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Vaccine against Streptococcus Pneumoniae

02 June 2020 Bonitas Medical Fund

The World Health Organization (WHO) stresses that although pneumonia vaccines are not effective against COVID -19, vaccinations against respiratory illnesses are highly recommended to protect your health and lowering the risk of becoming infected with any respiratory disease during this time.

WHO also states that globally more children, under the age of 5, die from pneumonia than malaria, AIDS and TB combined. In SA, flu and pneumonia rank second – after intestinal infectious disease – as the leading cause of children under 5, which doesn’t make sense when vaccines are available in both the private and public healthcare sector for children and adults.

Bonitas Medical Fund recommends having a flu vaccine, it is the first line of defence when it comes to protecting yourself. For those who are at risk of pneumonia, a second vaccination against Streptococcus pneumouniae is also recommended.

What is pneumonia?
Pneumonia is inflammation of the lungs caused by an infection. Many organisms can cause lower respiratory tract infections or pneumonia. Mixed infections with multiple viral and/or bacterial infections are common.

Streptococcus pneumoniae is a bacterium known to be a common cause of bacterial pneumonia in South Africa. Pneumococcal infection may cause mild disease such as a middle ear infection or more complicated infections like pneumonia or an infection of the blood called bacteraemia.

In South Africa, individuals at risk of more severe or invasive pneumococcal disease include the elderly, HIV-infected individuals and individuals with chronic medical conditions (e.g. chronic lung disease). Severe disease may require hospitalisation for treatment and may result in death.

These streptococcal bacteria can spread from the nose, throat and ears of infected individuals.

Pneumococcal vaccine
Two pneumococcal vaccines are registered for use in adults (over 18 years of age) in South Africa: The 23-valent polysaccharide vaccine (PPV23) and the 13-valent pneumococcal conjugate vaccine (PCV13).

PCV13 is also included in the South African Extended Programme of Immunisation (EPI) for childhood vaccines and is given to infants at 6 weeks, 14 weeks and 9 months.

These vaccines aim to provide immunity against the types of Streptococcus pneumoniae that are most commonly associated with severe disease.

According to local clinical guidelines from the South African Thoracic Society and Federation of Infectious Diseases Societies of Southern Africa, since the introduction of the PCV13 into the EPI there has been a reduction in the number of cases of pneumococcal pneumonia caused by these types of Streptococcus pneumoniae in South Africa.

Who should have the vaccination?
Infants routinely receive pneumococcal conjugate vaccines (PCV13) as part of the EPI for childhood disease*.

The pneumococcal polysaccharide vaccine (PPSV23) is recommended for individuals who are at risk of developing severe disease*:
- individuals 65 years or older
- anyone with chronic medical conditions affecting the lung, heart or kidneys
- HIV-infected individuals
- Those with a compromised immune system due to other medical conditions (e.g. individuals with cancer)

Pneumococcal vaccination during the COVID-19 pandemic
The pneumococcal vaccination is not active against the novel coronavirus and will not protect you from becoming infected; it will offer protection against Streptococcus pneumoniae.

However, the National Institute of Communicable Disease (NICD) states the following, ‘any intervention to lower the risk of becoming infected with any respiratory disease at this time may be of benefit. Lowering the risk of acquiring a respiratory infection, will allow for less visits to clinics and less hospital admissions, thus decreasing the burden on the health infrastructure at this time and lowering ones’ exposure to acquiring COVID-19 in the hospitals/clinics.’

Although pneumococcal vaccination does not protect against COVID-19 mild or severe disease or COVID-19 pneumonia, it could play a role in preventing secondary pneumococcal pneumonia infections in those with underlying conditions and the elderly.

When to get vaccinated?
If you think you may be within one of the groups at risk of severe pneumococcal disease, contact your pharmacy to check whether stock of the vaccine is available and schedule an appointment to be vaccinated.

Most medical aid plans offer a free flu vaccine annually to members as well as a once off –pneumococcal vaccine for those over the age of 65. As part of the preventative care benefit this is taken from risk cover so it doesn’t deplete members' savings.

Bonitas says that despite the evidence of the efficacy of both the flu and the pneumonia vaccinations, there is not enough uptake. To address this and encourage more members to get vaccinated the Scheme runs email and SMS vaccine drives targeted at the elderly, high risk/emerging risk members as well as children. It reports that this has shown an improvement in people taking the necessarily precautions, but the Fund still believes there is a long way to go.

*Subject to availability of stock due to increased demand for pneumococcal vaccines this season.

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