Dressed Down by the Captain of the Men of Death (Again)

The bacterium Streptococcus pneumoniae or the pneumococcus was labeled the "Captain of the Men of Death" by Sir William Osler because of its extreme prowess at killing. Today we are fortunate that the availability of pneumococcal vaccines has diminished the burden of invasive pneumococcal disease but it still causes approximately 3500 deaths per year. Those with the bacteria in their bloodstream succumb to the infection in 15% of cases--a figure that is thought not to have improved for decades despite myriad improvements in critical care. 

In my career I've taken care of several patients with severe pneumococcal infections and each time I am astounded by its deathly abilities. Last night, I unfortunately saw pneumococcus in action once again in a cirrhotic patient (who I don't believe was vaccinated).

There's a concept in treating patients with septic shock known as decompensation. Human physiology can hold out for so long and then, the deluge. Once decompensation occurs, it becomes a Herculean task to counteract the derangements induced by the infection, which soon become irreversible, and maintaining a blood pressure can become near impossible.

Pneumococcal vaccines, a life-saving technology developed by Dr. Robert Austrian, have the ability to make these types of occurrences a remnant of the past but if only if we avail ourselves of their benefits. For in those unlucky individuals in whom severe pneumococcal sepsis ensues, to rescue them requires beating back the devil.

Should Pneumococcal Meningitis Prompt a Public Health Response?

Here in Pittsburgh a 6 year old boy died from bacterial meningitis this week. There was some interest from the media and the county health department held a press conference to announce some of the specifics of the case, including the important fact that the culprit organism was treptococcus pneumoniae (the pneumococcus). As such, no major public health intervention--such as antibiotic prophylaxis--was needed. 

However, children dying of invasive pneumococcal disease is not something that should be considered commonplace in light of the availability of pneumococcal vaccines. The really are two pneumococcal vaccines that are relevant: the traditional 23-valent pneumococcal polysaccharide vaccine targeted primarily at the elderly and 13-valent (formerly 7) pneumococcal conjugate vaccine targeted primarily at children. 

While an important question will be whether the child was vaccinated and if the specific pneumococcus isolated was a vaccine serotype, I wonder what the pneumococcal vaccine rate is in his neighborhood. 

I think about this because of an innovative approach employed in Philadelphia for a similar problem that I once heard about in a lecture. In Philadelphia, rates of invasive pneumococcal disease are mapped with vaccination rates. Such an approach uncovers areas in which vaccine--which reduces carriage rate as well as infections--should be prioritized. The approach is reminiscent of the surveillance and containment approach used to eradicate smallpox.