THOUGH the business of prescribing and dispensing of medicines is exclusively the task of licensed medical doctors, the act of doing so must be exercised with good judgment. If done casually, the consequences might be fatal, a leading pediatric consultant warned. Sami Hussain Al-Hajjar, head of Pediatric Infectious Diseases, Department of Pediatrics at King Faisal Specialist Hospital and Research Center, Riyadh, said medical practitioners should be “judicious” in prescribing antibiotic drugs as these may lead to resistance to other drugs. Speaking to Saudi Gazette on the sidelines of an event on “Pneumococcal disease as the leading preventable cause of death in children” held in Jeddah, Dr. Al-Hajjar noted a “high prevalence” of streptococcus pneumoniae which colonizes the upper respiratory tract causing several types of serious disease including meningitis (inflammation of the membranes surrounding the spinal cord or brain), otitis media (inflammation of the middle ear) bacteremia/sepsis (bacterial invasion of the blood), and bacteremic pneumonia (inflammation of the lung tissue). He said “despite the availability of a few effective antibiotics against streptococcus pneumonia, the increasing resistance of these bacteria has been a major concern with many negative reflections on the public's health and economy alike. This triggers the need for preventive vaccines with a maximum coverage against streptococcus pneumonia serotypes, thus control the widespread of antibiotic-resistant microbes.” There are more than 90 serotypes of streptococcus pneumoniae, but only a small subset of 13 serotypes including (19A) cause the majority of pneumococcal disease and have been recently accountable for high incidence of pneumococcal disease in the US, UK and other western countries. However, Dr. Al-Hajjar said “the 7-valent serotypes vaccine has significantly reduced IPD in USA by 94 percent between the years 1998 and 2004. It has also reduced hospitalization due to all cause pneumonia by 39 percent and reduced hospitalization due to pneumococcal pneumonia by 65 percent.” A five-year retrospective surveillance study revealed that the average annual incidence of invasive pneumococcal disease (IPD) among children aged five years and under was 17.4 cases per 100,000 which is comparable to the incidence in the US and other European countries. The study, conducted from 1999 to 2003, and published in the International Journal of Infectious Disease, noted a total sample of 82 IPD cases in children up to five years old in the central and western regions which showed 19 (23.2 percent) meningitis and 63 (76.8 percent) bacteremia. A number of factors can increase the likelihood of contracting pneumococcal disease: • Age: Children younger than two years old are at increased risk of pneumococcal infection, as are adults 65 years of age and older. In fact, streptococcus pneumoniae is the most common cause of community-acquired pneumonia in these age groups. • Underlying medical conditions: Medical conditions including sickle cell disease, HIV, diabetes, pulmonary disease, and asplenia predispose individuals to pneumococcal disease. • Out-of-home child care: Children who attend out-of-home child care are at increased risk of contracting pneumococcal disease compared with those who do not. Out-of-home child care was defined as any setting outside the home where a child regularly spends four or more hours a week with at least two unrelated children under adult supervision.10 • Ethnic Group: Certain racial groups have a higher risk of contracting invasive pneumococcal disease. According to World Health Organization (WHO), pneumococcal disease is the leading vaccine-preventable cause of death in infants and children younger than 5 years of age. Pneumococcal disease is estimated to cause up to 1.6 million deaths in all ages each year worldwide, mainly from developing countries. Dr. Al-Hajjar said the prevalence of pneumococcal disease and associated co-morbidity and mortality were most probably higher, bearing in mind that many cases were not clinically and microbiologically investigated and randomly treated by antibiotics. He stressed the importance of raising awareness of the population as to the best preventive measures to address the disease, adding that the Saudi Ministry of Health is abreast with the latest developments and discoveries in medicine, and now evaluates new vaccines available in the international market before introducing them locally as part of the national vaccination program. He encouraged people to strictly comply with the Kingdom's immunization program, saying that vaccination is the best deterrent to invasive pneumococcal disease. Lately, he said, the 13-valent streptococcus pneumonea serotypes vaccine has been approved by the European Medicines Agency (EMEA) for the prevention of IPD, pneumonia and otitis media between 6 weeks and five years of age. In addition, it is the only approved vaccine by the US Food and Drugs Administration currently. WHO recommends the registration of the vaccine as part of the compulsory national immunization programs worldwide. The vaccine is available in more than 78 countries across the globe, including GCC countries, the Middle East and Africa which has the third highest prevalence of pneumonia based on the World Health Organization studies. Dr. Al-Hajjar is also the chairman of the committee investigating polio virus infection in the Kingdom and an active member in the National Scientific Committee in the MOH. He is also a full fellow of the American Society of Virology, Infectious Disease Society of America, Pediatric Infectious Disease society, the Association of Medical Microbiology and Infectious Disease in Canada, The American Academy of Pediatrics, and European Society of Clinical Virology.
