Pneumococcal Vaccine – Why is it a Good Idea?

By Jeff Cersonsky, MD, FAAP

“One more shot?  Don’t they get enough needles already?”  I often hear this refrain and I fully sympathize with parents and children.  By the time they reach two, children coming to our office will have received 13 shots.  Then three more before kindergarten and four more in adolescence. Not to mention the yearly influenza vaccines given to those children who need it.

 Though there has been a move to combine more vaccines (such as those covering diphtheria, tetanus, pertussis, and Hemophilus influenza b) and reduce the number of injections, the numbers keep going up.  The reason, of course, is that there are more and more valuable vaccines being approved every year. One such valuable vaccine is that which has been developed against a bacteria known either as “Pneumococcus” or “Streptococcus pneumoniae.”

 This new vaccine has the potential to prevent both serious illness and ear infections.  It will be given at ages two, four, six and 12 to 15 months by injection. Work is underway to combine it with other required vaccines, but this vaccine will initially be given separately, i.e. another four shots.

To discover why this vaccine is so important, we have to go back to the discovery by Sir Alex Fleming in 1928 of penicillin.  When this drug first came out, it was lauded as the wonder drug, able to cure almost all infections.  Indeed, when it first came out, that was largely true.

 However, over the intervening 72 years, many bacteria have acquired resistance to not only penicillin but also the other antibiotics that have been developed since Flemings’ discovery of that valuable mold on his bread.

Pneumococcus has recently become increasingly resistant to penicillin and other antibiotics making it very hard to treat when it infects the blood (sepsis), lungs (pneumonia), brain (meningitis), and ears (otitis media).

 Many parents have experienced the multiple trips to their pediatrician for several antibiotics to find the one to eradicate the infection in their children’s ears.  While this is bothersome, the elderly, immunodeficient, and immunocompromised (e.g. cancer patients) frequently succumb to pneumonia or sepsis from pneumococcus and normal healthy children can die or be brain-damaged from pneumococcal meningitis, the most common kind of bacterial meningitis in children.  (Note that the only reason that pneumococcus is the most common cause of bacterial meningitis is the enormous success of the Hemophilus influenza b vaccine.  HIB used to be the most common cause of bacterial meningitis.)  All these situations are potentially preventable with the use of the new vaccine. The first pneumococcal vaccines were not very protective against all the common strains of pneumococcus. Their use held a place in medicine for the elderly or immuno-compromised, but routine use could not be recommended.  However, the new conjugated vaccine is very effective against the seven strains of pneumococcus that cause disease most frequently.  This effectiveness is independent of whether the pneumococcus is resistant to one or many antibiotics.  So this vaccine comes at an opportune time to help us fight the increasing resistance to antibiotics by pneumococcus.  Safety of the vaccine has been shown in several studies.  Fever occurs in about 30 percent of vaccine recipients, and mild soreness is rarely a concern.

So one more vaccine is indeed necessary and a welcome breakthrough.  I would wholeheartedly recommend that parents get their children immunized against this bacteria as soon as the vaccine is released for general use later this year.