Pneumococci (Streptococcus pneumoniae) are bacteria that can cause serious illnesses. In Germany, around 5,000 people die of pneumococcal infection every year. How do you recognize pneumococci, what diseases are they responsible for and when does vaccination make sense?
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Pneumococci (Streptococcus pneumoniae) are common lactic acid bacteria of the genus Streptococcus, which colonize the mucous membrane of the nasopharynx and can trigger many different serious diseases (e.g. pneumonia or meningitis). The pathogens are protected by a mucous membrane made from multiple sugars (polysaccharides), which makes them very resistant.
At a glance:
The main vaccinations
Frequency of pneumococci
According to estimates, more than 5,000 people die from pneumococcal infection each year in Germany alone. The World Health Organization (WHO) estimates that around four million deaths per year worldwide; about a quarter of them are children.
To date, over 90 different pneumococcal strains have been identified, of which 23 to 90 percent of all pneumococcal-induced diseases are responsible according to current research. People with a weak or (not yet) fully developed immune system are particularly at risk. Even people without a spleen and with chronic diseases, especially the respiratory tract, for example asthma, have an increased risk of a life-threatening course of pneumococcal infection.
Pneumococcal diseases are particularly frequently registered in children between six and twelve months and between the first and fourth birthday. The Standing Vaccination Committee (STIKO) recommends pneumococcal vaccination for infants, toddlers, the elderly over the age of 60 or patients with chronic illnesses.
What diseases do pneumococci lead to?
A distinction is made between invasive (invading) and non-invasive pneumococcal diseases. Invasive forms in which pneumococci can be detected in body fluids such as blood are:
Non-invasive (locally limited) pneumococcal diseases, which can, however, develop into an invasive form, are:
Pneumococci cause about a fifth of all purulent meningitis in babies and toddlers. The younger a child is, the more dangerous the course of the disease. In Germany, about 300 young children develop pneumococcal meningitis every year. For about ten percent of them, the infection is fatal, with another 20 percent leaving long-term damage such as deafness or epilepsy.
Adults over 60 years of age most often develop pneumonia due to the spread of pneumococci in the body. The bacteria are estimated to trigger 80 percent of all pneumonia in the elderly. On average, about one in ten people die from the consequences. With increasing age and with a chronic pre-existing disease, the risk of death from pneumonia rises to around 30 percent.
Causes: How can an infection occur?
Like many other pathogens, pneumococci are primarily transmitted from person to person through droplet infection (coughing, sneezing, speaking or breathing). Doctors believe that around 40 percent of all healthy children and up to 10 percent of all healthy adults harbor the bacterium in their nasopharynx mucosa without showing symptoms of a disease. In this case, you can still infect other people with pneumococci. Symptoms only appear when the bacteria in the mucous membrane can multiply uncontrollably.
There is an increased risk of infection in the winter months, primarily in poorly ventilated interiors and when many people come together in one place, such as for rush hour in public transport.
The incubation period of pneumococci is difficult to determine because the disease can break out long after contact with the pathogens. Symptoms often only appear when the immune system of an infected person is significantly weakened, for example by the flu, another viral infection or by taking certain medications.
What are the symptoms of pneumococcal infection?
Since pneumococci cause very different clinical pictures, there are a variety of symptoms that can indicate an infection with pneumococci. Common to almost all diseases typical of pneumococci is that they are associated with a high fever and start relatively suddenly.
sepsis: high fever, rapid breathing, high heart rate, low blood pressure, kidney failure with unusually low urine output
Meningitis: acute, high fever, sometimes with chills, severe headache, typical neck stiffness, difficulty breathing, sensitivity to touch and light
Otitis media (mainly in children): fever, severe ear pain, possibly other symptoms such as headache and dizziness
Sinusitis: partial fever, throbbing pain in the sinuses (especially when moving the head downwards)
Community acquired pneumonia (CAP): Abrupt onset of illness with high fever, chills, severe feeling of illness, often shortness of breath or chest pain, heavy, painful breathing. Sometimes pneumonia is also preceded by cold symptoms. In the elderly, cough and fever intensity are often weakened; in young children, paleness, poor drinking and an accelerated pulse are also frequently observed.
How does the doctor diagnose pneumococci?
The general physical condition of the person affected, their blood values with inflammation markers and (if pneumococcal pneumonia is suspected) an x-ray of the chest organs (thorax) can give the treating doctor first indications of the present disease and its stage.
Pneumococcal infections can be fatal. Rapid bacterial detection is important to ensure targeted treatment. Rapid laboratory tests today can detect pneumococci in the urine (for example, in the case of bacteremia or pneumonia) or (in the case of meningitis) in the cerebral and spinal fluid (cerebrospinal fluid) within about two hours.
Since rapid tests do not guarantee 100 percent correct results – for example, because the pneumococcal concentration can still be below the detection limit of the test – they only provide initial indications. At the same time, a microscopic examination is usually carried out and a cerebrospinal fluid or blood culture is set up in the laboratory in order to reliably detect or rule out infection with pneumococci. Here, of course, it takes longer to get a result.
What are the treatment options for an infection?
Since pneumococci are bacteria, antibiotics are usually given in the event of a symptomatic infection. The preferred preparation is penicillin.
As an alternative – for example, for penicillin allergy, intolerance or inactivity, the active ingredient erythromycin and antibiotics from the group of cephalosporins of the third generation or fluoroquinolones (moxifloxacin or levofloxacin) can also be considered, with the latter recently being restricted due to critical side effects available.
It is problematic that bacteria become increasingly resistant to antibiotics due to the too frequent and untargeted use of antibiotics. Doctors assume that between one and five percent of all pneumococcal strains no longer react to antibiotics, and the trend is rising. The resistance rate is already significantly higher in other countries.
How does an pneumococcal infection progress?
There are very different forms and types of pneumococcal infections. In principle, a corresponding illness can lead to serious complications such as blood poisoning. Pneumococcal meningitis, for example, can be so acute and rapid that even a rapidly initiated antibiotic therapy can no longer work in time. The course and prognosis depend, among other things, on the general condition and age of those affected.
People who have no or no functional spleen can be at risk of life particularly quickly due to pneumococcal infection because the organ plays an important role in the defense against invasive infections caused by encapsulated pathogens.
How can you prevent pneumococcal infection?
As with any other infection, it is possible to prevent pneumococcal infection and its uncontrolled multiplication in the organism by following general hygiene and health measures:
avoid large crowds (especially during the flu season)
avoid getting too close to sick people
wash hands regularly
Do not touch public contact surfaces (such as handles, traffic light buttons, light switches) with your fingers or hands
touch each other as little as possible
do good oral, tooth and interdental care to limit the colonization of dangerous bacteria in the throat
no smoking (a damaged lung mucous membrane favors pneumococcal pneumonia)
balanced and nutritious nutrition
regularly take a walk in the fresh air and play sports (also helps to keep the lungs healthy)
get vaccinated against flu: Pneumococcal infections often occur when the body is already weakened by a viral infection. In addition, the organism recovers significantly worse with a double infection.
Wash hands: Best protection against bacteria and viruses
Who is recommended for pneumococcal vaccination?
Pneumococcal vaccination is the only targeted preventive measure against pneumococcal infection. The Standing Vaccination Committee (STIKO) recommends this for:
Infants from two months old
all over 60 year olds
Patients with special underlying diseases, such as diabetes mellitus, rheumatism or chronic lung diseases
People who have an immune deficiency or are receiving treatment with immunosuppressive drugs (for example, after an organ transplant)
Anyone who has already had a pneumococcal infection should also get advice on whether vaccination makes sense. For all risk groups listed, the statutory health insurance companies assume the full costs of the vaccination.
Various dead vaccines are available for immunization, which are divided into polysaccharide and conjugate preparations: Polysaccharide vaccines consist of the inactive components of the bacterial envelope. In the conjugate vaccines, the polysaccharides are still bound to a protein molecule (carrier protein), so that they are also effective in weakened or (not yet) fully developed immune systems.
The Konjungat vaccine (PCV13) protects against 13, the polysaccharide vaccine (PPSV23) against 23 pneumococcal strains.
Pneumococcal vaccination scarce due to COVID-19
In March 2020, there is currently a shortage of pneumococcal vaccines, since infection with the novel coronavirus SARS-CoV-2 for certain groups of people is at increased risk of developing a serious illness and can become life-threatening. Pneumococcal vaccination was therefore again recommended for the risk groups. Currently, the few doses of vaccine available are available to selected people from these groups.
How often are children vaccinated against pneumococci?
Matured babies up to the age of 12 months should receive a total of three vaccine doses at the age of two, four and eleven to 14 months. There must be a two-month interval between the first and second vaccinations, and a break of at least six months is recommended between the second and third vaccinations. Children who are older than one year at the first immunization receive only two vaccine doses at least eight weeks apart.
Babies clearly born prematurely (before the end of the 37th week of pregnancy) receive four vaccine doses at the age of two, three, four and eleven to 14 months. Because the pneumococcal vaccine is a dead vaccine, the immunization can be given at the same time as other vaccinations recommended for the appropriate age.
How often are over 60s and risk groups vaccinated against pneumococci?
STIKO recommends a one-time pneumococcal vaccination with a 23-valent polysaccharide vaccine (as of 01/2019) to healthy people aged 60 and over who do not belong to any risk group. For patients from two years of age with a chronic illness such as diabetes mellitus, bronchial asthma, chronic obstructive pulmonary disease (COPD) or HIV infection or a weakened immune system for another reason or known risk factors for pneumococcal meningitis (for example after the implantation of a hearing prosthesis in the cochlear implant (cochlear implant) is recommended as the first vaccination of the 13-valent conjugate vaccine, followed later by a vaccination with the 23-valent polysaccharide vaccine.
STIKO recommends that pneumococcal vaccination be repeated after at least six years only in high-risk patients. There are practically no study results for healthy adults to decide this question: The STIKO recommendation only refers to so-called immunogenicity data, i.e. data on the presence of protective antibodies. However, it is known today that the detection of antibodies after vaccination cannot necessarily be equated with effectiveness.
What are the side effects of pneumococcal vaccination?
The side effects of pneumococcal vaccination are divided into localized reactions (such as reddening and swelling around the injection site) and general signs of illness (e.g. fever, headache, fatigue). In young children, irritability and sleepiness are often noted after vaccination.
As a rule, all symptoms subside quickly. In general, all pneumococcal vaccines available in Germany are considered to be well tolerated. The risk of allergic side effects increases with repeated vaccinations.
Why is the STIKO vaccination recommendation for pneumococci repeatedly criticized?
No vaccine protects against all pneumococcal strains. However, many doctors are convinced that immunization can reduce the risk of serious pneumococcal infection and therefore generally recommend vaccination for infants, the elderly and other risk groups.
Due to a very ambiguous study situation, the question of effectiveness cannot be answered generally. For example, it is unclear whether the polysaccharide vaccine has a significant effect on acquired pneumonia, which is particularly common in older people. Scientific studies come to different results here.
In a position paper, the German Society for Geriatrics (DGG) and the German Society for Pneumology and Respiratory Medicine (DGP) therefore contradict the recommendation of the STIKO and advocate the administration of the Konjungat vaccine to healthy vaccineers over the age of 60: this protects more effectively against acquired pneumonia as the polysaccharide variant. In its vaccination recommendation, "STIKO places too much emphasis on the rate of invasive infections caused by pneumococci," the paper says. Instead, it must be taken into account that pneumococcal causes 80 percent of all pneumonia that are particularly dangerous for older people.