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Pneumococcal disease, invasive (Streptococcus pneumoniae)

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Reporting Obligations

Individuals who have or may have invasive disease caused by S. pneumoniae shall be reported to the local Health Unit.

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Epidemiology

Aetiologic Agent

Streptococcus pneumoniae, also known as pneumococcus, is a Gram-positive encapsulated coccus of which there are 90 known capsular serotypes.

Clinical Presentation

Invasive pneumococcal disease (IPD) most often presents as bacteremic pneumonia, bacteremia, and meningitis. Persons with pneumococcal meningitis generally present with high fever, headache, lethargy or coma, vomiting, irritability, nuchal rigidity, seizures and signs of meningeal irritation.

Modes of Transmission

Transmission is person-to-person by contact with the respiratory droplets of an infected person or asymptomatic carrier. Illness among casual contacts is infrequent. Pneumococcus often asymptomatically colonizes the human nasopharynx; duration of carriage varies, although generally longer in children than adults.

Incubation Period

Incubation period may be as short as 1–3 days.

Period of Communicability

Presumably until discharges from mouth and nose no longer contain virulent pneumococci in significant numbers. Usually no longer communicable after 24 hours of initiating effective antibiotic therapy.

Risk Factors/Susceptibility

The risk of disease is highest in persons 65 years of age and older, children less than 2 years of age, and those persons with certain medical conditions that put them at increased risk for IPD. Although serotype-specific immunity may last for several years following infection, persons previously infected with pneumococcal disease should still receive immunization due to the number of known pneumococcal serotypes.

Diagnosis and Laboratory Testing

A confirmed case includes clinical evidence of invasive disease (pneumonia with bacteremia, bacteremia without a known site of infection, and meningitis) with laboratory confirmation of infection.

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Treatment and Case Management

Treatment is under the direction of the attending Health Care Provider. Immunization as per the Canadian Immunization Guide, 7th ed. recommendations and the Publicly Funded Immunization Schedules for Ontario, is key to the prevention of IPD.

Routine practices are recommended, including respiratory isolation and the use of personal protective equipment by health care workers. No special management of contacts is required.

Patient Information

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Additional Resources

Ministry of Health and Long-Term Care. “Publicly Funded Immunization Schedules for Ontario”, December 2016

Public Health Agency of Canada. “Canadian Immunization Guide, 7th ed., Pneumococcal Vaccine.”

Ministry of Health and Long-Term Care. “Pneumococcal conjugate 13-valent vaccine (Prevnar® 13) for adults with high risk medical conditions: Q&A for health care providers.”

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.