Hong Kong boy, 9, dies of invasive pneumococcal disease as health officials investigate

A nine-year-old boy has died of invasive pneumococcal disease, Hong Kong’s Centre for Health Protection said on October 18. The center is investigating the case, with further bacterial testing planned and a referral to the coroner.

The boy had been in good health, according to the center’s statement. He developed fever, a runny nose, cough and chest pain associated with coughing on October 10, visited private clinics on October 10 and 13, and was taken to Tin Shui Wai Hospital’s accident and emergency department on October 14 after persistent symptoms and shortness of breath.

He was transferred to the pediatric intensive care unit at Tuen Mun Hospital, where his condition deteriorated and he died on October 15, the center said. The announcement did not say how he caught the infection.

What the investigation has found so far

A pleural fluid sample tested positive for Streptococcus pneumoniae, the bacteria that cause pneumococcal infection. The center reported a clinical diagnosis of severe pneumonia complicated by empyema, septic shock and acute renal failure. It said it would arrange further testing and serotype analysis of the bacterial samples.

Initial inquiries found no travel during the incubation period, and household contacts remained without symptoms at the time of the announcement, the center said. The case will also be referred to the coroner. Neither the further test results nor a coroner’s finding is available yet.

The release does not give the boy’s pneumococcal vaccination history, so it cannot show whether he was vaccinated or support any conclusion about vaccine failure. The center’s general vaccination advice is separate from those open questions.

Warning signs and how the bacteria spread

Pneumococci are commonly found in the nose and throat of healthy people, particularly children, according to the center. They can cause middle ear and chest infections, as well as invasive infections of the membranes around the brain or the bloodstream. The center said infection can be serious or life-threatening.

The bacteria mainly spread through droplets from coughing or sneezing, close contact with patients, or contact with contaminated materials, the center said. It urged hygiene measures and pneumococcal vaccination, and did not identify a source of exposure for the boy.

The center advised parents to seek medical attention promptly if a child develops fever or respiratory symptoms. A child whose condition persists or worsens, with symptoms such as shortness of breath, chest pain, blue lips, convulsions, drowsiness, a stiff neck, refusal to eat, persistent vomiting or reduced urination, should go to an accident and emergency department immediately, it said.

Vaccination advice

The Department of Health added pneumococcal conjugate vaccine to the Hong Kong Childhood Immunisation Programme in September 2009, providing free vaccination for children, the center said. It advised parents to follow the program’s schedule and said elderly and high-risk people should also be vaccinated against pneumococcal disease.

What is known so far is limited to the clinical findings and initial inquiries released on October 18. The further testing and the coroner’s referral are still to come.