Liz Watling

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INVASIVE PNEUMOCOCCAL DISEASE Australia

• Liz Watling
• General Manager

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Overview of disease

• Streptococcus pneumoniae
• 90 different serotypes
• 23 serotypes in adults
• 7-11 serotypes in children

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Disease process

• Meningitis
• Bacteremia
• Pneumonia
• Sinusitis
• Otitis media

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How is it spread?

• Nasopharyngeal carriage
• Incubation time 1-3 days
• Picked up by close contact
• Children in pre school have a carriage rate of
  60, primary school 35, high school 25 and
  adults who have children in their household
  18-29

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(No Transcript)
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Risk factors

• Attending day care or kindergarten
• Inadequate housing
• Recent ear infection
• Asplenia
• Immunocompromised people
• Lung, heart, kidney, liver disease

• Children lt 5 yrs
• Children lt 2 yrs
• gt65 yrs of age
• Aboriginal or Torres
• Strait Islanders
• Children from
• Central Australia
• Poor nutrition

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Meningitis and septicaemia signs symptoms

• Specific
• neck stiffness
• pale floppy body
• high pitched cry
• rash
• cold hands and feet
• photophobia
• altered levels of
• consciousness

• Non specific
• drowsiness
• irritable and distressed
• diarrhoea
• fever
• headache
• aching joints/limbs

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Case reports nationally
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Disease impact
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Pneumococcal vaccines

• Polysaccharide vaccine 23 valent, can only be
  given to children over 2yrs of age
• Conjugated vaccine 7 valent, can be given to
  infants of 6 weeks of age up to 9 yrs of age only
• 4 doses requires at 2,4,6,12-24 months booster
• Costs 410 per course, recommended by ATAGI for
  Childhood Immunisation Programme but no funding
  from Federal Budget

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Pneumococcal disease surveillance

• In 1999 a Pneumococcal Disease in Australia
  workshop was held and findings reported in the
  Communicable Disease Intelligence report in April
  2000
• Reported variance in incidence between indigenous
  and non indigenous population, high incidence in
  CA generally and a diverse range of serotypes as
  well as increasing levels of antibiotic resistance

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Pneumococcal disease surveillance

• In Dec 2000, 7V conjugate vaccine was approved by
  TGA
• The IPD working party recommended a publicly
  funded immunisation programme for children at
  high risk, lt5yrs and indigenous children lt2 yrs.
• Immunisation programme commenced in CA in July
  2001 and implemented in all states and
  territories over the next 6 months

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Disease notification

• At the time of the first workshop, IPD was only
  notifiable in NT (since 1995) and QLD (since
  1996)
• Jan 2001, IPD became notifiable
• A second national workshop was held in November
  2002 which evaluated the impact of enhanced
  surveillance and the 7-valent vaccination
  programme

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Pneumococcal cases 2001
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Reported IPD cases 2001 - 2003
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NSW disease surveillance

• 68 of cases of IPD are in the over 65s
• Bacteremia is the most common illness in children
  and pneumonia in adults
• Meningitis present in 3 of adults and 7 in
  children
• 9 cases were in Indigenous or Torres Straight
  Islander origin
• 90 of serotypes isolated are covered by the 7
  valent conjugate vaccine

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NT disease surveillance

• 78 of IPD is reported in the indigenous
  population
• Indigenous people make up 27 of the population
• 68 of cases are pneumonia(78 in 2001) in the
  gt15yr age group this increases to 83
• 2 cases of meningitis reported in 15-49 yrs age
  group
• 326 cases IPD per 100,000
• Too early to assess serotype coverage by the
  conjugate vaccine

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WA disease surveillance

• 159 cases reported 11 per 100,000
• Children under 5 represent 35 cases
• Adults over 65 represent 21 cases
• 3 fold higher incidence in the Indigenous
  population
• 78 of serotypes isolated from children under 2
  years were covered by the 7 valent conjugate
  vaccine
• 86 of serotypes isolated where covered by the
  23 valent polysaccharide vaccine

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Victorian disease surveillance

• 449 cases notified, lt 1 were in the Indigenous
  population
• Infants lt2 yrs, 68 cases per 100,000
• 89 of serotypes isolated covered by 7 valent
  vaccine in children under 2yrs age
• Over 2yrs age, 98 of isolated serotypes covered
  by the 23 valent vaccine
• Polysaccharide vaccine has been publicly funded
  since 1998 for gt65 yr olds

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Tasmanian disease surveillance

• 52 cases reported in 2002, 12 of the 15 cases for
  the 0-4 yrs age groups were under 2 yrs
• 8 of the 52 cases died 15 fatality rate
• target indigenous population - adults over 50
  years, persons over 15 and anyone with risk
  factors will be vaccinated

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SA disease surveillance

• IPD notifiable in SA since 2002
• 129 cases reported, 78 are serotyped
• 41 under 5 yrs, 28 under 2 yrs, 24 gt65 yrs
• In the lt5yrs, 75 had bacteremia, 11.3 had
  pneumonia, 7.5 had meningitis
• gt65yrs, 80 has pneumonia
• 7 cases reported in vaccinated individuals

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QLD disease surveillance

• 351 cases in 2002
• Childrenlt5 yr 38, lt2yr 26, gt50 yr 32
• No indigenous state recorded for 56 cases
• 59 cases lt5yrs old had bacteremia, 32 had
  pneumonia, 1.6 had meningitis
• Coverage rate for vaccination 69 in North, 45
  in central and 36 in south
• Vaccine programme for indigenous adults gt50
  started in 1995, coverage is 53 in 2002

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Summary and conclusion

• Enhanced surveillance in NT must continue due to
  high incidence and high serotype diversity a
  23v booster vaccine is now recommended, this is
  unique internationally
• Recommendations for 23v vaccine for all gt65s and
  7v vaccine for all childrenlt2 to be publicly
  funded
• Improving identification of Aboriginal and Torres
  Strait Islander children is important

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Meningitis Foundation PO BOX 654 Spit
Junction NSW 2088 www.meningitis-trust.org www.i
nmedonline.com www.meningitis-learning.org