Invasive Pneumococcal Disease

Question 1

True or false: IPD is nationally notifiable?

Answer 1

True

Question 2

Which organism causes IPD?

Answer 2

Streptococcus pneumoniae

100+ serotypes

Question 3

How is IPD transmitted?

Answer 3

Respiratory droplets
Direct oral contact
Indirect contact with secretions

Person-person transmission leading to infection is infrequent; many factors involved in acquisition, colonisation and disease development.

Question 4

What are the clinical features of IPD?

Answer 4

Non-invasive: otitis media, sinusitis, bronchitis

Invasive: pneumonia, septicaemia, meningitis.

Commonly found in URT (esp young children) - invasive disease when normal mechanisms of immunity impaired.

Pneumonia more in adults, septicaemia and meningitis in children.

Question 5

Which groups are high-risk for IPD?

Answer 5

• First Nations (several fold)
• < 2yo
• > 65 yo
• Smokers
• Harmful alcohol use
• Immunocompromised
• Asplenia
• Chronic disease (resp/renal/liver/diabetes)
• Hep C
• Prematurity/LBW
• Trisomy 21

Question 6

How is IPD diagnosed?

Answer 6

Culture / PCR from normally sterile site.

Serotyping at reference lab (MDU)

Question 7

What is the incubation period for IPD?

Answer 7

1-3 days

Question 8

What is the infectious period for IPD?

Answer 8

• Unknown
• Until virulent pneumococci no longer in discharges
• No longer infectious 24-48hr after ABx

Question 9

What is the outbreak definition of IPD?

Answer 9

2 + cases (same serotype) in 1 week with epi link.

OBs Vvry rare but do occur e.g. remote communities, residential facilities, CC

Question 10

How are outbreaks of IPD managed?

Answer 10

• Consider immunisation if vaccine-preventable serotype (may not be useful in acute control but for long-term prevention)
• Targeted PPx may be useful if non-vaccine strain and not resistant to ABx

Evidence for prevention of further cases limited. Re-colonisation occurs rapidly.

Question 11

How is IPD prevented?

Answer 11

Vaccination
* NIP - 13 valent vaccine at 2, 4, and 12 months
* Extra doses 6mo and 4y (inc 23v) for First Nations children and certain medical risks
* 13v - 70-79yo
* 13v + 23v - adults specific conditions, First Nations 50+

General and respiratory hygiene measures e.g. hand hygiene, cough etiquette, avoiding contact when unwell, cleaning, masks

Question 12

What resources are available for public health management of IPD?

Answer 12

DH protocol. No SoNG

Question 13

How are cases of IPD managed?

Answer 13

• Treatment, droplet precautions, education (clinician)
• Exclude from CC/school until 24h post ABx and well
• Collection of surveillance data (clinical, vax, RFs) from hospital/GP

Question 14

How are contacts of IPD managed?

Answer 14

Nil

Question 15

What environmental management is required for IPD?

Answer 15

Disinfection of articles with nose/throat discharges.
Nil routine.

Question 16

True or false: IPD is common worldwide

Answer 16

True

Question 17

Which group has the highest rate of IPD globally?

Answer 17

First Nations children in central Australia.

Question 18

True or false: case numbers of non-vaccine IPD serotypes are increasing

Answer 18

True

Question 19

True or false: AMR to IPD is increasing

Answer 19

True