Healthpedia

SARS Septal Defect Scabies Sinusitis Sleep Apnea Strabismus

Schizophrenia Septicaemia Skin Cancer Smallpox Systemic Lupus Erythematosus Streptococcus pneumonias

 

SARS

 

Definition:

Severe acute respiratory syndrome (SARS) is a viral respiratory infection. It is caused by a coronavirus. SARS is predominantly transmitted through close person-to-person contact, especially via respiratory droplets produced when an infected person coughs or sneezes and deposited on the mucous membranes of the mouth, nose, or eyes of the bystanders. The incubation period typically ranges from 2-10 days. As the virus can survive to up to 72 hours at the contaminated surfaces, it can also be spread when a person touches a surface or object contaminated with infectious droplets and then touches his or her mouth, nose, or eyes. In Hong Kong, there were 1755 confirmed cases of SARS and 386 cases are healthcare workers and the death toll was 299.

 

Who is at risk?

• Hospital workers who have physical contact with SARS patients especially those with inadequate or inappropriate usage of the personal protection equipment;
• Patients at the same ward of the SARS patients;
• Laboratory researchers or technicians handling the SARS sputum;
• Close contacts and family members who lived with SARS patients;
• Residents of Amoy Garden at the time of the endemic (secondary to the contamination of the environment).

 

Symptoms:

1. Fever over 38 degrees Celsius is the most common reported symptom (>90%)
2. Respiratory symptoms: Cough, sore throat, breathlessness and running nose
3. Gastrointestinal symptoms: Diarrhea, vomiting and nausea
4. Two thirds of the patients presented with respiratory symptoms and one third presented with gastrointestinal symptoms

 

Treatment:

Options include

• Antibiotics.
• Antiviral agent (Ribavirin) and corticosteroids.
• Hyperimmunoglobulin infusion.
• Supportive treatment.

Thus far, there is no international agreement to the best treatment regime. Antibiotics are ineffective for the primary disease and the Ribavirin/steroid treatment in Hong Kong had variable response rates and complications.

 

Research:

• Glycyrrhizin showed inhibitory activity against the virus associated with SARS.
• Cinanserin reduces the ability of the virus to replicate in virus cell cultures. Cinanserin was tested as a treatment for schizophrenia and mania in the early 1970s, but trials were halted after the drug was found to cause cancer in rats.

 

Prevention:

1. Administrative control by the government
   
   • Case detection and treatment.
   • Contact tracing and isolation.
   • Daily reports and monitoring.
   • Prevention of export of cases by health checks at borders.
   • Educating the public about the symptoms of SARS.
   • Setting up of Designated Medical Centres.
   • Schools: Daily temperature checks and closure of the school for cleaning once a suspected case is identified.
   • Set up a SARS alert system and the evidence based treatment regime.
2. Engineering/environmental control
   
   • Maintain good ventilation.
   • Maintain a healthy lifestyle: Well balanced diet & regular exercise.
   • Cleaning of furniture and household facilities with hypochlorite.
   • Keep the toilet clean and maintain proper function of drains and pipes.
   • Clean the floor drain outlets regularly.
   • Wash hands thoroughly and maintain good personal hygiene. Avoid touching the eyes, nose and mouth. Always carry a handkerchief or tissue paper. Cover the nose and mouth when sneezing or coughing. Wash hands immediately with liquid soap for at least 10 seconds. People with symptoms of respiratory tract infection or fever should wear a mask and consult a doctor promptly.
3. Personal protection equipment
   
   • Surgical mask: As good as N95 if properly worn.
   • N 95 mask: Use in high-risk contact.
   • Goggles: Protect the eyes from contamination.
   • Gown: Disposable after each contact.
   • Gloves: Disposable after each contact.

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Schizophrenia

 

Definition:

Schizophrenia is a disease of the brain which manifests as a psychiatric illness. Patients often have terrifying symptoms such as hearing internal voices not heard by others, or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them.

 

Who is at risk?

Approximately 1% of the population develops schizophrenia during lifetime. People who have a close relative with schizophrenia are more likely to develop the disorder, but the genetic transmission is still poorly understood. Other constitutional factors such as the physical built, early childhood experiences, psychological and social stresses and physical illnesses can contribute.

 

Symptoms:

Symptoms may develop very gradually, or may strike dramatically within days. Symptoms can be classified into negative and positive symptoms:

• Negative symptoms
  The patients appear to be absorbed in their own thoughts and are socially withdrawn. There is a general lack of affection for relatives and friends. They appear cold, bored, apathetic, and have lost interest in things happening around them. Their thoughts tend to be disconnected and their replies to questions may be irrelevant.
  
  
• Positive symptoms
  They may have hallucinations, often in the form of hearing voices which are not there. They may hold false believes that do not make sense. These false beliefs are often paranoid in nature, so that their may believe that they are being watched or followed or suspect people are trying to harm them.

 

Treatment:

A group of drugs called "antipsychotic drugs" are very useful in controlling some symptoms of schizophrenia. These drugs may have side effects such as drowsiness and abnormal movements. Newer antipsychotics may be better tolerated. Long acting injected preparations are useful in uncooperative patients.

Apart from drugs, psychotherapy and psychosocial treatment may also be used.

 

Prevention:

There is no way to prevent schizophrenia as the cause of the disease is still poorly understood. The community should work towards diagnosing and treating the disease early. We should also prevent relapses by ensuring that patients are compliant with the prescribed medication and provide good social and rehabilitation support to families.

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Septal Defect

 

Definition:

Septum is a wall partition. A septal defect is a hole in the partition.

The upper two chambers of the heart, called the atria, are separated by the atrial septum; and the lower two chambers, called ventricles, by the ventricular septum.

A patient suffering from atrial septal defect is having a hole in the atrial septum, similarly with ventricular septal defect.

 

Who is at risk?

Most cases of septal defects are congenital, and occur by chance as the fetus develops. The risk of having a child with congenital heart disease in general is 1% and increases to 2% if you already have one child with the condition. No cause can be identified in most cases, although the following conditions are known to be associated.

1. Certain chromosomal abnormalities or genetic defects.
2. Viral infections in the womb such as rubella.
3. Exposure of the fetus to drugs in pregnancy, such as those against epilepsy.

Statistically, septal defects occur more often if the mother is abusing alcohol, has poor nutrition, or is suffering from poorly controlled diabetes.

 

Symptoms:

Babies born with small septal defects may not have any symptoms. Symptoms may not appear until adolescence or adulthood especially with atrial septal defects. Often, a doctor picks up a murmur (a rumbling sound as blood is flowing through the defect) or abnormal heart sounds incidentally during routine examination.

When the defects are large, the following symptoms can occur during infancy or childhood.

1. Poor feeding, sweat profusely when feeding, and choke easily.
2. Failure to gain weight and growing poorly.
3. Have frequent respiratory infections, including pneumonia.
4. Getting tired and breathless easily.

 

Treatment:

When a septal defect is suspected, doctors need to confirm the diagnosis and assess its severity with tests. This would often include an echocardiogram (echo) - which uses sound waves to locate the hole and find out the size and blood flow.

One of the following strategies may be recommended depending on the patient's condition and results of tests:

• Expectant
  Many small, asymptomatic septal defects may close spontaneously with growth. Patients just need to be followed.
  
  
• Medical
  Symptoms caused by septal defects often respond to drugs which strengthen the heart or decrease its workload. Nutritional supplements may be advised to feed up the underweight. These are often prescribed while waiting for the hole to close by itself or by surgical intervention.
  
  
• Surgical
  Surgical closing of a septal defect, often with a patch of synthetic material, is recommended when symptoms cannot be controlled with drugs or when the chance of spontaneous closure is remote. A new closure device may be possible for limited types of septal defects, thus avoiding open heart surgery.
  
  

 

Prevention:

Most cases of congenital septal defects are chances of nature, and little can be done to avoid them. You should of course avoid the known risk factors. Screening tests are available in early pregnancy for certain chromosome disorders, which can occur with septal defects.

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Septicaemia

 

Definition:

Commonly called blood poisoning or sepsis, septicaemia is caused by toxins or bacteria circulating in the blood. The presence of bacteria or toxins in the blood activates severe inflammatory responses and affects blood coagulation. These cause failure in multiple organs. It is a serious, rapidly progressive, life-threatening infection.

 

Who is at risk?

The following categories have the highest risk of having septicaemia:

• Newborns
• Elderly
• Immunocompromised
• Surgery
• Injection drug users

Septicaemia is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% to 60%.

 

Symptoms:

Septicaemia often begins with spiking fevers and chills though some patients may have body temperature below normal. The patient may complain of general pains and aches, or may have abdominal pain and vomiting. He looks severely ill and is breathing rapidly. Soon he becomes confused, with a weak, rapid pulse and a falling blood pressure. Red spots may appear in the skin, as a result of bleeding into the skin.

 

Treatment:

Successful treatment of septicaemia depends on:

1. Prompt use of antibiotics
   The drug must be effective against the microorganism, and is given in adequate dosage directly into the blood.
   
   
2. Drainage of infected fluid collections in the body, if any.
   Doctors are still debating on the role of other drugs such as steroid hormones and blood products in the treatment of septicaemia. Supportive treatments to failing organs such as the lung, the kidneys, the liver and the coagulation system are also essential.

 

Prevention:

A bacterium called Group B Streptococcus carried in mother's birth canal is a common cause of septicaemia in newborn babies. Screening and treatment of infected pregnant women can prevent the disease in newborn.

For infants and children, there are effective vaccines against bacteria such as Haemophilus influenza type b (a germ that causes meningitis) and pneumococcus (a germ that causes pneumonia) which are common causes of septicaemia in children. These are available in private clinics and hospitals in Hong Kong. Early, appropriate treatment of localized infections can prevent septicaemia.

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Sinusitis

 

Definition:

Sinusitis is inflammation of the sinus cavities. The sinus cavities are air-filled spaces in the skull. Depending on the severity of the infection, often little or no treatment is needed and 70% of sufferers will feel better within a week Acute sinusitis lasts for less than three weeks. Chronic sinusitis is diagnosed when symptoms last for at least 3 months. Recurrent sinusitis refers to repeated bouts of acute sinusitis.

 

Who is at risk?

• People with recent flu or cold;
• People who smoke or have exposure to second-hand smoke;
• People exposed to other sources of indoor or outdoor air pollution;
• People with allergies particularly hay fever;
• Abnormalities of the facial bones or nasal passages, such as:
  1. Deviated septum (an anatomical variation where the partition between the two sides of the nasal cavity is shifted towards one side);
  2. Nasal polyps;
  3. Cleft palate (a congenital defect in the palate, the separation between the nasal and oral cavities);
  4. Large adenoids (the collection of lymphatic tissues at the rear of the nose);
• Head injury or a medical condition requiring a tube inserted in the nose;
• Certain chronic illnesses, including:
  1. Cystic fibrosis (a genetic disease where patients has impaired secreting function in various organ, such sweat glands, lungs, intestines and pancreas) ;
  2. HIV;
  3. Diabetes.

 

Symptoms:

1. Headache when you wake up in the morning is typical of a sinus problem. The sinuses most commonly affected are:
   • the cheekbones (maxillary)
   • the forehead (frontal), and
   • the parts of the skull near the eye sockets (ethmoid and sphenoid sinuses)
2. Other symptoms of sinusitis can include
   • Nasal congestion. Runny nose or post-nasal drip (discharge from back of the nose)
   • Cough, often worse at night and with thick, yellow or green mucus
   • Ear or teeth pain
   • Fever
   • Facial congestion or fullness
   • Bad breath
   • Bad taste in your mouth
   • Decreased ability to smell
   • Acute brain infection (rare)

 

Treatment:

1. Loosen nasal secretions: Drinking lots of fluids. Salt water nose sprays or irrigation using various devices may also help.
2. Steam treatments/ humidifier.
3. Over-the-Counter pain medication such as paracetamol and ibuprofen as analgesic (pain killers). Aspirin is not recommended for children with a current or recent viral infection.
4. Decongestants: To shrink nasal passages. Don't use nasal sprays for longer than 3-4 days in a row.
5. Antihistamines: May help sinusitis symptoms if it is caused by allergies, but may also dry out the nasal mucosa.
6. Stroid nasal spray: If longer term treatment is indicated.
7. Antibiotics if the infection seems to be caused by bacteria.
8. Surgery includes: Repair of a deviated septum (an anatomical variation where the partition between the two sides of the nasal cavity is shifted towards one side), removal of nasal polyps or functional endoscopic sinus surgery (a lighted scope to enlarge the sinuses to improve drainage).

 

Prevention:

• Drink lots of fluids and use a humidifier when you have a cold, allergic symptoms, or sinusitis.
• Avoid known allergens if you already know what you are allergic to.
• If you have allergies, consider using cortisone nasal spray or antihistamines to decrease inflammation of your nasal passages.
• Try not to fly in an airplane when you are congested. If you must fly, use a nasal spray decongestant to decrease inflammation prior to take-off and landing.
• Avoid cigarette smoke.

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Skin Cancer

 

Definition:

Skin cancer is a disease in which cancer (malignant) cells are found in the outer layers of your skin. Your skin protects your body against heat, light, infection, and injury. It also stores water, fat, and Vitamin D. Skin cancer falls into two broad areas:

1. Non-melanoma skin cancer (basal-cell cancer and squamous cell cancer).
2. Melanoma.

Although skin cancer can occur in people of all races, those with darker skin typically have a lower risk because their skin contains more of the pigment melanin, which protects against skin cancer.

 

Who is at risk?

1. People with fair skin;
2. People with a history of sunburns;
3. People with excessive sun exposure;
4. People at sunny or high-altitude climates;
5. People who have dysplastic nevi and moles;
6. People with precancerous skin lesion;
7. A family history of skin cancer;
8. A personal history of skin cancer;
9. People with a weak immune system;
10. People with fragile skin;
11. People who are exposed to environmental hazards e.g. herbicides.

 

Symptoms:

The most common symptoms are

• A new growth on the skin
• A change in an existing skin growth: Changes in size, shape, color and contours of border
• A sore that does not heal

 

Treatment:

Various modality of treatment are used for most skin cancers. They are:

• Surgery: Taking out or destroying the cancer.
• Chemotherapy: Giving drugs to kill the cancer cells.
• Radiation therapy: Using powerful energy from X-rays or other sources to destroy the cancer cells.
• Photodynamic therapy uses drugs that collect inside a tumor. The doctor then focuses a special light on the tumor. The light triggers a chemical reaction in the drug that destroys tumor cells, but does not harm surrounding normal tissue.
• Biological therapy tries to use the body's own natural defenses to attack and destroy cancer cells. It sometimes is called biological response modifier (BRM) therapy or immunotherapy.
• People with small basal cell carcinomas, for instance, may need only simple treatment. That's because basal cell cancers rarely spread to other parts of the body and seldom are fatal.
• Squamous cell carcinomas have a greater tendency to spread, and may require more treatment.
• Malignant melanoma may require complicated treatment because of its high risk for spreading.

 

Prevention:

Prevention must begin in childhood. That's because most people get about 50% of their lifetime sun exposure before age 18.

Practical measures to prevent skin cancer include:

• Avoiding direct sunlight and strong rays reflected from water, sand and snow.
• Staying out of the sun especially between 11 a.m. and 3 p.m. when the strongest UV rays reach Earth's surface.
• Shielding the skin with tightly knit clothing. Long-sleeved garments made from light fabric can protect the skin in summer and yet be cool and comfortable. Hats with broad brims can shield the face.
• Using sunscreen with at least a SPF-15 or higher, to all areas of the body which are exposed to the sun. Pick a sunscreen that provides "broad spectrum" protection against both kinds of UV radiation in sunlight, UVA and UVB. Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
• Avoid exposure to UV radiation from sunlamps or tanning parlors.
• People with close relatives who developed malignant melanoma may have inherited a damaged gene that increases their risk. For them, preventive measures and regular skin exams can be especially important.

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Smallpox

 

Definition:

Historically, smallpox is a highly contagious disease that is caused by a deadly virus called Variola. A virulent strain of the virus typically kills 20 to 40 % of those infected. Those surviving the disease are left with and persistent skin scarring known as pockmarks. Scarring in the eyes can cause blindness.

 

Who is at risk?

The last naturally occurring case in the world was in Somalia in 1977. The WHO has announced that the Smallpox virus has successfully been eradicated in nature since the virus cannot survive onside human bodies in nature.

It doesn't follow that nobody is at risk now. Samples of the virus are still kept in research laboratories. Scientists, medical professionals and technicians working in such research facilities would be vulnerable if accident happens. There are also concerns that the virus could be used by terrorists and in biological warfare.

 

Symptoms:

Symptoms appear about 7 to 17 days after exposure and starts with high fever, headache and body aches. A rash follows two to three days later, which spreads and progresses to become raised bumps with severe blistering in the following 10 to 14 days. The blisters scab and fall off after about three weeks, leaving a pitted scar.

 

Treatment:

Treatment is supportive, there being no cure for smallpox. Vaccination within 3 days of exposure may prevent or lessen the severity of the disease.

 

Prevention:

Routine vaccination against smallpox among the general public was stopped in all countries because it was no longer necessary. The vaccine is still given to those working in research laboratories and sometimes to the military.

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Sleep Apnea

 

Definition:

Apnea means cessation of breathing. Sleep Apnea is defined as a pause of breath lasting ten seconds or more during sleep.

There are two main types of sleep apnea:
Obstructive Sleep Apnea (OSA):causes collapse of the upper air during sleep
Central Sleep Apnea:the brain fails to send the appropriate signals to move the respiratory muscles.
Since central sleep apnea is rare, people use the term sleep apnea loosely to mean OSA.

 

Who is at risk?

• Obesity
• Male
• People with thick neck and small chin
• People with enlarged tonsils or adenoids
• Chronic drinkers and smokers
• Patients with high blood pressure or diabetes

 

Symptoms:

Loud snoring
Obstructive sleep apnea is usually associated with snoring. The snoring proceeds at a regular pace for a period of time, often becoming louder, but is then interrupted by a long silent period with no breathing.
Breathing cessation during sleep (Apnea)
If the duration of breath holding exceeds 10 seconds, it is called apnea. Patients may become awake gasping for breath.
Morning headache
Since sleep is fragmented, the patient wakes up un-refreshed, with vague symptoms such as headache, tiredness, dry mouth and throat.
Excessive daytime sleepiness (hypersomnia)
Patient may fall asleep during business meetings, eating or even driving

 

Treatment:

Continuous positive airway pressure (CPAP)
This is a machine that delivers air pressure through a mask placed over the nose during sleep to keep the upper airway passages open.
Oral appliances
Devices may be designed by dentists to keep the jaw forward. They can relieve snoring and mild obstructive sleep apnea.
Surgical procedures
The most common type of surgery recommended by experts involves removing excessive soft tissues from the back of the mouth and top of the throat along with the tonsils and adenoids.

 

Prevention:

• Treat any nasal symptoms that are caused by infections or allergies
• Lose weight
• Avoid alcohol
• Do not use sleeping pills
• Sleep on your side

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Strabismus

 

Definition:

Strabismus is sometimes known as crossed eyes, walleye, lazy eye or squint. The eyes do not point to the same direction. While one eye is looking straight ahead, the other may be looking up, down, in or out.

 

Who is at risk?

Strabismus is most common in children. Often there's no known cause, though sometimes the condition runs in families. Children with strabismus may also be farsighted, with both eyes affected asymmetrically.

Babies born prematurely and requiring high levels of oxygen have an increased risk of strabismus. Strabismus can also occur in children with neurological disorders. It is also common in children recovering from birth trauma, meningitis or brain bleeding. Patients with brain tumors may suffer from strabismus if the nerves controlling eye movements are interfered with. In adults, strabismus can also occur as a result of diabetes, or when a tumor grows around the eye.

 

Symptoms:

The eyes do not point to the same direction. While one eye is looking straight ahead, the other may be looking up, down, in or out.

 

Treatment:

A child with strabismus would receive a different image from each eye. With time the brain would learn to ignore the weak eye. Even when the vision of the weak eye has been restored, the patient's brain would not be able to "see". This permanent loss of vision is called amblyopia.

So the purpose of principle of treatment is to encourage the child to use the weaker eye by patching up the good side. Corrective spectacles need to be prescribed early. Surgery can correct strabismus in older children, but any loss in vision cannot be recovered.

 

Prevention:

Although strabismus cannot be prevented, its consequence can, provided the condition is detected early and treated properly. That's why every check-up should include a screening test for strabismus.

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Systemic Lupus Erythematosus

 

Definition:

Systemic lupus erythematosus (SLE) is a chronic immunological disorder. The patients' immune system is attacking and causing harm to their own organs. The skin and the joints are most commonly affected, but no organ is exempted. Accumulation of immune products can also damage small blood vessels and the kidneys.

 

Who is at risk?

SLE is more common in certain ethnic groups, including the Chinese. A family history of SLE would increase the risk. The exact genetic mechanism is still uncertain. If a person has an identical twin suffering from SLE, the chance of having the disease is about 30 to 50%. SLE can affect all age groups and both sexes, but is most common in women aged 20-45 years. The disease can get worse with pregnancy.

 

Symptoms:

The most common early symptoms are joint pain, fever and skin rash. Typically the rash is distributed over both cheeks, like a butterfly. Virtually any organ, including the heart, lungs, the gut and the blood, may be involved as the disease progresses. There is wide variation in the degree of severity. The chronic disease is marked by unpredictable periods of remissions and flares. When the brain and kidneys are involved, the disease is life-threatening.

 

Treatment:

Very mild cases may just need pain-killers and rest. Skin rash may respond to steroid creams. Some patients, especially those with joint pains, may require drugs related to aspirin as anti-inflammatory agents. Severe cases often require steroids given systemically. Those severely ill with the disease may be helped with anti-cancer drugs.

 

Prevention:

Most cases of SLE are not preventable as the exact mechanism of the disease is still unknown. Drugs that can give rise to symptoms of SLE should be avoided whenever possible. Patients should avoid exposure to the sun and UV light. Combined contraceptive pills can trigger a flare up in patients with SLE.

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Scabies

 

Definition:

This is a contagious skin disease caused by a parasitic mite. The mite burrows into the skin and causes an intensely itchy rash.

 

Who is at risk?

• People living in crowded conditions
• People who live or work in institutions or prisons
• Patients and workers in hospitals and nursing homes
• Students, teachers, and caregivers in day-care centers
• People who have multiple sex partners

 

Symptoms:

• Intense itching, often worse at night
• A characteristic rash, typically affecting the skin between the fingers, and often involving the genitalia, the breast and the skin folds at the wrists, knees, elbows and armpits.
• Some patients may develop bumps or nodules on the affected areaOther family members often have similar symptoms.

 

Treatment:

Scabies can be treated with topical medicine applied to the skin. Many chemicals can kill the mite, but the doctor needs to consider the patient's age and sensitivity in order to prescribe the right treatment. The medication needs to be applied from neck to toe after bathing and must be remained on the skin overnight before being washed off. Sometimes a second application may be needed. The rash and itchiness may linger for weeks after treatment. Close family members and all sexual partners must be treated at the same time even they have no symptoms.

 

Prevention:

• Do not share clothing and towels.
• If you work in institutions, reflect to the management if there is overcrowding. Report suspicious cases and take infection precautions.
• If someone in your household has been diagnosed with scabies, wash the clothing, bedding and towels in hot water. Dry clean items with high temperature that you can't wash at home. Clothing that cannot be washed should be sealed in plastic bags and stored for approximately one month before being used again.

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Streptococcus pneumonias

 

Definition:

Infections in the lungs caused by the bacteria Streptococcus pneumoniae. The bacteria can live in our upper respiratory tract and may invade into one or more lobes of the lung. The disease frequently occurs after viral upper respiratory tract infections such as influenza.

 

Who is at risk?

• Though the disease is also common in children and young adults, those younger than 2 and above 65 years of age have greater risk for complications
• Smokers and alcoholics
• Patients with chronic obstructive pulmonary disease (COPD)
• Patients with congestive heart failure or cerebrovascular diseas
• Patients with immune deficiencies
• People who have their spleen removed, or those with sickle-cell disease or thalassemia who have a diseased spleen
• People with cochlear implants.

 

Symptoms:

• Fever and chills, usually of acute sudden onset
• Cough, which is dry initially, becoming productive later and may be blood stained
• Chest pain, which is sharp and worse with deep breathing
• Shortness of breath
• Headache, nausea and vomiting
• Abdominal pain

 

Treatment:

Treatment with antibiotics, such as penicillin, is usually effective if the disease is diagnosed early. However, the incidence of penicillin-resistance is rapidly increasing. More powerful and expensive drugs are necessary in such cases.

 

Prevention:

There are two kinds of vaccines. "Polysaccharide vaccines" are made from polysaccharide antigens (sugar capsules) purified from the bacteria. It is not very effective in small children. Those younger than two should receive "conjugate vaccines" which are made by attaching a protein molecule into the polysaccharide antigen to boost immunity.

Pneumococcal vaccine was introduced into the Childhood Immunisation Programme in Hong Kong in September 2009. Newborns should receive a standard 3-dose primary series at 2nd, 4th and 6th months of age with a booster dose at 12-15th months. Those above 65 years old are also entitled to government subsidy scheme to be vaccinated.

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