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Pneumococcal rates plunge after widespread vaccination of infants

The number of young children contracting the most common strains of potentially fatal pneumococcal disease has plummeted…

The rate of young children contracting pneumococcal disease has plunged since the introduction of universal vaccination against the disease in 2005. http://www.flickr.com/photos/sanofi-pasteur

The number of young children contracting the most common strains of potentially fatal pneumococcal disease has plummeted 97% since the universal vaccination against this bacterial disease began in 2005, with unvaccinated adults also reaping the benefits of widespread immunisation of infants.

Pneumococcal disease, caused by infection with the bacteria Streptococcus pneumoniae and spread through respiratory droplets, can lead to pneumonia or meningitis, an infection of the membranes around the brain and spinal cord.

It most commonly affects children under the age of two and the elderly, and those who go on to develop meningitis are at risk of permanent brain damage or death.

A new paper, published by Australian Prescriber, said that since a program of universal pneumococcal vaccination for under two-year-olds was introduced in 2005, severe infection (referred to as ‘invasive’ pneumococcal disease) caused by the seven most common strains of pneumococci had plunged by 97%, from 60.9 per 100,000 to 2.1 per 100,000.

Overall, the rate of infection with any of the pneumococcal disease strains fell by 75% among non-indigenous children under two, from 78 per 100,000 in 2002–04 to 19.5 per 100,000 in 2007, the data showed.

“Substantial reductions in invasive disease were also observed in older children and adults, the age groups who did not receive the vaccine,” the paper said.

Co-author of the paper, Dr Clayton Chiu from the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, said the rapidly falling rates of toddlers contracting the disease had benefits for everyone.

“That’s partly because of the herd immunity we get in the community. There’s a second benefit of the program,” he said.

Risks for Indigenous people

Dr Chiu said that Aboriginal people are at higher risk of developing pneumococcal diseases.

“We are seeing a gap of about three times higher rate of pneumococcal infection in indigenous children,” he said.

“Immunisation rates are very good but it’s partly because of the nature of the disease and how it’s transmitted. There is work being done on trying to reduce that gap.”

Non-indigenous people aged 65 and over, as well as indigenous people aged 50 and over, are also advised to get immunised against the disease.

“For younger adults with factors that increase their risk, like being a tobacco smoker or having lung disease, the vaccine is also recommended,” he said.

Jabbed

The vaccination documentary Jabbed, screened on SBS last night, recounted the story of five-year-old Abigale Peterson, who died in her mother’s arms en-route to hospital after contracting pneumococcal disease. She was immunised against other diseases but not against pneumococcal.

The documentary shed light on the science of vaccinations and those who oppose immunisation, but Dr Chiu said there was no evidence to suggest that there had been a recent decrease in pneumococcal vaccination rates in Australia.

David Isaacs, Professor of Pediatric Infectious Diseases at the University of Sydney, said the pneumococcal vaccine program had been “a great success story.”

“Pneumococcal meningitis is a horrible, horrible condition and it’s likely to leave your child brain damaged. When I was a medical student, there were no pneumococcal vaccines and we just hated seeing children with pneumococcal meningitis,” said Professor Isaacs.

“This is a wonderful example of how vaccines really do work and the side effects are minimal.”

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16 Comments sorted by

  1. Mark Amey

    logged in via Facebook

    Can you get rid of Cytomegalovirus, group B strep, and toxoplasmosis, while you're at it?

    Great work, by the way. Children's lives saved, as well as some fairly uncomfortable hospital stays!

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Mark Amey

      I'm looking forward to the times when most toddlers are rotavirus immune, saving GPs, emergency departments, parents and - most of all - the babies from the misery of diarrhoea and dehydration. Anyone who has had to hold their distressed child for the insertion of an IV for fluid replacement will be grateful to know that one major cause of winter diarrhoeal disease can be minimised.

      In my own medical career, I went from learning all about the HiB infection epiglottitis, and watching out for it in sick children (because it could be rapidly fatal) to seeing it virtually wiped out.

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    2. Mark Amey

      logged in via Facebook

      In reply to Sue Ieraci

      Yes, Sue, now I see babies with Noravirus, enterovirus, rotavirus and RSV. Some are quite crook, others just have some very mild symptoms.

      Yes, there's another whole host of horrible stuff we would all like to never see again!

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  2. Blair Donaldson

    logged in via Twitter

    Thanks for posting this. Marvel spun a bit of science, determination and education can do. Now we only need to find a way to inoculate everybody against pseudoscience, education isn't enough.

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  3. Blair Donaldson

    logged in via Twitter

    Edit. I'd kill for an edit key… The previous post was supposed to read, "marvellous what a bit of science…"

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  4. Trevor Kerr

    ISTP

    The history of pneumococcal vaccines in the context of the government "free" list would be an interesting compilation. I guess there was a time when the vaccines were available, just that they were an out-of-pocket expense. I wonder how many medical parents had their bubs vaccinated back then, when pneumococcal sepsis was well known, although uncommon.
    When we knew there was another grandchild on the way, we forked out for the pertussis vaccine, at $75 each. What would we have done if the cost…

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    1. David Arthur

      resistance gnome

      In reply to Trevor Kerr

      "Educated" libertarians?

      Do you mean "ill-educated" libertarians, or perhaps "mis-educated"?

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  5. Mark Amey

    logged in via Facebook

    I was hoping that the anti-vaccinationist would make a comment, but it is quite difficult to argue with these statistics!

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    1. David Arthur

      resistance gnome

      In reply to Mark Amey

      They should have put the terms "MMR" and "autism" in the title, perhaps the autotosh generator down at AVN HQ would have been activated.

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  6. Trevor Kerr

    ISTP

    Abusing anti-vaxers as "ill-educated", or "dumb", is unfair on the children, and unwise. If by "educated" I mean literate, then there is a hint that anti-vaxers are more educated than average (which is a pretty low bar, anyway). That's the observation that pockets of low vaccination rates have been centred around particular types of schools. Parents who seek out independent schools are more likely to have higher educational expectations for their children.
    Antagonism seems a counter-productive strategy…

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    1. Blair Donaldson

      logged in via Twitter

      In reply to Trevor Kerr

      The level of education is irrelevant if people have no regard for honesty, are not capable of critical thinking and objective assessment of various claims.

      The people at the AVN may well be educated but their ideology overrides common sense, honesty and objectivity.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Trevor Kerr

      Trevor - I don't actually administer vaccinations, but I see lots of kids with fevers, and I've seen many over the years with febrile convulsions. The overwhelming majority have a fever from ordinary viral infections.

      According to the literature, treating fever doesn't seem to be very effective because it is the steep rise of temperature that seems to be the issue (in kids who are predisposed to have seizures with fever).

      Have you seen evidence that vigilance can reduce the incidence of febrile convulsions?

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    3. Trevor Kerr

      ISTP

      In reply to Sue Ieraci

      No, Sue, haven't seen evidence. Haven't looked for it, either. :)
      Referring to the Stokes Review, they reported comments from the Central Immunisation Clinic, including
      "Parent information provided at the time of vaccination needed to include monitoring the child’s temperature and administering Parecetamol [sic] if the child’s temperature goes above a certain point, for example 38 degrees."
      Have no idea if that translated into recommendations down the track, but I guess there is a literature review, somewhere.
      I've been impressed by the latest generation of thermometers, the infra-red jobs. Saw them at the local pharmacy for $75, bought one off the 'net for $24. Don't have many kiddies to zap, but use it often to gauge the temperature of yeast starter for my bread.
      I guess my point was that there may be a way to empower parents to be more confident in managing childhood fevers, that would go a way to disarming the 'adverse reaction' bogey.

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    4. Trevor Kerr

      ISTP

      In reply to Trevor Kerr

      This isn't the place, so maybe someone with credentials can write about the science of human behaviour as applied to improving the health of a population. One example could be the (proposed) need, as above, to get more data on fevers after vaccinations. Another could be hand hygiene in hospitals http://www.nytimes.com/2013/05/29/nyregion/hospitals-struggle-to-get-workers-to-wash-their-hands.html and at home.
      Self-monitoring is becoming more popular, eg gadgets to wear during exercise. Are more…

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  7. Sue Ieraci

    Public hospital clinician

    For those readers who have heard the myth that vaccines did not reduce infectious diseases, but better sanitation and nutrition did, this is an interesting example.

    Like Haemophilus influenzae Type B (HiB), which used to cause life-threatening airway blockage in young children (epiglottitis), here is another infection that is being targetted only by immunisation - with no change in living conditons (in our society).

    While it is true that the death rates for many infections was reducing prior to widespread vaccination (due to better medical care as well as better hygiene and nutrition), vaccination targets both death and incidence rates. We know that not everyone with pneumococcal infection dies - far from it - but many suffer and some do die.

    Both HiB and pneumococcal disease are real-life examples of the efficacy of vaccination, over and above any lifestyle/hygiene effects.

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