Chapter reviewed and updated in October 2017. A description of changes can be found at Updates to the Communicable Disease Control Manual.
Invasive pneumococcal disease was added to the notifiable disease schedule primarily for the purposes of surveillance – in particular to monitor the effect of introducing the pneumococcal vaccine for children in June 2008 and the incidence of disease in the community. This epidemiological information, along with information on the distribution of serotypes from laboratory-based surveillance, helps inform future immunisation policy.
Local public health action is not expected in response to individual notifications of this disease.
Epidemiological information is available on the Institute of Environmental Science and Research (ESR) surveillance website.
Streptococcus pneumoniae (pneumococcus) is a gram-positive encapsulated coccus (gram-positive diplococcus). Most pneumococcal serotypes can cause disease, but only a few produce the majority of invasive pneumococcal infections. Invasive pneumococcal disease is defined as pneumococcal disease with detection of S. pneumoniae in a normally sterile site, such as the meninges, cerebrospinal fluid (CSF), blood, pleural fluid or joints.
Depending on the site of infection, the main presenting condition is meningitis, pneumonia or septicaemia.
In approximately 25 percent of the population, the bacteria are carried asymptomatically at the back of the nasopharynx. Invasive pneumococcal disease occurs most commonly in the winter months. The risk of disease is higher in infants, the elderly and those with predisposing conditions such as immune deficiency states. It is the most common cause of community-acquired pneumonia in all ages and probably the most common cause of bacterial meningitis in children.
Laboratory confirmation requires at least one of the following:
Note, detection of S. pneumoniae from CSF by microscopy (detection of gram-positive diplococci) can be a useful diagnostic test, but is not sufficient for case confirmation.
Note: in the absence of invasive disease, isolation of S. pneumoniae from a non-sterile site (such as sputum, nasal aspirates and ear discharge) is not notifiable. A positive urine antigen test is also not notifiable.
Variable, but may be as short as 1–3 days. Illness usually occurs within 1 month of acquiring a new serotype in the respiratory tract.
By droplet inhalation or direct contact with respiratory tract secretions. Person-to-person transmission is common, but illness in casual contacts and hospital staff is uncommon.
The laboratory undertaking the testing must notify the local medical officer of health of all confirmed cases of invasive pneumococcal disease.
See Appendix 5: Escalation pathways for more information
Ensure complete case information is entered into EpiSurv.
Medical officers of health should review the hospital case notes and/or contact the attending clinician or general practice to obtain information about immunisation history, clinical presentation, clinical course and outcome, and risk factors (such as prematurity, chromosomal or congenital abnormality, immunocompromised, chronic illness, smoking) and to ask about earlier vaccinations with either the pneumococcal polysaccharide or conjugate vaccine. It should only be necessary to contact the case or their family/whānau in exceptional circumstances.
If an outbreak occurs, contact 0800GETMOH - CD option, and liaison staff at ESR, and complete the Outbreak Report Form.