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Slide 7 The signs and symptoms of pneumococcal pneumonia, otitis media and sinusitis are generally specific and recognisable so are not listed. This slide describes only those related to meningitis and septicaemia in the most vulnerable group – young children and babies. Septicaemia is rare but the symptoms of bacteremia can be similar. The non-specific symptoms of the disease are much the same as with any febrile illness. As we all know, a headache is not specific to meningitis, but combined with some of the more specific symptoms especially neck stiffness and photophobia, it is indicative. The presence of a rash is more associated with meningococcal disease but can occur with pneumococcal infection.

Slide 8 This slides reflects the variance in the number of reported cases between the high profile meningococcal disease and pneumococcal disease during the years 2001 and 2002. These figures represent all manifestations of pneumococcal disease, not just meningitis. For Australians, pneumococcal disease remains the most important in terms of numbers of people affected, however meningococcal disease has the power to shock with the speed of its attack within the body and its obvious consequences of limb loss and death.

Slide 9 Again, these statistics reflect all cases of pneumococcal disease, not just meningitis. These are overall figures across all age groups. In general the case fatality rate for IPD is higher in those people over 65 than in children aged less than five years, however meningitis is more likely to occur in the young. The after effects of pneumococcal meningitis can be particularly severe, with brain damage, epilepsy and deafness being common. In those children who apparently recover completely from pneumococcal meningitis, behavioural and learning difficulties may become apparent at school age. 1997-2000.

Slide 10 There are currently two types of vaccines which are used in disease prevention. The 23 valent polysaccharide vaccine, which covers 23 of the most common pathogenic serotypes found in all age groups, can only be given to children over two years of age. At this age antibody production is sufficiently mature to give protection on vaccination. The seven valent conjugate vaccine, which covers those serotypes most often isolated from children, can be given much earlier. The Australian Therapeutic Advisory Group on Immunisation (ATAGI) has recommended the inclusion of this vaccine in the childhood vaccination programme but there is no funding available from the Federal budget for a nation-wide initiative. The individual State initiatives which are in progress are funded from the State Budget.

Slide 11 Pneumococcal disease surveillance is still relatively new in Australia. A workshop was held in 1999 and its findings are briefly summarised in this slide. An important finding was the difference in incidence between indigenous and non-indigenous populations. A high incidence was reported in Central Australia (CA), along with serotype diversity and increased antibiotic resistance.

Slide 12 The Therapeutic Goods Administration (TGA) approved the conjugate vaccine at the end of 2000, and after recommendation by the IPD working party, an immunisation programme for high risk groups was commenced in Central Australia and implemented across the country by the end of 2001.

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