Ear infections in young children are extremely common, with nearly all children having experienced an episode of otitis media (middle ear infection) by their third birthday⁶. Whilst many of these will be viral, up to half of the cases that are bacterial in origin are the result of pneumococcal infection⁷. Children who suffer severe and recurrent ear infections have been shown to be more likely to get "glue ear" and perforations of the eardrum, which can lead to hearing loss resulting in delays in speech, language and cognitive development^6,8. Severe and recurrent otitis media has been shown to be more likely caused by the pneumo bug than by other organisms

Deafness Research provides a range of information on ear infections and other causes of hearing impairment. Go to www.deafnessresearch.org.uk for further information.

The British Lung Foundation (www.lunguk.org) have a general leaflet on pneumonia which also mentions the condition in children, however, there is not much information specifically aimed at childhood disease available.

Although the conjugate vaccine is highly effective at protecting infants and children against serious disease caused by the bacterial strains covered by the vaccine^9,10, it is not yet possible to create an effective vaccine that covers all the strains of the pneumo bug and offers 100% protection. There are over 90 different types of pneumococcal bacteria and the conjugate vaccine protects against seven of these. However, these seven types account for about 80% of the serious, life-threatening pneumococcal diseases that affect children between the age of two and twenty four months in the UK¹¹. Furthermore, the conjugate vaccine has significantly reduced the rates of pneumococcal disease in the USA where it has been on the National Immunization Programme since 2000¹⁰. Vaccinating children in the US has also shown to be associated with a reduction in disease in other age groups, such as those of parents and grandparents¹⁰. It is thought that this is because children are not passing the pneumo bug onto their friends and relatives. The conjugate vaccine is licensed for the prevention of pneumococcal diseases such as meningitis, septicaemia, pneumonia and middle ear infection (otitis media)^7,9.

All medicines and vaccines are routinely monitored for safety following their introduction. The safety profile of the conjugate vaccine has been demonstrated in clinical trials in the US and across Europe. There were almost 40,000 children involved in these trials and all the results showed that the conjugate vaccine is well tolerated^7,9,12. The most common side effects observed were local injection site reactions such as redness and swelling. These were reported as being mild and transient⁹. The safety profile of the conjugate vaccine is confirmed by experience in the United States⁹. The conjugate vaccine is recommended for all American children under 2 years of age and, in addition, to other children up to the age of 5 years considered to be at increased risk. The conjugate vaccine does not contain thiomersal or any other mercury-based preservative.

For up-to-date information on the dosing regimen for the conjugate vaccine and to see the childhood immunisation schedule, please go to http://www.who.int/vaccines/globalsummary/immunization/ScheduleSelect.cfm

Prevenar^® can be administered simultaneously with other paediatric vaccines in accordance with the recommended immunization schedule¹³.

Any episode of meningitis is quite rare so it is even more rare for a child to have it twice whatever the cause, however it is known to have happened in the past. There are many different pneumococcal strains and it may not be clear which caused the disease - the child could have had a completely different type of meningitis. If the child was under the age of two when they contracted pneumococcal meningitis, they may not have developed adequate natural protection and may still be vulnerable to infection even with the same bug. This is especially true if the child suffers from one of the conditions that cause their immune system to be inefficient, such as a missing or defective spleen, chronic heart, liver, kidney or respiratory disease, immunosuppression, and diabetes. All infants and children under two years of age are at a higher risk of pneumococcal meningitis than older children¹⁴.

In the US, the pneumococcal conjugate vaccine (or 'the conjugate vaccine') has been available since 2000. It is recommended by the US Advisory Committee on Immunization Practices (ACIP) for routine use in all children up to the age of two years and for certain groups of other high-risk children up to the age of five years. It is being made available through both private medical health insurance schemes and through the federal government's Vaccines for Children programme. In Australia, the conjugate vaccine received a fully funded national universal recommendation in 2004. In EU countries, the conjugate vaccine has been licensed since February 2001. As in the UK, it is recommended in childhood immunisation schedules in Belgium, France, Germany, Greece, Italy, Luxembourg, the Netherlands, Kuwait, Mexico, Costa Rica, Australia, New Zealand and Saudi Arabia Qatar, oman, Bahrain & UAE is expected to be listed in the NIP many countries in 2009. It is also recommended in the childhood immunisation schedules in Norway and Switzerland. In Canada, the conjugate vaccine is now being introduced on a routine basis in most of the provinces.

Pneumococcal disease is any disease caused by the pneumococcus bacterium (scientific name: Streptococcus pneumoniae). This bacterium has more that 90 sub-types and can cause different invasive and non-invasive pneumococcal diseases.

Invasive Pneumococcal Disease (IPD) includes types of meningitis (inflammation in the spinal cord and the brain), bacteraemia / sepsis (infection of the blood) and pneumonia (infection of the lung). Non-invasive pneumococcal disease includes pneumonia (without infection of the blood), acute otitis media (infection in the ear) and sinusitis (inflammation of the sinuses).

The World Health Organization (WHO) has declared pneumococcal disease as the Number One cause of vaccine-preventable deaths in children under 5 years worldwide. According to the WHO, up to 1 million young children die every year because of pneumococcal disease globally.

In the region, epidemiological studies done in different GCC countries like Bahrain, UAE, Oman and KSA showed that invasive pneumococcal disease in children under 5 years ranges between 60 to 112 per 100,000, which is higher than a lot of other western countries.

Pneumococcal disease can happen to anyone but are very common in children. Children are both major carriers and victims. In addition, adults of 65 and above are at higher risk. Due to this, the social impact of pneumococcal disease is huge. For example, children can transfer the disease to grandparents and other older people easily.

A number of factors can increase the risk:

• Age: Children younger that 2 years are at increased risk as are adults of 65 years or above.
• Other medical conditions: Medical conditions like sickle cell disease, HIV, diabetes, pulmonary disease and asplenia increase the risk of pneumococcal disease.
• Out-of-home childcare: Children who attend out-of-home childcare, regularly spending four or more hours a week with at least two unrelated children under adult supervision, have a greater risk of getting pneumococcal disease than children who do not.

The disease is spread from person to person by droplets in the air (for example, when someone sneezes and coughs). This bacterium is found in the nose and throat of healthy children and sometimes adults.

The symptoms are different for different diseases.

• Bacteremia may include fever with other non- specific signs of illness
• Meningitis may include fever, severe headache, vomiting, sleepiness, irritability, seizures and stiff neck
• Pneumonia may include cough, fever, shortness of breath and chest pain
• Acute otitis media (AOM) may include earache, fever, vomiting and temporary hearing loss
• Acute sinusitis may include fever, runny nose and cough

Invasive pneumococcal disease (IPD) is diagnosed through blood tests. Non-invasive pneumococcal disease is diagnosed through blood tests, physical examinations and x-rays.

Pneumococcal disease is mainly treated with antibiotics like penicillin. However, the types of pneumococcus bacterium that can resist antibiotics are increasing worldwide. These antibiotic-resistant types complicate treatment decisions, cause treatment failures and increase the cost of medical care.

The best way to protect against pneumococcal disease is through vaccination. Infants and toddlers need the most protection and the vaccine to protect them against invasive pneumococcal disease is called Prevenar^®. Prevenar^® is a pneumococcal conjugate vaccine that helps in protection against the most common and serious types of invasive pneumococcal diseases found in children like meningitis (inflammation in the spinal cord and the brain) and bacteraemia (infection of the blood). Since its introduction, Prevenar^® has reduced the rate of pneumococcal infection among children by 97% in clinical trials.

Prevenar^® is available through your child’s doctor. You cannot purchase it over the counter in a pharmacy.

Prevenar^® is available in 92 countries worldwide. Health authorities around the world have recognized the importance of protecting infants and young children against pneumococcal disease. 36 countries included Prevenar in their NIPs including Kuwait, Qatar, Bahrain, KSA, UAE, Oman, Turkey, South Africa.

Although less common than meningitis B, pneumococcal meningitis is significantly more life threatening. Before the pneumococcal vaccine became available in the routine childhood immunization schedule, one in five children diagnosed with pneumococcal meningitis died^1,2, twice the rate associated with meningococcal meningitis³. Furthermore, for children who survive pneumococcal meningitis, the risk of suffering long-term and severe neurological complications (brain damage) is higher than with survivors of meningitis caused by other bacteria^3,4. One in six children who survive pneumococcal meningitis suffer mental retardation; one in seven develop epilepsy or other seizure disorders; while one in four become deaf (half of these profoundly so)³. Overall, more than half the survivors of pneumococcal meningitis will be left with some level of disability⁵. In addition, pneumococcal meningitis is not often associated with the non-blanching rash that characterises meningococcal septicaemia, the blood poisoning form of the disease that often accompanies meningococcal meningitis. As a result, diagnosis of pneumococcal meningitis is sometimes more difficult to make. This makes prevention an even more logical solution to the problem.

Suspected meningitis or septicaemia is a medical emergency and you should seek medical assistance immediately.

If you would like more information on how to spot the signs and symptoms of any form of meningitis, contact any of the following organisations that provide excellent backup in this area:

Meningitis Trust - www.meningitis-trust.org
Meningitis Research Foundation - www.meningitis.org
or ask your doctor