Possible Disease Issues On Pneumococcal Vaccines (PCV13 and PPSV23)

What causes pneumococcal disease?
Pneumococcal disease is caused by Streptococcus pneumoniae, a bacterium that has more than 90 serotypes. Most serotypes cause disease, but only a few produce the majority of invasive pneumococcal disease. The 10 most common types cause 62% of invasive disease worldwide.
How does pneumococcal disease spread?
The disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%-70% of normal, healthy adults.
How long does it take to show signs of pneumococcal disease after being exposed?
As noted above, many people carry the bacteria in their nose and throat without ever developing invasive disease.
What are the types of invasive pneumococcal disease?
There are two major clinical syndromes of invasive pneumococcal disease: bacteremia, and meningitis. They are both caused by infection with the same bacteria, but have different manifestations.
Pneumococcal pneumonia is the most common disease caused by pneumococcal infection. Pneumococcal pneumonia can occur in combination with bacteremia and/or meningitis, or it can occur alone. Isolated pneumococcal pneumonia is not considered invasive disease but it can be severe. It is estimated that 175,000 cases occur each year in the United States. The incubation period is short (1-3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.
Pneumococcal bacteremia occurs in about 25%–30% of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococcal bacteremia occur each year in the United States. Bacteremia is the most common clinical presentation among children less than two years, accounting for 70% of invasive disease in this group.
Pneumococci cause 50% of all cases of bacterial meningitis in the United States. There are 3,000-6,000 cases of pneumococcal meningitis each year. Symptoms and signs may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children less than one year have the highest rate of pneumococcal meningitis, approximately 10 cases per 100,000 population. The case-fatality rate of pneumococcal meningitis is about 8% among children and 22% among adults.
How serious is pneumococcal disease in the U.S?
Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined.
An estimated 28,000 cases and 2,900 deaths from invasive pneumococcal diseases (IPD-bacteremia and -meningitis) occurred in the United States in 2014. Young children and the elderly (younger than age five years and older than 65) have the highest incidence of serious disease.
Case-fatality rates are highest for pneumococcal meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 15% among adults. Among elderly patients, this rate may be as high as 60%.