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Prevention is better than cure

Posted by: Dr Kenneth Chan

When was the last time you went for a health check up? When was the last time you got vaccinated for a disease that could be prevented by a single jab? Unlike common belief, vaccinations are not just for children. There are vaccinations for adults too.

Many of you may have been the primary care-giver for many years, but have you ever sat back to think why have you been so quick to take on preventive measures when it comes to the young and vulnerable like your children or grandchildren but neglect yourselves?

One such vaccination is Prevenar 13 which helps protect against the deadly Pneumococcal Disease. It has recently been approved by HSA and has been indicated for use for adults 50 years of age and older. It is been prescribed and administered for use in children for many years and is currently in the Ministry of Health’s recommended list of vaccinations for children below five.

So what is Pneumococcal Disease?

A mouthful to say, Pneumococcal Disease is a group of illnesses caused by the bacteria Streptococcus Pneumoniae. These may include infections of the lung (Pneumonia), middle ear (Otitis media), lining of the brain (Meningitis) and blood (Bacteraemia). Anyone can get pneumococcal disease although it is most common amongst young children, elderly and people with serious underlying medical conditions such as heart, lung or kidney disease. In addition, alcoholics, diabetics and patients with lowered immunity (such as HIV, sickle cell anaemia) are also at risk.

Things to look out for before getting vaccinated

  • Patients should not undergo vaccination if they are having a febrile illness.

  • Patients who are allergic to any vaccine containing diphtheria toxoid should not be vaccinated with Prevenar 13.

  • There are also other vaccinations available in Singapore for adults protecting against Hepatitis A & B, Influenza, Chicken Pox and COPD.

1. How is it spread and what symptoms are there?

The pneumococcus bacterium is carried in the nose and throat in up to 10% of normal people. It may be spread by direct exposure to droplets from an infected person who coughs or sneezes. It causes disease when the immune system is overwhelmed, for example if the patient has any of the illnesses above or if the patient is recovering from flu.

Symptoms may include fever, chills, headache, ear pain, cough or confusion.

2. How dangerous is it?

Pneumococcal disease (PD) is a very important cause of disease and disability worldwide. For example, World Health Organisation reports that in patients aged above 65, approximately 24- 85 per 100,000 of the population develop invasive pneumococcal disease every year. However PD, including pneumonia, is often under-recognised as data showing the specific rates of PD in many Asian countries are absent or underestimated.

In fact, PD is the number one cause of vaccine-preventable deaths. PD causes approximately 1.6 million deaths per year globally. In 2002, there were 896,000 deaths in adults worldwide due to PD.

In Singapore, the mean annual hospitalisation rate for PD is 10.9 per 100,000 with Pneumococcal Pneumonia as the predominant type followed by Pneumococcal Septicaemia and Pneumococcal Meningitis. This rate increases significantly to 56.4 per 100,000 amongst patients aged above 65.

Pneumococcal Disease is one of the causes of Pneumonia.

In Singapore, pneumonia is the 3rd highest killer disease behind cancer and coronary heart disease and it is the 4th highest cause of hospitalisation in Singapore. In 2010, there were 2764 deaths in Singapore due to Pneumonia. It also caused 11,475 people to be hospitalised.

3. So why should elderly adults get vaccinated?

As PD, especially pneumonia, is a leading cause of death and disability in the elderly. With increasing drug resistance, pneumococcal disease is becoming increasingly difficult to treat.

Pneumococcal vaccination like Prevenar 13 is a safe and one-off injection that has been proven to protect against the most severe forms of illness (bacteraemia and meningitis) and even pneumonia in the elderly.

Side effects are minimal and are limited to occasional pain, redness or swelling at the injection site. Downtime is minimal and most patients are able to carry on with their activities of daily living.

4. How does the vaccination work?

The vaccine Prevenar 13, uses conjugate technology that links the pneumococcal polysaccharide sugar chains found on the surface of each bacterial strain with a carrier protein CRM 197 which has more than 20 years of clinical and commercial use in vaccines. What this simply means is that through the use of a carrier protein, a conjugate vaccine activates several pathways in the immune system and is thought to establish “immune memory.” This immune memory may help the immune system remember an infection and fight it in the future.

Currently, Prevenar 13 is not the only vaccine in the market; others include Pneumo 23 and Pneumovax 23 which are both pneumococcal polysaccharide vaccines (PPV23). The key difference between Prevenar 13 and these two vaccines is in the conjugate technology used which is believed to be able to generate higher affinity antibodies and immunological memory in order to offer long term protection to patients.

5. So how many jabs do adults require?
Only one jab of Prevenar 13 is needed for now until the need for revaccination is established in the future. With conjugate technology, it should be able to provide long term protection with its immunological memory benefit.

6. A little help goes a long way 

As age catches up on us, we slowly start to see two extreme camps when it comes to one’s health. Some say that ignorance is bliss, the other believes that it is better to be safe than sorry. The former, usually disregard most advice and do not go for regular check-ups. They live life on the edge and generally take on the attitude that ‘Life is short, play hard’. The latter are proactive about knowing their health status and even go for free health talks and seminars regularly held by the ministry and health organisations.

Whatever your choice is, it is important to take on a balanced attitude to be able to live happily in your silver years. If you could get protection from deadly illnesses through the help of vaccinations, why not?

Live long, live healthy, and remember prevention is better than cure.

Are you fond of group gatherings?

In Singapore, the elderly like to congregate. We have our day-care centres; we meet up to play chess, have potluck at each other’s homes or even go for marathon karaoke sessions. Some of us even like to organise gatherings and travel in large groups.

However as there is safety in numbers, the close contact we have with each other also brings forth the problem of community-acquired pneumonia (CAP). It is an important cause of mortality and morbidity amongst adults in the Asia-Pacific region especially in patients with severe disease requiring intensive care. 

Streptococcus pneumoniae accounts for 29.2% of isolates from adults with CAP in South Korea, China, Taiwan, Hong Kong, India, Singapore, Vietnam and the Philippines.

CAP is a prolonged illness with 35% unresolved symptoms even after 28 days of contracting the disease. More than 50% of people suffering from CAP are unable to resume normal activity even after 6 weeks. There is also an increased risk of re-hospitalisation and long-term risk of mortality.

The burden of CAP amongst adults in Asia may be underestimated owing to self-treatment with antibiotics, poor accessibility to diagnostic testing and lack of surveillance programmes in those countries.

However, this does not mean that you should lock yourself up at home and refuse contact with your friends to enjoy meaningful activities with them. 

This just gives you more reason to vaccinate yourself from Pneumococcal Disease.