Every time eight-year-old Ng Rui coughs or sneezes, her mother, Madam Chan Mei Ling, is reminded of how close she came to losing her child from pneumococcal disease (PD) two years ago.

Rui has fully recovered but she went through an almost month-long ordeal then.

She is lucky. The World Health Organisation reported that PD takes the lives of more than a million children under the age of five in developing countries each year.

The disease refers to a range of illnesses caused by streptococcus pneumoniae, a bacterium commonly known as pneumococcus.

This bug can cause meningitis (infection of the lining of the brain or spinal cord), pneumonia (infection of the lungs), bacteraemia (blood infection) and otitis media (infection of the middle part of the ear).

Most healthy adults and children carry this bacteria in their nose and throat but they are harmless, said Associate Professor Daniel Goh, president of the Singapore Paediatric Society. Although the bug can be transferred to others via air droplets, usually by sneezing or coughing, it usually does not cause illness.

But when a person's immunity is weakened, it can multiply and spread to vital organs like the lungs.

The disease can hit both young and old but children under the age of two are most susceptible as their immune system is not fully developed.

The Singapore Paediatric Society says that each year, 13.6 per 100,000 children under the age of five here become infected with invasive PD. Of these, as many as 25 per cent develop complications such as pneumonia and more than 6 per cent die from the disease.

Prof Goh said that the risk of infection can be substantially reduced with a vaccine called Prevenar, the first and only vaccine to prevent PD in young children.

Prevenar, introduced here in 2005, is one of the non-compulsory vaccines in the Ministry of Health's national childhood immunisation schedule.

But 26 countries worldwide including Australia, France, Britain and the United States have made it mandatory for all young children to receive the Prevenar vaccination.

With the memories of her daughter's ordeal still fresh, Madam Chan said: 'The thought of losing Rui two years ago was so hard to bear. I think the vaccine should be made compulsory so no parent has to go through what I did.'

Prof Goh and the Singapore Paediatric Society echo her hope that the vaccine will become mandatory for all children in Singapore.

'Although the number of children in Singapore with PD is low, even if one child dies from PD, that is too many, especially when every death is preventable,' said Prof Goh, chief of paediatrics at National University Hospital.

A Ministry of Health spokesman said the ministry 'has reviewed our local situation and has decided not to incorporate the pneumococcal vaccine into the National Childhood Immunisation Programme at this point in time'. The spokesman added that the ministry will monitor the situation and review its decision if necessary.

A survey by market research company Synovate Healthcare last year found that only 15 per cent of Singapore mothers have vaccinated their children against PD.

Prof Goh said the side-effects of the PD vaccine are mild and can include fever and slight pain over the injection site.

Each PD vaccine dose costs around $180. Babies less than six months require four doses; those between six and 12 months require three doses; those between one and two years, two doses and those older than two need just one dose.

Prof Goh said the Baby Bonus payout can be used.

There is another benefit of vaccinating children.

Studies have shown that widespread PD vaccination can reduce the number of young children who carry the bacteria and this decreases the incidence of transmission to other susceptible groups, such as the elderly, said ProfGoh.

It started with common cold symptoms

While most people were enjoying themselves on Christmas Eve in 2006, Madam Chan Mei Ling was nursing her then six-year-old daughter Ng Rui, who seemed to have caught the common cold.

The little girl was ill with a runny nose, cough and high fever.

Madam Chan, 51, treated her at home with over-the-counter medication.

But when Rui did not get better two days later, Madam Chan took her to Mount Alvernia Hospital's paediatric department.

With a fever that would go up to 43 deg C and given Rui's weakened state, the doctors knew at once she had more than just a cold.

It took another two days and a battery of tests, including an X-ray of the girl's chest, to confirm that she had pneumococcal disease.

Rui's left lung was found to be filled with fluid and she was put on an antibiotic drip.

After five days, Rui's condition still did not improve so Madam Chan decided to transfer her to KK Women's and Children's Hospital (KKH) to get a second opinion.

At KKH, Rui was sent to the intensive care unit. Madam Chan was told her child needed an operation to drain the fluid in her lungs.

'This was the worst time for me. From what I thought was a common cold, my daughter now needed an operation. I didn't know it would get so risky,' Madam Chan said.

The operation, conducted under general anaesthesia, was a success. Rui's condition improved following the surgery and after 18 days at KKH, she was discharged.

Today, Rui is an active girl who enjoys cycling and swimming. Her mother still sends her for a check-up every six months, just in case.

Madam Chan, who owns a restaurant with her husband, Mr Ng Ngeng Hee, 54, said the ordeal was a difficult time for the family.

'I had to juggle work and looking after Rui in the hospital. I waited till she fell asleep at night before returning to work while our nanny watched over her,' she said.

After that experience, she vaccinated Rui and her other two daughters Xin, five and Jing, four.

Associate Professor Daniel Goh, president of the Singapore Paediatric Society, said that although Rui has had PD, vaccination is still important.

'There are 90 different strains of the PD bug. The Prevenar vaccine - the only one available for children - protects against 80 per cent of the strains. Rui was infected with only one strain, so it's good for her to be vaccinated against the others,' he said.

Madam Chan said that she wishes someone had told her about the PD vaccination earlier.

'Children are so young, so helpless. It is up to parents to protect them. I almost lost my daughter because I was unaware of PD and the vaccine. I thought the vaccinations that were compulsory were enough but I was wrong,' she said.

This article was first published in Mind Your Body, The Straits Times on July 23, 2008.