Battling Invasive Pneumococcal Disease
Jaron Chor, a 3-year-old preschooler, was diagnosed with Invasive Pneumococcal Disease (IPD) in January 2011 caused by the Streptococcus pneumoniae bacteria, which infected his lungs and bloodstream. His mother, 31-year-old IT consultant Doreen Lim, shares her experience.
Jaron Chor, 3 years old, started experiencing cough and cold symptoms in early January. On 17 January, Jaron’s grandmother, who was his caregiver during the day, alerted Doreen about his deteriorating condition.
Doreen said, “At first I thought it was due to the change in environment, as he had just started preschool in January. He usually gets a cold every few months, but doctors told me this was normal for toddlers due to their immune systems being weaker.
“I didn’t think it was that serious.”
The concerned mother brought Jaron to consult a general practitioner, who prescribed medication including antibiotics. Soon after, Jaron developed a fever. Doreen further consulted the doctor – three times in two weeks – before Jaron was referred to a specialist.
Jaron was referred to Dr. Malathi, a consultant neonatologist and paediatrician at Parkway East Hospital. After a series of examinations, he was found to be infected with 19A, a strain of the S. pneumoniae bacteria which causes IPD.
Local studies have found that the prevalence of bacteria strain 19A in paediatric cases has increased from just three per cent1 to 12 percent2 since 1997.
Jaron was hospitalised at Parkway East hospital on the same day as his consultation with Dr. Malathi, where he was administered antibiotics through an IV drip and oral medication. On the eve of Chinese New Year, the family was fraught with anxiety as Jaron was sent for surgery to remove a build up of pus in his right lung.
“Jaron has always been an active boy. Once he got diagnosed with IPD, the activeness slowly went away. He was crying all the time in the hospital, and always wanted us to carry him around,” said Doreen.
Jaron was previously vaccinated with PCV-7, which did not cover the emerging serotype 19A.
Power Up Against Pneumococcal Disease
“Doreen did the right thing by consulting a GP first before going to a specialist. Unfortunately, the strain of bacteria which infected Jaron was very antibiotic resistant, and the medication prescribed to Jaron did not work,” said Dr. Malathi.
According to a World Health Organization (WHO) 2002 estimate, pneumococcal disease is the leading cause of vaccine-preventable death worldwide in children under five. Pneumococcal disease describes a group of complex illnesses, all caused by the bacterium S. pneumoniae. IPD can rapidly develop into serious health complications including bacteremic pneumonia, meningitis (inflammation of the coverings of the brain), sepsis and bacteremia (bloodstream infection).
PCV-13 succeeds the current PCV-7 under the National Childhood Immunisation Programme (NCIP), and it covers six additional pneumococcal bacteria strains including 3, 6A and 19A, which are associated with complicated pneumonia, and pneumonia is the most common disease caused by pneumococcal bacteria. Pneumonia kills more children than AIDS, malaria and measles combined3.
Local studies on IPD have found that:
The older vaccine PCV-7, which protects against seven bacteria strains, provides 71.3 per cent coverage against IPD in children under the age of five2.
The inclusions of 19A and 6A pneumococcal strains in the PCV-13 vaccine will increase protection against IPD for children up to five years of age to 96.2 per cent2.
The new PCV-13 vaccine protects against the emerging bacteria strain 19A, which can lead to serious complications in children.
Importance Of Vaccination
Jaron finally recovered on 23 March, when Dr. Malathi declared Jaron completely cured after an X-ray scan which showed his lungs were clear.
Looking back, Doreen is glad that she protected Jaron with all the vaccines available, including the vaccine for pneumococcal disease. She feels that if this was not done, Jaron might have been in a worse state.
“I made sure that my son had all the relevant vaccinations, even those that were not compulsory. I wanted to ensure my child was well protected. Unfortunately, Jaron was infected by a strain of bacteria which was not covered by the previous vaccine.
“However, I do not regret having him vaccinated previously. Vaccination is a must. It will give you peace of mind to know that at least your children are protected. Even after this experience, I will still send Jaron to get the updated vaccine to ensure that he has the maximum protection against IPD,” said Doreen.
Dr. Malathi said, “Parents tend to wait until their child is two years old before getting the vaccine. I strongly recommend that parents send their children under the age of one for the pneumococcal vaccination, as that is the age most children are susceptible to the disease. These newly emerging strains, such as 19A, can lead to severe illnesses. Having protection against these strains can allow parents and their children to avoid lengthy treatments.
“The most important thing for parents is to ensure the best protection is provided for their children by vaccinating their children against these infections.”
Dr. Malathi also added that parents of children who have already received PCV-7 should consider sending their child to receive the updated PCV-13, especially those in high-risk groups, such as children with underlying medical conditions such as sickle cell disease, ear implants or absent spleen. This should be done in consultation with their doctor.
1 Chong, C Y et al., Invasive pneumococcal disease in Singapore children, Vaccine 26 2008, 3427-3431.
2 Tee, N et al., Distribution of vaccine stereotypes among invasive streptococcus pneumoniae isolates in KK Hospital from 2001-2010. Singapore:2010.
3 2UNICEF/WHO. Pneumonia the Forgotten Killer of Children. Geneva:2006.