe pain.
- Heart muscle inflammation: a heart muscle inflammation is usually manifested by symptoms such as general fatigue, headache and dizziness, as well as nausea and loss of appetite. In addition, it may possibly come to fever, cardiac arrhythmia, shortness of breath and a feeling of tightness in the chest.
- Blood poisoning: typical symptoms of blood poisoning include high fever, which often occurs in episodes, a rapid pulse, accelerated breathing, confusion, and very low blood pressure. If pneumococcal blood poisoning is not treated promptly, it can lead to life-threatening septic shock.
How to get infected with pneumococcus.
In most cases, an infection with pneumococcus is an endogenous infection. This means that the pathogens do not come from outside, but from the body’s own flora. Endogenous infections occur primarily in the case of a weakened immune system. The bacteria are usually transmitted by droplet infection and then preferentially colonize the nasopharynx.When the body is colonized with pneumococci, there are normally no symptoms – this only happens when the immune system is weakened and the bacterium spreads. Smokers have a particularly high risk of pneumococcal infection. Because tobacco smoke ruptures the top cell layer of the respiratory tract, bacteria can enter the nasopharynx more easily. In addition, smokers have impaired self-cleaning of the airways because the work of the cilia is impeded by tobacco smoke.
Treatment of pneumococcal infection
Pneumococcal infections are treated with antibiotics – preferably penicillin. An exception is meningitis caused by pneumococci, which is often treated with cephalosporins. If the pneumococci are resistant to penicillin, rifampicin or vancomycin can be used as an alternative. It should be noted, however, that pneumococcal strains that are resistant to antibiotics continue to increase. Therefore, prevention of pneumococcal disease by vaccination is becoming increasingly important.
Pneumococcal Vaccination
Especially for risk groups such as people over 60 years, vaccination is the most effective protection against pneumococcal disease. For babies and young children, a separate active ingredient has been available since 2001 that protects against seven pneumococcal strains that are particularly dangerous for babies and young children. The vaccine is a dead vaccine that consists of parts of the bacteria’s envelope. However, these parts are not capable of causing disease. After vaccination, the body forms antibodies against the vaccine. If one later becomes infected with pneumococcus, the antibodies fight the bacteria and thus prevent the outbreak of disease. Vaccine protection begins about three weeks after vaccination. Pneumococcal vaccination is usually well tolerated. Nevertheless, only a small proportion of the groups of people at risk are vaccinated: about seven percent of them have effective vaccination protection. Health insurance companies cover the costs of pneumococcal vaccination – as long as the vaccination is recommended for the respective group of people. Vaccination against pneumococcus is available throughout the year.
For whom is pneumococcal vaccination useful?
The Standing Committee on Vaccination (STIKO) recommends pneumococcal vaccination for the following groups of people:
- Persons aged 60 years and older
- Babies and toddlers between two months and two years old
- People with chronic diseases or immunodeficiencies such as diabetes, asthma, AIDS, COPD, etc.
In young and healthy people, on the other hand, vaccination against pneumococci is usually not necessary, because the pneumococci are fought by their immune system and outbreaks of disease in them usually pass without complications. In babies, pneumococcal vaccination is usually divided into four injections, given in the second, third and fourth months of life and between the 11th and 14th months. As babies get older, the number of doses of vaccine needed decreases.
Pneumococcal and coronavirus: what to watch for?
As part of the coronavirus pandemic, the German Ministry of Health recommends that at-risk groups receive preventive pneumococcal vaccination. While this does not protect against infection with the SARS-CoV-2 virus or the associated respiratory disease COVID-19, vaccination may still be useful to prevent simultaneous or short-lived infection with coronavirus and pneumococcus. This is because a combination of both diseases would expose the body and lung tissue to a double burden at once, which can increase the risk of a severe course. The STIKO currently recommends vaccinating especially those groups of people who are particularly at risk. These include seniors over 70 years of age, babies and young children, and the aforementioned individuals with pre-existing conditions.
Effectiveness of vaccination in babies controversial
Especially in babies and young children, however, it should be noted that the effectiveness of vaccination in them is controversial. For example, reports from other countries indicate that there was an increase in illnesses caused by a type of pneumococcus not included in the vaccine after vaccination. Long-term studies of pneumococcal vaccination in young children have yet to be conducted.
How many vaccinations are needed?
In adults, one vaccination is already sufficient for reliable protection.However, with certain pre-existing conditions, the pneumococcal vaccine should be boostered every five to six years to provide continued protection against disease. These diseases include:
- Congenital or acquired immunodeficiencies with residual T and/or B cell function.
- Chronic kidney disease, nephrotic syndrome
Pneumococcal disease survived once does not provide protection against further disease.
Possible side effects of pneumococcal vaccination.
During pneumococcal vaccination, the vaccine is injected into the upper arm. Around the injection site, mild pain may occur after vaccination, as well as redness of the skin. Normally, however, the symptoms disappear after one to two days. A general feeling of fatigue, gastrointestinal complaints or a slight increase in temperature may also occur. Other side effects are not usually to be expected. Babies and young children are also usually unlikely to experience side effects. However, in rare cases, loss of appetite, discomfort, fever and drowsiness may occur after vaccination. Take the test now to see if pneumococcal vaccination makes sense for you.
