Public health priority: Routine.
PHU response time: Enter all confirmed cases in NCIMS within 5 working days of notification.
Case management: Responsibility of treating doctor.
Contact management: Responsibility of treating doctor.
Revision history
Revision
Urinary antigen positive for Streptococcus pneumoniae- not notifiable
Section 6 - Investigation is limited to enhanced surveillance groups - children under 10 years of age, Aboriginal people 50 years and older, and non-Aboriginal people 70 years and older
Response procedure and data collection recommendations
Removal of serotyping follow up requirements
Active immunisation in public health responses
Appendix 1: Invasive Pneumococcal Disease case questionnaire
CHO
To monitor the epidemiology of the disease and so inform prevention strategies.
A confirmed case requires laboratory definitive evidence only.
Not applicable.
Streptococcus pneumoniae causes localised infection of the respiratory tract (in particular otitis media and sinusitis) as well as invasive pneumococcal disease (IPD), commonly manifested as bacteraemia, pneumonia or meningitis. Only invasive disease is notifiable. Isolation of S. pneumoniae from a non-sterile site (such as sputum, nasal aspirates and ear discharge) or positive pneumococcal urinary antigen tests are not notifiable.
Serotyping of the organism, based on the differences in polysaccharide antigens, is currently performed in a few laboratories in Australia. Although it is not required for individual patient management and rarely for investigation of clusters, surveillance of isolates from cases of IPD and serotyping will assist in monitoring changes in serotype distribution following introduction of vaccination programs.
Invasive pneumococcal disease is to be notified by laboratories on microbiological confirmation (ideal reporting by routine mail).
Only confirmed cases should be entered onto NCIMS.
The bacterium Streptococcus pneumoniae (pneumococcus). There are 90 known capsular types, some of which are commonly carried in the upper respiratory tract.
The organism is transmitted by respiratory droplets, direct oral contact, or indirectly through articles freshly soiled with respiratory discharges.
The typical incubation period is not well determined, probably as short as 1 to 3 days.
The period of communicability is unknown, although it is presumably until discharges from the mouth and nose no longer contain virulent pneumococci in significant numbers. Penicillin will render patients with susceptible strains non-infectious within 24-48 hours.
Pneumococcal pneumonia is the most common clinical presentation of IPD (the organism must be isolated from a blood culture or other sterile site to be counted as IPD). Symptoms are usually sudden in onset and include chills, fever, pleural pain, dyspnoea (breathing difficulties) and productive cough. Symptoms may be less sudden in the elderly. Fever, vomiting and convulsions may be seen in infants and young children. Pneumococcal pneumonia is an important cause of death in infants and the aged. The case fatality rate of pneumococcal pneumonia has fallen to 5-10% with antimicrobial therapy but remains higher in the elderly and immunocompromised people. The case fatality rate for pneumococcal meningitis ranges from 10- 30%.
Follow up is limited to age groups routinely targeted for pneumococcal vaccination under the NSW Immunisation Schedule − children under 10years of age, Aboriginal people 50 years and older, and non-Aboriginal people 70 years and older.
Where follow up is undertaken, begin investigation within 5 working days of notification.
Within 5 working days of notification enter confirmed cases on NCIMS.
Collection of case information can be primarily from review of available medical records and information on the Australian Immunisation Register.
PHU staff can enter data directly into NCIMS. The Invasive Pneumococcal Disease Case Questionnaire (Appendix 1) can be used to assist with data collection if preferred but is not a requirement. If the Case Questionnaire is completed, please attach it to the NCIMS event.
PHU staff are encouraged to complete all relevant NCIMS fields where the information is available. The minimum data requirements for cases being followed up are:
If the information is not known, then data must be completed as "unknown".
The reporting laboratory should routinely refer all sterile site isolates to the NSW Pneumococcal Reference Laboratory at ICPMR. for typing and additional antibiotic susceptibility testing.
See the latest edition of Therapeutic Guidelines: Antibiotic.
In general, the medical practitioner should provide information to the case about the nature of the infection and the mode of transmission. A Pneumococcal disease fact sheet is available.
Hospitalised patients with antibiotic resistant respiratory disease may be isolated to reduce the risk of transmission to other high-risk patients.
None required for sporadic cases.
None.
Two types of pneumococcal vaccine and four formulations are currently available in Australia: Conjugate (13-valent, 15-valent, and 20-valent formulations) and Polysaccharide (23-valent formulation). The number and timing of doses, and the type of vaccine recommended for individuals depends on their age, Aboriginal and Torres Strait Islander status, whether they have conditions that increase their risk of penumococcal disease, and previous history of pneumococcal vaccination. Please refer to The Australian Immunisation Handbook and NSW Immunisation Schedule for more detailed guidance.
While these vaccines are very useful in preventing disease, it is not routinely recommended in public health responses.
Generally speaking, in outbreaks in institutions or in other closed population groups, immunisation is not useful in acute control but may be useful for longer term prevention.
Appendix 1: Sample Invasive Pneumococcal Disease case questionnaire.