Last updated on 3 February 2023
Pneumonia is an infection whereby the air sacs in one or both lungs get inflamed. In serious cases, the sacs may fill up with fluid or pus, which can lead to life-threatening complications for the old and the very young.
Being stricken with pneumonia is often a distressing experience, with symptoms such as a very bad cough with phlegm or pus, fever, chills, and difficulty breathing.
Causes and risks of pneumonia
In the majority of cases worldwide, pneumonia is usually caused by a bacteria called streptococcus pneumoniae, or pneumococcus. Other than the lungs, streptococcus pneumoniae infection can also affect other organs such as the ears (otitis), sinuses (sinusitis), brain and spinal cord (meningitis), and blood (bacteraemia).
In severe cases, pneumococcal disease can cause hearing loss, brain damage, and even death. Thus, it is important for those with risk factors for pneumococcal disease or for severe adverse outcomes to be vaccinated against it.
Anyone can get pneumococcal pneumonia, but infections are more commonly experienced by adults aged 65 years and older. Studies show that when compared with younger adults, adults aged 65 years and above are nearly 4 times more likely to get infected with pneumococcal pneumonia and 10 times more likely to be hospitalised with pneumococcal pneumonia.
Furthermore, senior adults – with immune systems that are generally weaker because of age – are more prone to invasive pneumococcal disease. This entails more severe infections, such as bacteraemia and meningitis, and leads to a 10 – 36% higher chance of death (mortality rate).
Individuals with chronic medical conditions (and weaker immune systems) as well as children below 5 years of age, particularly those below 2 years old (with immune systems that are still maturing), are also at increased risk for pneumococcal disease.
Signs of pneumonia
Pneumococcal bacteria can be spread through direct contact, respiratory droplets produced from coughing or sneezing, and items contaminated with these infected droplets.
The common symptoms of pneumococcal pneumonia include high fever, chills and rigors, sweating, fatigue, coughing, difficulty breathing, shortness of breath and chest pain.
Signs and symptoms of pneumococcal pneumonia can be very subtle in patients of advanced age, with or without impaired immune systems. These older patients may present with atypical symptoms, such as changes in mental status including confusion or reduced alertness. They may not even have the commonly-experienced symptoms such as fever and cough.
Getting protected against pneumonia
As pneumococcal pneumonia is the most common cause of community-acquired pneumonia worldwide, those at increased risk are advised to take pneumococcal vaccines to protect themselves from an infection.
There are two types of vaccines commonly available: pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23).
PCV13 vaccine protects against 13 pneumococcal bacteria strains that most commonly cause pneumococcal disease, while the PPSV23 vaccine protects against 23 strains. In selected groups of patients, PCV13 is given before PPSV23 as this provides extended protection as compared to them receiving the PPSV23 vaccine alone.
Infants, too, should be given two doses of PCV13 at ages 4 months and 6 months, followed by a booster at 12 months. Children who fall behind should be given catch-up vaccination through to 59 months of age.
In adults, one dose each of PCV13 and PPSV23 is recommended for those aged 65 years and above. Other adults who should take the pneumococcal vaccines include:
Individuals aged 18 years and older with chronic illnesses, such as chronic lung, heart, kidney or liver diseases and diabetes mellitus
Individuals who are immunocompromised or have other medical conditions, such as having had cochlear implants or cerebrospinal fluid leaks; and abnormal spleen function (including conditions such as homozygous sickle cell disease and coeliac syndrome).
Adults aged 18 years and above can also opt for the newly-launched PCV20 vaccine, which is available in Singapore starting 2023. Unlike the older vaccines, PCV20 is administered as a single dose and does not require any boosters, making it a more convenient choice for patients.
Those who have taken only PPSV23 previously can also take the PCV20 vaccine, provided it’s been at least one year after their last PPSV23 vaccination. However, those who received only PCV13 vaccination previously should still continue to take PPSV23 as per the current guidelines. If in doubt, consult your family doctor on which vaccine you should take, and when to take it.
Subsidies for pneumococcal vaccines
In Singapore, pneumococcal vaccination is part of the National Childhood Immunisation Schedule (NCIS) and National Adult Immunisation Schedule (NAIS). All Singaporeans and Permanent Residents who meet the criteria for vaccination under the NCIS and NAIS are eligible for government subsidies for PCV13 and PPSV23 pneumococcal vaccination, but not PCV20 as of now. You can also opt to use your MediSave to pay for the vaccine at MediSave-accredited healthcare institutions, such as polyclinics and CHAS GP clinics. Our Parkway Shenton GP clinics are all MediSave-accredited.
It is especially important now in the current COVID-19 pandemic for those at risk to be vaccinated against pneumococcal pneumonia. Given that COVID-19 will not be going away anytime soon in the near future, there will be an increased risk of COVID-19 and pneumococcal pneumonia co-infections. Such cases have already been reported overseas, and will make the diagnosis and treatment of COVID-19 or pneumococcal pneumonia more challenging.
A range of vaccinations, including pneumococcal vaccinations, are available at all Parkway Shenton clinics in Singapore. Our doctors will also be able to answer any questions you may have about the vaccinations.
Article contributed by Dr Edwin Chng, medical director at Parkway Shenton, The Arcade (level 19)