SingaporeMotherhood | Baby & Toddler
September 2024
A Parent’s Guide to Pneumococcal Disease & Vaccinations for Infants & Children
Every year in Singapore, approximately 10 in 100,000 infants and children under the age of five become very sick from severe pneumococcal disease. They require intensive treatment in the hospital for pneumonia and other serious infections. Sadly, three per cent of them eventually succumb to the disease. Thankfully, pneumococcal conjugate vaccines, such as the latest Prevnar 20 vaccine, are making a difference.
According to consultant paediatrician Dr Mohana Rajakulendran, many more children become unwell with pneumococcus, even if they display milder symptoms. Dr Mohana, who helms general paediatrics at Petite Practice and has a special interest in paediatric allergy and immunology, explains how pneumococcal disease affects children and what protection various vaccine options offer.
(See also: Gaucher Disease: Rare, but Dangerous, especially for Infants and Children)
1. What is pneumococcal disease?
Pneumococcal disease is an illness caused by the bacteria Streptococcus pneumoniae (or pneumococcus). There are approximately 90 different types of this bacteria circulating in our environment. However, a handful of serotypes are responsible for most of the invasive pneumococcal disease in infants and children.
Pneumococcal bacteria spreads through respiratory secretions from close contact with an infected person. It can cause pneumonia (infection in the lungs), meningitis (infection of the outer coverings of the brain), middle ear infections, or even bacteraemia (infection that spreads into the bloodstream).
2. What symptoms should parents look out for?
The early symptoms of pneumococcal disease are very similar to the symptoms of common childhood infections like the flu. These include fever, cough, runny nose, earaches, and irritability.
But as pneumococcal disease progresses, these symptoms may become more severe. Children may appear unwell and exhibit breathlessness, drowsiness, and increased lethargy. They may have poor appetite, chest pain, and persistently high fevers. Parents who suspect that their child may have pneumococcal disease should seek immediate medical attention.
3. How is pneumococcal disease diagnosed and treated?
The doctors will run tests on your child’s respiratory secretions, blood, or spinal fluid. It usually takes 48 to 72 hours to perform a bacterial culture to confirm a diagnosis of pneumococcal disease.
Treatment involves antibiotics that target the bacteria. In very sick children, the antibiotics would need to be given intravenously in the hospital. Some cases may even require prolonged treatment duration of up to three weeks in hospital.
(See also: Does your Child have a Medical Emergency? Bring them to this Paediatric Urgent Care Centre)
4. Who is most vulnerable to pneumococcal infections?
Pneumococcal bacteria can infect anyone of any age. However, children younger than five years old are at increased risk. Since pneumococcal disease can be transmitted by coughing and sneezing, babies and children attending childcare tend to be more susceptible.
It also occurs more commonly in seniors 65 years and older, as well as people with weakened immune systems. For example, children who are on immunosuppressants, children with chronic heart and lung conditions, and those with an absent or removed spleen.
5. How can I best protect my child?
Thankfully, pneumococcal disease is a vaccine-preventable illness. Hence, infants and children should receive their vaccinations promptly to protect them from an early age.
Vaccinations are also available for adults and recommended for the elderly above the age of 65. Other household members can also get vaccinated to reduce the risk of transmitting the disease to infants and children.
6. When should my child get vaccinated?
The earliest age for vaccination is from six weeks old. The Prevnar 13 (PCV13) vaccine is currently available for free at local polyclinics and GPs under the National Childhood Immunisation Scheme. An infant gets two doses, at four months and six months of age, followed by a booster at 12 months.
Singapore’s Health Sciences Authority recently extended the use of Prevnar 20 (PCV20) to children from six weeks, the first in Southeast Asia to do so. It confers protection against seven additional bacterial strains, on top of those in PCV13. Those choosing PCV20 vaccinations should receive them at two months, four months, six months, and a booster at 12 months.
(See also: Why Childhood Vaccinations Matter – and is there a Dengue Vaccine?)
7. Can my child still catch pneumococcal disease after vaccination?
Approximately eight to nine per cent of children who are vaccinated for pneumococcus may still fall ill with the disease. However, pneumococcal vaccinations are highly effective in preventing severe pneumococcal disease.
Factors such as earlier vaccination from six weeks of age; considering a 3 + 1 dose regimen instead of a 2 + 1 regimen, with an additional dose given below the age of one year; and encouraging pneumococcal vaccinations among adults and elderly in the household can further help to mitigate the spread of pneumococcal disease.
8. Is Prevnar 20 replacing Prevnar 13?
For the moment, the National Childhood Immunisation Programme will continue administering the PCV13 vaccine. However, Prevnar 20 is approved for use in private practice in Singapore. Consult your child’s paediatrician or GP clinic if you wish to opt for Prevnar 20.
If your child was already vaccinated with a two or three dose series of PCV13 under the age of 12 months, you may consider getting an additional Prevnar 20 booster dose after 12 months for extra protection.
9. But… is the new pneumococcal vaccine safe?
Studies show that Prevnar 20 is not only safe, but that it does not cause any more side effects than Prevnar 13, which Singapore has used in routine infant vaccinations since 2009. Prevnar 20 has also been in use in national vaccination programmes in the USA and Canada since June 2023.
Any side effects are usually mild and resolve on their own in a few days. These commonly include injection site redness or swelling, fever or chills, headaches or muscle aches, and fussiness or tiredness in children. You can give your child paracetamol for fever or pain, and sponge them with lukewarm water to help them feel better.
(See also: How to Prevent 3 Common Illnesses that Children often get in School)
Featured image: lifeforstock on Freepik
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