Invasive Pneumococcal Disease - Australia.
By Liz Watling

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Slide 1 - Title Slide Infection with the bacterium Streptococcus pneumoniae is known to be a significant cause of illness and death world wide. Invasive pneumococcal disease (IPD) has been notifiable in all Australia States and Territories since 2001, after changes in public health legislation. The highest global incidence of the disease has been recorded in the indigenous children of Central Australia and Northern Territory where a staggering 97% start their schooling with hearing problems as a result of the infection. This presentation details the disease process, its epidemiology and preventative measures.

Slide 2 Invasive pneumococcal disease (IPD) is caused by an ecapsulated gram-positive diplococcus. The serotypes recognised world wide now number 90 of which 23 are found commonly in adults and 7-11 in children.

Slide 3 IPD is a clinical condition in which the bacterium is isolated from a site normally expected to be sterile, for example the blood, pleural or cerebrospinal fluids. Common presentations of the disease are listed in this slide; and while pneumonia and bacteremia are the most common, meningitis is the most frightening for many people. Bacteremia, defined as the presence of bacteria in the blood stream, can be symptomless. However fulminating septiceamia, where the bacteria multiply in the blood stream, is a serious but fortunately rare condition

Slide 4 The bacteria are carried in the nose and throat and the carriage rate is highest in the very young. These are also the groups where there is likely to be the close contact necessary for the spread of the organisms from person to person. The incubation time for the disease can be as short as 24 hours.

Slide 5 In Australia IPD is largely a disease of youth (47.3 cases per 100,000 in 2001) and old age (38.7/100,000 in 2001). The under-fives are particularly vulnerable. This graph reflects the incidence of IPD in the under 5 yr age group per 100,000 population in 2001. The blue columns represent the figures for males and the green columns for females. Slightly more males contract the disease, with a male to female ratio of 1.2:1, and the most vulnerable time is at one year. For meningitis the most vulnerable period is under 18 months of age.

Slide 6 The risk factors are probably similar to those of other infectious diseases. The very young and the very old, those who are immunocompromised and those with underlying disease or history of recent infection are all likely to have compromised antibody production. The risk of spreading the disease is likely to be greater in over crowded or poor conditions or where vulnerable groups are in close contact.

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