Pneumonia ranks as one of the top ten causes of death in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 16,000 people died of pneumonia in 2012. More than 20% of community-acquired pneumonia cases are caused by Streptococcus pneumoniae, a bacterium that can also lead to severe pneumonia and even death. Recently, the sudden death of a famous female star, Da S, due to influenza and pneumonia has highlighted the dangers of severe pneumonia and the importance of vaccination.

Influenza can cause concurrent bacterial infections, leading to bacterial pneumonia. Streptococcus pneumoniae is a major culprit in such cases. Experts emphasize that vaccination is the most effective way to prevent disease infection, enhance protection, and avoid severe illness.

Why does influenza lead to pneumonia complications? Dr. Qiu Zhengxun, chairman of the Taiwan Society of Child Infectious Diseases, explains that there are two types of influenza and pneumonia complications. One type affects adults and the elderly, causing an “immune storm” that destroys the lung barrier, allowing bacteria to invade. In severe cases, this can lead to “big white lung,” where the entire lung is infected and inflamed, possibly resulting in sepsis. When patients develop “big white lungs,” they may experience respiratory failure, requiring intensive treatments like intubation and mechanical ventilation. This condition has a high mortality rate, primarily affecting the elderly and those with low immunity.

When the patient develops ‘big white lungs,’ lung respiratory failure will occur, and severe treatments such as intubation and leucorrhea membrane are required. From the infection to the onset of the disease, it may progress to ‘big white lungs,’ with a high death rate. Most of this happens to the elderly and those with low immunity.

In children, influenza complications can lead to rare conditions like myocarditis, pericarditis, or encephalitis, and continuous bacterial infections such as otitis media, sinusitis, and pneumonia. Pneumonia in children is often a continuous bacterial infection, differing from the complications seen in adults. While adults can also experience continuous bacterial infections and encephalitis, the frequency and severity differ between adults and children.

In addition to influenza complications, Streptococcus pneumoniae is a common cause of continuous bacterial infections following influenza. Simply put, influenza can lead to continuous bacterial infections, with Streptococcus pneumoniae being the biggest threat. There are many bacteria that cause continuous respiratory infections, but Streptococcus pneumoniae is the most common. This bacterium can cause pneumonia complications after influenza, making it a significant concern.

Even without influenza, one can be infected with Streptococcus pneumoniae. Mild infections can cause upper and lower respiratory tract discomfort. Severe complications can include otitis media, sinusitis, and pneumonia. Further invasive infections may lead to sepsis and meningitis.

Who are the high-risk groups for Streptococcus pneumoniae infection? Dr. Qiu Zhengxun notes that Streptococcus pneumoniae is a Gram-positive Streptococcus with a capsular membrane. Over 90 serotypes have been identified, with about 30 causing human infections. High-risk groups for severe invasive infections include:

• People with spleen function defects or spleen resection.
• Individuals with congenital or acquired immune insufficiency, including HIV-infected people.
• Those with artificial ear implants.
• Patients with chronic diseases such as chronic kidney disease, chronic heart disease, chronic lung disease, diabetes, chronic liver disease, cirrhosis, alcohol addiction, and smoking addiction.
• Those with cerebrospinal fluid leakage.
• Patients with malignant tumors or organ transplants who receive immunosuppressants or radiation treatment.

Streptococcus pneumoniae can pose a threat year-round. High-risk groups should be vaccinated to protect against severe complications.

The World Health Organization (WHO) lists Streptococcus pneumoniae as a “super bacteria” with high drug resistance. Initially, penicillin and ampicillin were effective, but resistance emerged in the 1970s. Now, at least third-generation cephalosporin antibiotics are needed for treatment. The antibiotic resistance problem is worsening, so self-medication with antibiotics should be avoided. Dr. Qiu Zhengxun reminds that while there are still effective drugs, prevention through vaccination is key.

The government has promoted vaccination for high-risk groups, including the elderly over 65. The elderly receive one dose of Streptococcus pneumoniae-conjugated vaccine (PCV13/PCV15) and one dose of Streptococcus pneumoniae-polysaccharide vaccine (PPV23) a year later. Babies receive their first dose of PCV13/PCV15 after two months, the second dose at four months, and the third dose between 12-15 months. Additional doses can be given at six months for complete protection.

Streptococcus pneumoniae often lurks in the nasopharyngeal part of the human upper respiratory tract and is transmitted through droplets. Wu Zhixing, director of the Department of Family Medicine, Chengda Medical College, notes that while Streptococcus pneumoniae has about 90 serotypes, only about 30 are highly toxic and prone to causing human infections. The vaccine is designed to protect against the most toxic serotypes. The value of the Streptococcus pneumoniae vaccine refers to how many serotypes it can prevent, such as 15-valent vaccines preventing 15 serotypes. The latest 15-valent vaccine, launched in 2022, targets serotype 3, which is highly toxic and prone to causing infections.

Currently, the Streptococcus pneumoniae vaccines on the market are mainly 13-valent and 15-valent, both of which are conjugate vaccines. There are also 23-valent polysaccharide vaccines, but they have lower antibody titers and less lasting immunity. The difference between conjugate vaccines and polysaccharide vaccines lies in the serotypes protected, applicable age, and administration schedule.

What are the benefits of administering a Streptococcus pneumoniae vaccine? Dr. Wu Zhixing explains that the vaccine reduces the chance of infection and the severity of the infection. Streptococcus pneumoniae is particularly difficult to manage due to its thicker caps, which fight immune cell phagocytosis. Serotype 3, in particular, releases more polysaccharides, inhibiting the immune response and having immune escape characteristics. According to statistics, serotype 3 accounts for about 10% of invasive Streptococcus pneumoniae infections in Taiwan and is among the top three invasive serotypes in the over-65 age group.

Dr. Wu Zhixing advises that if you go out and take a breath, more than 100 kinds of bacterial viruses may invade. The best way to prevent Streptococcus pneumoniae invasion is to vaccinate against serotypes with immune escape characteristics, such as serotype 3. If the 15-valent Streptococcus pneumoniae vaccine is administered, it can prevent the highly toxic serotype 3. If the 13-valent vaccine has been administered, an additional 15-valent vaccine can provide more protection.

Dr. Wu Zhixing reminds the public, especially adults over 65, patients with pneumonia, and high-risk groups, to consider getting the Streptococcus pneumoniae vaccine when receiving the influenza vaccine to achieve dual protection. For businesspeople who travel frequently or plan to travel abroad, it is recommended to get vaccinated two weeks before departure to ensure comprehensive protection and good health.