Pneumococcus - innocent symptoms, serious consequences. Episode 67

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you very warmly to the next episode of the First Patient programme. Worldwide, more than 1 500 000 people die each year from pneumococcal infections. Today, I will be talking to Dr Piotr Ligocki, who is a specialist in internal medicine and a specialist in rheumatology, about who they are particularly dangerous for. Good morning, and a warm welcome, doctor.

Piotr Ligocki
Editor, good morning to you.

Monika Rachtan
Well, we tend to associate pneumococci with children and it seems that they are the ones we are mainly going to talk about today. But this is not true, because pneumococci are also dangerous for another group of patients. For whom, doctor?

Piotr Ligocki
Of course, we tend to associate pneumococci only with children. Of course, there are studies showing that it may be a bacterial flora that lives in our organism and does not harm us, but mainly if it is a so-called carrier flora, or let us call it the presence of pneumococci, then we are talking about children. On the other hand, we also have it in some adults. However, the situation changes when we have adults over 50 years of age who still have associated diseases.

Monika Rachtan
What are these conditions?

Piotr Ligocki
Oh, that is a lot. Actually, we can start with the, let's call it, the most delicate ones. The first thing is diseases broadly speaking autoimmune diseases.

Monika Rachtan
That is, hypothyroidism.

Piotr Ligocki
With hypothyroidism, I know that now Hashimoto's is a very fashionable disease, but I would here more. My other speciality, which is rheumatology, is precisely rheumatic diseases, rheumatic diseases, all the ones that stimulate our immune system in a perverse way. Certainly, thyroid diseases are also a certain factor that alters and distorts our immunogenicity, our immuno-immunity. However, it is certainly not such a clear-cut factor. On the other hand, we have another disease that is actually, well, autoimmune. This is diabetes, which is also, unfortunately, a very strong predisposing factor for pneumococcal pneumonia, but a worse thing, in fact, one that is always an alarm for us to watch out for these patients. These are malignant diseases, these are both solid tumours, that is oncology in the broadest sense, but also haematological conditions. In fact, all haematological diseases could be mentioned here, which make people more susceptible to contracting, or perhaps in other words being infected by, pneumonia, as we are only talking about the form of, in inverted commas, respiratory pneumococcal infection.

Monika Rachtan
And she may also have some other facets, not just respiratory?

Piotr Ligocki
And of course it is, because pneumonia is, as it were, the lowest sentence for that patient who is infected. On the other hand, we can also have an invasive form of pneumococcal infection and then we already have a big problem, because we simply have sepsis and, unfortunately, sepsis, which enters our patient, who has accompanying diseases. I have not yet mentioned them all here, because, for example, it is also chronic renal failure.

Monika Rachtan
Which affects a very large group of Poles.

Piotr Ligocki
Of course it does.

Monika Rachtan
And it is also often the case that we do not know that we have this chronic kidney disease, because here with the diagnosis is a big problem, so the patient, when he gets one. When he develops an infection just with pneumococcus, he does not know that he has chronic kidney disease, this disease can progress very quickly. It can also have an unpredictable course.

Piotr Ligocki
And it is also a factor that causes a particular patient with kidney failure to become infected more quickly. It is the case that the kidneys are such an organ somewhat similar in this respect to the liver, that half of them are no longer working, and we do not yet really know that they are not yet working. Of course, such slight fluctuations in creatinine and other factors that show us that something is going on with these kidneys are sometimes not so much that they are overlooked by GPs only. And that's you drink a bit more fluids, but there should be a recommendation in a month or two, please do a creatinine level so we can see what's going on. Glomerular filtration rate as EgFR so called, so that we know then what is happening with this patient.

Monika Rachtan
Doctor, I would like to ask you one more very important thing, because the programme is aimed at patients, at all of us. It is worthwhile, if there is something abnormal in these kidney parameters and the doctor does not order these additional tests. However, it is worth asking your primary care physician for these tests, asking the doctor to prescribe them and he will then certainly do it, because these tests are in the basket of services of a primary care physician and we can perform them free of charge within the framework of a referral.

Piotr Ligocki
But it's not free, because you have to pay for it. But this is the truth. However, I would also like to warn you as a patient about one thing: if your doctor recommends that you drink 2 litres of fluids, it means that you have to drink these 2 litres of fluids, because it is often the case that it is such an elevated serum creatinine level caused precisely because a person does not drink fluids, it is hot, it is warm, they do not drink fluids and it is a result that is a false positive. Therefore, follow the recommendations and then only really go for another test. Usually, GPs and other specialities, when they see an elevated creatinine due to the fact that it is also a factor that makes us unable to use certain medications, including non-steroidal, anti-inflammatory drugs or limit their dosage, they pay very close attention to this. However, returning to pneumococci, to pneumococcal infection, we also have one of such atypical conditions which is a factor strongly predisposing to pneumonia, namely lack of spleen. Lack of spleen, which can occur even in very young people as a result of trauma from some fall somewhere.

Piotr Ligocki
Removal of the spleen, because it is an organ that is often unfortunately damaged in accidents and must then be removed. Various diseases affecting the spleen unfortunately predispose very strongly to pneumococcal pneumonia. There is also the cochlear implant, for people with ENT problems. Here, too, there is a strong predisposition due to the fact that pneumococci are also often present in children. Otitis also occurs in the ear. And there is a kind of, let's call it, transmission belt that allows them to infiltrate. Whether this ends in pneumonia or meningitis varies from person to person.

Monika Rachtan
That is to say, it turns out that in this group of 50-year-olds and older people, this population of patients, of people who are not yet patients, who are particularly at risk of pneumococcal infection, is very wide and that it is nevertheless very important to be aware that pneumococci are also dangerous for older people. But doctor, why are they dangerous? What if such an elderly person becomes infected? What can happen next?

Piotr Ligocki
Well, this is where the problem starts, because yes, if we are already carriers of these pneumococci, then we get a foreign pool of these pneumococci it doesn't mean that they get together and attack us, but our body may not be able to cope with these very foreign ones, because it feels like it is already a carrier. It should be protected, no? It doesn't work like that, unfortunately. I would also like to add one more thing here, one thing that is also a very predisposing factor for pneumococcal infections. It is the use of glucocorticosteroids, or in other words the popular steroids. This is very common at the moment, not only in rheumatology, but also in other specialities, even in endocrinology, which we have talked about here. And this is a factor that can be a causal factor in infection. But coming back to what is happening, we can have two forms of this disease, that is, we can have pneumococcal infections, that is low symptomatic, that is mainly in children sinusitis, otitis media, and we can even have the normal, normal cold. And that is also a pneumococcal infection.

Piotr Ligocki
Whereas usually in people who have risk factors they end up with pneumonia and unfortunately pneumonia caused by the results, by pneumococcus. This is about half of the patients who end up in hospital. We usually succeed empirically in isolating a group of these patients because they have quite characteristic symptoms. However, you, as patients, should be warned that you may never have pneumococcal pneumonia, because sometimes it is the case that I may make a comparison here. A family calls their mum's dad. Listen, the children could not go to kindergarten, they have a cold. Could you come? Because we're in the middle of something at work there?

Monika Rachtan
Yes, could you take care.

Piotr Ligocki
Take care.

Monika Rachtan
And of course the grandmother agrees.

Piotr Ligocki
Well, because Grandma, Grandma, who has diabetes, has kidney failure. Because of that, of course she's going to go. Well, what can happen to her when they only have a slight cold and they only snot a little bit and there's no problem. Well, yes, but you don't know. We think it's just a viral infection. There's a moment of fever, then it settles down a bit, then it's chronic and that's why, among other things, mummy daddy has to go to work. And what does it end up with? It ends with a person who doesn't have this protective coat, this vaccine coat, because children are mostly vaccinated and, besides, children over the age of two already have such a prepared immune system that it can usually cope with these infections. Unless, of course, they have diseases that cause immune incompetence of the immune system, i.e. the immune system is unable to block the action of pneumococci on its own.

Monika Rachtan
That is, this two-year-old's immune system works in such a way that he ends up with a simple runny nose with an ordinary cough that just doesn't last long. The illness is mild, it is manageable. We use symptomatic treatment and it is likely that this child can cope with such an illness. And what does it look like in an older person who does not have a protective coat, does not have a vaccination, Because as we look at it, I do not want to shoot now, but these vaccinations against pneumococci in children have not been used for 40 years or 30 years either, but we have had them for several decades, for a dozen years in fact, in the protective calendar. So there are some people who are getting older and it can work.

Piotr Ligocki
And this is where the problem begins, because such an elderly person may initially have the symptoms of a common cold, high temperature, cough, runny nose and at some point, after a few days, this cough starts to appear with phocin, which is a typical phocin of pneumonia, that is, it is watery, greenish and then we already have developed pneumonia. So there can also be a point at which the person who has been infected will think and surely it's just a runny nose, they won't go to the doctor, right? Of course I'm not going to go to the doctor, and where am I going to stand in line. And that's when the problem starts. And if he has these concomitant diseases, if he has these co-morbidities, then it becomes a basic problem. In a way, these diseases open the door to further infection. Besides, let us remember one more thing, somewhere between the age of 50 and 55, our immune system, in inverted commas, starts to age. That is, it no longer responds in the way it does for a person who is 20 30 years old. On the one hand, other diseases have already altered its response, and on the other hand, unfortunately, it also wears out in a certain way.

Monika Rachtan
Well, like all our organs.

Piotr Ligocki
Like all our organs. And that is why, at some point, we have a situation where this patient needs this additional protection. This additional protection is in the case of this group, in fact, the group from 50, which, admittedly, at the moment, in our country the reimbursement provision is from 65 years of age, which will protect, and here I am talking especially about people who have some disorder in the scope of their immune system or some oncological diseases. And now, if you look at such a group of 50-year-olds, it is not half, it is 70 80% people who have indications to be vaccinated. What is interesting is that we have four vaccines of different types in Poland at the moment. We have three vaccines at the moment. They differ in that there is a different amount of these polysaccharides, which are responsible for the fact that pneumococcus is more, let us call it, malignant towards our organism. But this does not mean that the one that is 13 is better than the one that is 20. Because it is also a question of what pools this vaccine contains. In our country at the moment there is a reimbursed vaccine for people 65+, the one that is 13 polyvalent and it is corrected, that is conjugated, it has a kind of an additional motor that causes it to affect the immune system, hammering in a cipher so to speak.

Piotr Ligocki
If you see the right cell there, remember, this is it and that is it and you have to destroy it, because the problem is this. Pneumococci are clever, they make themselves this envelope, these polysaccharides, so that our immune system, which does not know the cipher, can penetrate and attack accordingly. On the other hand, when our immune system knows this cipher, it is just like a thief who walks in and suddenly the light comes on. In the same way our immune system turns on the light, says Well we've got you pneumococcus. Well we're going to deal with you now. And then you only end up with about one or two days of fever at the most. On the other hand, once pneumonia develops, it is a greater danger. Besides, let us remember one thing. It seems to us that we are at such a point in pharmacotherapy that pneumonia is not a problem.

Monika Rachtan
That there is an antibiotic for everything.

Piotr Ligocki
That there is an antibiotic for everything, which is not the case, because pneumococci are also cunning and have started to set themselves up appropriately so that antibiotics also produce a certain antibiotic resistance, so that these antibiotics do not act on them appropriately, so that this force from the body itself aided by antibiotics does not kill them. Well, simply put, pneumococcus is a normal creature that wants to live. Cunning. Of course it wants to, it wants to thrive.

Monika Rachtan
Doctor, but can I still make such an appeal? Because we're talking about the elderly, we're talking about infections We're talking about antibiotics among other things as well, because just now. The doctor mentioned antibiotic resistance and I always on this occasion. I always want to talk about the fact that antibiotics do not cure all respiratory infections and that it is absolutely not allowed to take antibiotics that we have left over from another illness. You must not take your husband's antibiotics and you must not force your doctor to prescribe an antibiotic. And you really have to be sure that this antibiotic is necessary for it to be taken. Because just then there is the situation that the doctor was talking about. The patient has been taking a lot of antibiotics, comes down with a serious pneumonia that was caused by pneumococcus and it turns out that no antibiotic works in that patient. So this is very, very important.

Piotr Ligocki
And we can still manage sometimes with pneumococcus in a person who has these associated diseases, less advanced treatment at home. On the other hand, when she is already, let's call it overstimulated by various antibiotics for viral infections, where it makes absolutely no sense to administer. Suddenly she is just, there is no protection. The Spanish at one time introduced something where you could buy antibiotics without a prescription at their pharmacy. Well, and they ended up having such resistance to even the simplest bacteria that you really have to take drugs from a very high level to be able to deal with all sorts of infections sometimes.

Monika Rachtan
The doctor said that if a patient has this protection, they may end up getting sick at home and dealing with this infection. But in a situation where they don't have the protection, for example they are unvaccinated or they have just developed antibiotic resistance, then many patients end up in hospital, they have to be hospitalised. Moreover, not all patients end up in the internal medicine ward, because some have to go to the ICU because of their condition. It also happens that a patient, as a result of an encounter with that sneaky pneumococcus, dies as a consequence. And we need to bear this in mind as well.

Piotr Ligocki
Yes. Especially as about half of pneumonia is caused by pneumococci. Pneumococcus was discovered by Pasteur. It was named precisely because it was then the typical infection causing pneumonia. Back then, the mortality rate was 80 90%. At the moment we have a mortality rate much lower between 6 and 8 9%. These higher values apply to those who have concomitant conditions, i.e. oncological haematological patients, or those with renal failure or diabetes. On the other hand, let us also remember one thing: if we are fighting and want to be vaccinated against pneumococci, let us also remember to use appropriate prophylaxis for infections that are at home, viz.

Monika Rachtan
What does it consist of?

Piotr Ligocki
That's what it was during covidu. What we are shaking off now because covid is no longer there. Unfortunately covid is coming back and it's coming back very strongly, because they are in right now. We are starting to get very sick again. Although patients are coming in, it is much lighter than it was in the first wave. On the other hand, let us remember that if we have someone infected at home, these masks, which are left over from the covidu days, are useful to us, we should use them, disinfect surfaces, wash our hands. We have forgotten a bit about that.

Monika Rachtan
But on the other hand, I also observe, especially when I see parents with young children, that nevertheless these hand sanitisers have stayed a little bit in those trolleys and that some people actually take care to sanitise their hands. I'm glad too, because I noticed that after the pandemic we started to wash our hands after leaving the toilet and that is very much to the good. But on the other hand, it would be good to go back to that prevention. It's washing your hands, it's spraying them, just disinfecting them. It is just a few moments. And today, even though I go into a shop sometimes, there's a station where I could disinfect my hands, and there's no liquid there, so we have to take care of it ourselves. And even when we're not sick, it's worth taking care of that hygiene.

Piotr Ligocki
Yes, of course, because let's remember that it's not just droplet-transmitted pneumococcus, but many, many other infections. Let's even look at what the number of pneumococcal infections were during the pandemic. Of course, someone might say maybe they weren't reported, they weren't reported much less, there were hardly any flu cases.

Monika Rachtan
It's true, we've forgotten that there is a flu.

Piotr Ligocki
Well, because we used to wear masks and there was peace with the flu. I am not urging us all to wear masks at the moment, but what I like about Asian countries, the Far East, Asia, is that if someone is sick and comes to work, they come in wearing a mask. If he is in the underground, he walks in a mask.

Monika Rachtan
This is a responsibility.

Piotr Ligocki
This is responsibility and let's be responsible too. It happened to me recently, I woke up in the morning so infected. I went to work because I didn't have a fever. I wore a mask, conducting a briefing in the mask and there was no problem with it. I wiped myself out. It turns out there's nothing wrong. After a few hours, it turns out that there was probably something there that scratched my throat, as they say in inverted commas, and everything calmed down. On the other hand, let's be responsible and this is important here. So it has to be in this case, especially for those people who are people with disorders elsewhere located in our body that make us more ill. This is, firstly, this active protection, that is to say, vaccination, and this protection consisting in so-called external hygiene, that is to say, this disinfection by walking around in a mask.

Monika Rachtan
As far as vaccinating seniors is concerned, we have said that the age of 50 is the age at which it would be worth thinking about vaccination against pneumococcal disease. We know, of course, that we have an immunization calendar, where these vaccinations for seniors are also included? We have vaccinations reimbursed from the age of 65 for all seniors. Is it just this select group of patients with comorbidities?

Piotr Ligocki
The provision which is at the moment as a reimbursement so-called senior, that is free for the person, well because we pay as a society for it, and it's so broad that actually what I was saying about the 50 year olds, when you get 65 year olds lined up, one of them always has any of these conditions that is and that predisposes. Of course sometimes GPs here are afraid to discharge because there's wording, well it's a bit non-specific. For example, tomorrow gene for tomorrow administration of immunosuppressants. Any preparation can be given, actually put into it, because someone can say well, but if someone has, for example, bronchial asthma, and it's written after HP, well, you can't, they don't just get asteroids. End of full stop. We already have the issue solved. Then there's a group of patients like that that we should also look at. These are patients who smoke cigarettes.

Monika Rachtan
This is also a group that is particularly vulnerable.

Piotr Ligocki
Yes, And especially when it's still a group of patients who are long-term smokers, who have the beginnings of chronic lung disease, that is after. H.P. And they still smoke on top of that because they can't explain it to themselves. It's just as wide-open a gateway for the streptococcus ducoides to get in and make a really big, big mess for themselves there.

Monika Rachtan
So yes we have the option to get vaccinated at our primary care doctor. When do we go? When now, in the cold season we can already say, because it's September. We go to the primary care doctor. Many of us are probably planning to get the flu vaccination, because it's popular and it's something I hope seniors remember. It is also a good idea to ask your primary care doctor specifically about pneumococcal vaccination. What is the procedure here, doctor? Is this vaccine ready at the primary care physician? Does the patient have to take a prescription for it? What does it look like?

Piotr Ligocki
Of course, he has to take a prescription for this, because otherwise he will not get this discount, because the PCP here cannot order such medicines for himself, so he can simply dispense them. The places where pharmaceuticals are dispensed in Poland at the moment are pharmacies. However, this is also, let us call it, an improvement for the patient, because the moment he receives the pneumococcal vaccine, he can also receive the flu vaccine. By the way, some pharmacists are authorised to vaccinate, so you can also take advantage of this in the pharmacy to be able to vaccinate yourself, and not only that.

Monika Rachtan
Against influenza, but also against pneumococcus. The vaccination can be given in a pharmacy.

Piotr Ligocki
Yes, it's just that most pharmacists are afraid of this, because that there could be some kind of anaphylactic shock. Here, in the case of the pneumococcal vaccine, there is an interesting fact, Until yesterday, there was no report of anaphylactic shock in any patient vaccinated in Poland in the last few years. And this proves that this vaccine is safe. The only thing I would point out is that it is a convenience. The patient takes the two vaccines, goes to the GP, makes an appointment for vaccination there and can be vaccinated with these two vaccines on the same day.

Monika Rachtan
So it is safe. We don't have to worry about it overlapping, something coming together. Here the doctor knows what he is doing. Absolutely you can.

Piotr Ligocki
I'm just pointing out one thing, because it's sometimes maybe in the heat of the battle that people who vaccinate forget, not to give in one hand. One is right, the other is left, vaccinated and then there is no problem.

Monika Rachtan
One is from pneumococcus the other from influenza.

Piotr Ligocki
This is the case and we have the matter settled. It's not that there are such clear-cut, zero-one recommendations. But all over the world it is said to rather. If we vaccinate in this way, not in the same place, not in the same area.

Monika Rachtan
I understand. And please tell me, should I still pay special attention to any symptoms after such a vaccination? Is there anything I should be concerned about? Or can I, for example, fall ill at any time? But I have been inoculated with the bacteria, so could something worrying happen?

Piotr Ligocki
In other words, we don't get a bacterium, we get its most malignant fragment, but it is a fragment which is not alive, because it doesn't have its own material, which will properly attack there. What we get, so to speak, is a key for our immune system, thanks to which, later on, when the bacterium enters our organism, the immune system opens up this polysaccharide envelope and then the bacterium is defenceless. You could say it is a bit like a closed clam. When we open it, it is just as defenceless and so is our immune system. Occasionally there is a reaction where there is redness of the skin there, but it is really quite quite. It is very rare. We can have one or two days of such a sub-febrile state, well it's the organism, it's not bad, because it just means that our organism is producing an immune response. It is preparing itself, just as it was in the case of the vaccination against SARS-CoV-2. That also some people had two, three, four days of fever. Why? Because this was indicative of the fact that our immune system is interacting in the right way and acting in this way to be prepared for this enemy later on.

Monika Rachtan
We often say that children should be vaccinated. We remind ourselves of this, we remember as grandparents, we say to our children, just remember to vaccinate your grandchildren. This is very important, we remind ourselves of this, and we do not necessarily remember about our own health, and we do not necessarily have a positive attitude towards vaccinations, and it seems to me that a responsible senior citizen is a vaccinated senior citizen. Such seniors protect themselves, but they also protect their loved ones, because when an infection occurs and, for example, we are still in the early stages of an illness, it seems to us that it's no big deal. And we have an infant at home, who has only just arrived in the world, and we meet such an infant, then already here an encounter with our sneaky pneumococcus can be particularly dangerous. So when we have protection, our loved ones also have protection.

Piotr Ligocki
Yes, and even more so because let's remember that children up to the age of two are that their immune system is not yet accustomed to all the bacteria that are badly used. It is not prepared to respond in an appropriate way to a given infection. However, in addition to what the editor said about the responsibility not to get infected, I would also like to mention one more thing. It is also our responsibility not to be a burden on our children, because after a pneumococcal pneumonia, it is not the case that after five or seven days of antibiotics, we can stand up and do everything ourselves. We will have a period of convalescence, if there are concomitant illnesses that may be exacerbated and the late effects of this infection, because pneumococcal it seems. Obviously sepsis. It's a life-threatening condition, but we all know that. Yes, but the one that is in the lungs, that causes pneumonia, these chemotoxins that it secretes from itself attack all the organs in the body.

Monika Rachtan
And they all weaken, don't they?

Piotr Ligocki
And they are all debilitating. It is established that there is the possibility of more myocardial infarctions not during the illness itself, but even a few months after. More strokes after contracting pneumococcal disease. So it is also a responsibility for THOSE grandparents. The children did not have the problem later that they had a young child and also a disabled person, who had previously managed completely on their own.

Monika Rachtan
Such a special group of patients who should be taken care of, who are also particularly vulnerable to pneumococci, to pneumococcal infection, are oncology patients. But can these patients safely receive the pneumococcal vaccination?

Piotr Ligocki
They must, I will only answer so briefly must. And why do I say they must? Let us remember that the current treatment of oncology and haematology patients, although it seems to us that it is one big bag. It is so modern that we are able to prolong life and extend a good standard of living for these patients. What 20-30 years ago, for example, was sometimes a death sentence. At the moment, oncology patients sometimes go into remission of their diseases and live many years. However, remission does not mean cure. At the moment, we also often have the situation that after five years, in some cancers, of course, because not all, we have a period of complete remission and the patient is healthy. But let us remember, he or she already has this immune system slightly warped and both the patient who is ill at the time should be vaccinated without fail, as well as the patient who seems to have emerged victorious from this battle with cancer, because this will protect him or her from having another bad knife stabbed in the back.

Monika Rachtan
Let me come back to this group of oncological patients, because we know that there are currently around one million people in Poland who may even be suffering from oncological conditions. Should an oncology patient ask their family doctor, their oncologist, for a referral for a vaccination prescription. Who can take care of this protection here and provide him or her with this protective coat?

Piotr Ligocki
This is where it starts to become an administrative type of problem, because prescriptions for s. That is, seniors can only be written in Poland by a family doctor, unfortunately, so that it is an S. We are waiting all the time for the Ministry to bend over so that it can also be written out here. Any of the specialist doctors could write it out.

Monika Rachtan
When visiting the dermatologist. Seniors, however, make these many visits. This would be very useful.

Piotr Ligocki
Yes, of course. I am already sometimes tired of writing out lists of medicines to GPs and I don't envy them the work, prescribing it either. I try, for example, to write it very precisely, that this is an s, this is a lump sum, this is this, this, this, so that they know, so that they have as little work as possible. Whereas talking to my colleague, the GP, he says Well listen At the moment it's 40% visits. Those are the prescriptions. And here, unfortunately, the way the system works is that it has to be written by the family doctor and the family doctor, the PCP, is also the one who can initiate it himself or initiate it under the supervision of another specialist. Of course, GPs here sometimes have some concerns about conditions, so I, for my part as a rheumatologist, for example, write a note that I am asking for a vaccination. This is sufficient, sufficient information for the PCP to write such a preparation for the s.

Monika Rachtan
But let us also, as patients, not be afraid when our primary care physician offers us this vaccination, regardless of what chronic diseases Accompanying us, this vaccination for seniors is advisable. And are there any contraindications to pneumococcal vaccination.

Piotr Ligocki
And does every company always write that you are allergic to any of the preparations that are used in the vaccine. But as I said, there is no such thing as what is called anaphylactic shock that will occur with the vaccine at the moment. Certainly acute infections that occur at the moment are a contraindication at the moment. On the other hand, there is no such contraindication that there is a medical condition that completely eliminates. We have to be careful in immuno-incompetent people that they are in a phase of low disease activity and give them then. This is not because the vaccine will fuel the disease, but we should remember that these people are taking a number of different medications that may weaken the potency of the vaccine a little.

Monika Rachtan
Today we have said a lot about seniors, we have mentioned a little about children. And should such 30-40 year olds of my age also consider pneumococcal vaccination.

Piotr Ligocki
I for 30 40 year olds unfortunately with full payment here is a problem, although it is not some very big money, big costs and more so that what is interesting is just for example the vaccine vaccines that are polysaccharide codified 13 Valentine. One vaccination is enough.

Monika Rachtan
That is, we do not have to repeat as with the flu every year with the vaccine.

Piotr Ligocki
It depends in which group of patients, because some of the patients are those who need to have a repeat, or a different type of vaccine are those who are immuno-competent patients, that is, who have some medical conditions. But for a person who does not have any additional conditions, one vaccination is actually enough and there is no problem. On the other hand, we also have to find such people who have immunological conditions. Well, at the moment, we have a lot of people who have diabetes. These people should be vaccinated. Liver conditions as well. In the same way, they should be vaccinated. I draw attention to diabetes in particular here because, unfortunately, through the pandemic period, the number of people who have diabetes has increased dramatically. This is true. And this is also a group that is unfortunately at very high risk of contracting pneumococcus. And here the green light is definitely on. Consideration should also be given to people who work in, so to speak, a pneumococcal-friendly environment.

Monika Rachtan
Kindergarten ladies, for example.

Piotr Ligocki
For example, teachers. Certainly the health service.

Monika Rachtan
Okay, so we know that seniors especially, but that we all should consider such pneumococcal vaccination. That's right. The cold season is approaching. It is probably worth remembering about prevention, that is to say, about hygiene, which the doctor mentioned, but also about vaccination or whether we should remember about any other vaccinations during this cold season. Is there anything else worth vaccinating against in autumn?

Piotr Ligocki
I mean, I wanted to say one thing here at the beginning, the pneumococcal vaccination is not a vaccination that is seasonal. We can get vaccinated all year round, we even have to get vaccinated and it doesn't matter what time. Whether it be January, whether it be March, whether it be August. It is always worth getting vaccinated. Always. Because this is not a seasonal disease. It is a disease that circulates around us all the time. Influenza certainly does too. Now there is the issue of a certain whooping cough epidemic circulating around us here at the moment. Well, unfortunately, we do not produce antibodies that are immune, that give us full immunity, so here, I would particularly ask people who have to deal with sick people and who work in large groups of people to think about this. Here it is like this.

Monika Rachtan
Because this pertussis vaccine should also be repeated every 10 years. We're vaccinated when we're children, then when we're a bit older, but then adults are rather not vaccinated. We forget about it. Sometimes pregnant women are vaccinated if they see a gynaecologist who reminds them. Yet whooping cough has now become a serious problem not only in Poland, but also in many European countries.

Piotr Ligocki
What's worse is that this whooping cough is now coming full circle anyway. It came out through Europe once. At one time such an epidemic reached us from the Czech Republic. But we have this pertussis all the time at the moment. There is a constant increase in the number of cases, and it is quite considerable, as the increases can be several or more percent month-on-month.

Monika Rachtan
Ladies and gentlemen, we live in times when viruses and bacteria attack us from every side, but fortunately we have a safe weapon. It is vaccination, and it is vaccination against pneumococcus. This year, we would like you to be vaccinated. It does not matter whether you are in your 30s or 40s, but if you are in your 50s, 60s or over, be sure to see your GP. Today, my guest, but above all your guest, was Dr Piotr Ligocki. Thank you very much, doctor.

Piotr Ligocki
Thank you, editor, thank you.