Ryan Haumschild, PharmD, MS, MBA: Hello, and welcome to this Pharmacy Times®Peer Exchange, “The Critical Importance of Pneumococcal Vaccines in Protecting Adult Populations.” My name is Dr Ryan Haumschild, director of pharmacy at Emory Healthcare and the Winship Cancer Institute [in Atlanta, Georgia]. Joining me in this discussion today is Dr Christina Madison, TEDx speaker, founder and CEO of The Public Health Pharmacist, and associate professor of pharmacy practice at Roseman University of Health Sciences [in Las Vegas, Nevada].

Dr Mary Bridgeman, clinical professor at the Ernest Mario School of Pharmacy at Rutgers University [in New Brunswick, New Jersey], and internal medicine clinical pharmacist at Robert Wood Johnson University Hospital [in New Brunswick, New Jersey].

And Dr William [Bill] Schaffner, professor of preventative medicine and infectious diseases at Vanderbilt University School of Medicine [in Nashville, Tennessee]. Today we are going to talk about several topics including an overview of pneumococcal infections, clinical insights on the importance of vaccination against pneumococcal bacteria, and addressing barriers associated with pneumococcal vaccination. Let’s get started.

Let’s start with an overview of pneumococcal infections. The best way to do that is to start with the signs and symptoms of these infections in adults.Dr Bridgeman, if you could, can you characterize what those signs and symptoms of pneumococcal infections are and what we should be considering?

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: Pneumococcal infections caused by the bacteria, Streptococcus pneumoniae or pneumococcus, can certainly manifest in many different clinical presentations. We know if the bacteria invades the lungs, it can be associated with pneumonia and associated symptoms. If it’s meningitis, we know that there can be CNS [central nervous system] involvement, or can presentation that way. Bacteremia or osteomyelitis is an organism that affects the blood or the bones, respectively, and even otitis media and sinusitis, if the inner ear or the sinuses are involved. When we think about symptoms of pneumococcal infections, they are dependent on the part of the body or the system that’s really involved. Pneumococcal pneumonia, for example, one of the most common types of bacterial pneumonia, can present as we would expect with respiratory and systemic symptoms; fever, chills, cough, dyspnea, difficulty breathing, or even chest pain. We know older adults experiencing pneumococcal pneumonia may experience altered mental status or present with some confusion or altered levels of mentation. If we’re talking about meningitis, then the symptoms on the other hand can include those associated with meningitis presentation with a stiff neck, headache and fever, photophobia, or sensitivity to light. In general, I think the common symptoms of pneumococcal infections really tend to include fever, aches and pains, and headaches, possibly. I think the bottom line is the symptoms of pneumococcal infection really depend on the body site and body system that’s affected.

Christina Madison, PharmD, FCCP, AAHIVP: I’m so glad that you pointed out that even though it says pneumococcal, and people just automatically assume pneumococcal pneumonia, this can also cause a meningeal presentation. Because I think that often gets confused and I’m really glad that you covered it.

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: Absolutely. I think it’s a good opportunity. I know we’re going to talk a little bit about this, but we can even think about classifying infections and symptom presentation as being either noninvasive or invasive.

Christina Madison, PharmD, FCCP, AAHIVP: Correct.

Mary Bridgeman, PharmD, BCPS, BCGP, FASCP: Where you’ve got that otitis media sinusitis presentation more noninvasive, and generally less severe than a more invasive meningitis bacteremia and others.

Ryan Haumschild, PharmD, MS, MBA: Well, that’s a great overview and I appreciate it. There is definitely a lot we need to keep on the radar as we’re diagnosing and working up our different patients. Speaking of seeing how pneumococcal manifests in patients, Dr Schaffner, I’d love to get your thoughts on how you see these manifestations occur. What manifestations of pneumococcal infections are most commonly seen in adults rather than children?

William Schaffner, MD: As Dr Bridgeman and Dr Madison have just said, pneumococcus is a total potential organism. It can affect any number of body sites. Now in children, the most common presentation of pneumococcal infections is undoubtedly middle ear infection, otitis media. It can also result in pneumonia and there’s a bridge to the adult side. We think of pneumococcal infections. I think most of us when we went to school, first learned about pneumococcal infections in the context of lower respiratory infection, pneumonia, but it also can clearly cause occasionally a middle ear infection in adults that’s comparatively rare. But also if this pneumonia is severe enough, it can be associated with bacteremia. You can get a septic presentation and sometimes you can even get pneumococcal bacteremia absent, ear pneumonia. It usually does have a focal point. Once this pneumococcal infection circulates in the bloodstream, it can affect other organ systems as we already mentioned. For example, if you can get pyogenic arthritis, you can get empyema. You can get pericarditis. And, of course, you can get very serious meningitis. So when we think about pneumococcal infections, particularly in adults, we think pneumonia community-acquired pneumonia and also pneumonia accompanied by bacteremia as well as other invasive pneumococcal infections that can affect other body sites—the central nervous system, arthritis, pericarditis, and the like.

Ryan Haumschild, PharmD, MS, MBA: I appreciate that you went through the different systems that are affected because you’re right, typically a lot of us think of pneumonia as that traditional presentation, but what we’re learning is it can impact a lot more.

Transcript edited for clarity.