Pneumococcal [noo-muh-KOK-uhl] disease is a name for any infection caused by bacteria called Streptococcus pneumoniae, or pneumococcus. Pneumococcal infections can range from ear and sinus infections to pneumonia and bloodstream infections. There are vaccines to help prevent pneumococcal disease.

There are many types of pneumococcal disease. Symptoms and complications depend on the part of the body that the bacteria infects.

Pneumococci are a type of streptococcus bacteria. The bacteria spread through contact with people who are ill or by healthy people who carry the bacteria in the back of their nose. Pneumococcal infections can be mild or severe. The most common types of infections are

• Ear infections
• Sinus infections
• Pneumonia
• Sepsis
• Meningitis

How the diagnosis is made depends upon where the infection is. Your doctor will do a physical exam and health history. Possible tests may include blood, imaging, or lab tests. Treatment is with antibiotics. Vaccines can prevent pneumococcal infections. There are two vaccines. One is for infants and young children. The other is for people at high risk, including those who are over 65 years old, have chronic illnesses or weak immune systems, smoke, have asthma, or live in long-term care facilities.

1. Pneumococcal disease can be very serious.

• Pneumococcal pneumonia causes an estimated 150,000 hospitalizations each year in the United States.
• Pneumococcal meningitis and bacteremia killed approximately 3,250 people in the United States in 2019.

2. Anyone can get pneumococcal disease.

• Young children and older adults are at increased risk compared to other age groups.
• Certain medical conditions and other risk factors put people at increased risk for pneumococcal disease.

3. CDC recommends safe and effective pneumococcal vaccines for children and adults.

Children

All children younger than 2 years old should receive PCV13.

Children 2 through 18 years old with certain medical conditions should receive PCV13 and PPSV23.

Adults

Adults who have never received a pneumococcal conjugate vaccine should receive PCV15 or PCV20 if they

• Are 65 years or older
• Are 19 through 64 years old and have certain medical conditions or other risk factors

If PCV15 is used, it should be followed by a dose of PPSV23.

Pneumococcal disease in adults can range from mild to serious, and can sometimes be deadly. Two types of vaccines provide protection against this disease. Talk to your doctor to see if they recommend these or any other vaccines for you.

What is pneumococcal disease?

Pneumococcal disease is a term used for a wide range of infections caused by bacteria called Streptococcus pneumoniae (pneumococcus), including:

• Ear infections
• Sinus infections
• Pneumonia (lung infection)
• Bacteremia (bloodstream infection)
• Meningitis (infection of the lining of the brain and spinal cord)
• Sepsis (the body’s extreme response to an infection)

What are the symptoms of pneumococcal disease?

Symptoms depend on the part of the body the bacteria are affecting. For sinus and ear infections, symptoms are usually relatively mild, such as:

• Cough
• Ear pain
• Fever
• Sore throat

For pneumonia, bloodstream infections, meningitis, and sepsis, you can also have more severe symptoms, including:

• Fever or chills
• Cough
• Rapid or difficult breathing
• Chest pain
• Headache
• Stiff neck
• Increased pain when looking at bright lights
• Confusion or low alertness

How do doctors diagnose and treat pneumococcal disease?

Early diagnosis and treatment are very important for serious pneumococcal infections. Diagnosis depends on which type of infection a doctor thinks a patient may have. For meningitis or bloodstream infections, doctors will collect samples of cerebrospinal fluid or blood and send them to a laboratory for testing. Doctors can also use a urine test to diagnose some cases of pneumonia. For illnesses like ear and sinus infections, doctors usually diagnose them based on history, symptoms, and a physical exam. Doctors can treat pneumococcal disease with antibiotics.

How does the bacteria that cause pneumococcal disease spread?

Pneumococcal bacteria spread from person to person through coughing, sneezing, and close contact. People can carry the bacteria in their nose and throat without being sick and spread the bacteria to others.

Which adults are at increased risk for pneumococcal disease?

Adults 65 years or older are at increased risk for pneumococcal disease.

Adults of all ages are also at increased risk for pneumococcal disease if they have:

• Alcoholism
• Cerebrospinal fluid leak (a health problem where fluid surrounding and protecting the brain and spinal cord leaks)
• Chronic heart, lung, kidney, or liver disease
• Cochlear implant (a small electronic device that is surgically implanted to help people with severe hearing loss be able to hear)
• Diabetes
• HIV infection, cancer, solid organ transplant, or another condition or taking medicine that weakens the immune system
• Nephrotic syndrome
• Sickle cell disease, a damaged spleen, or no spleen

Adults who smoke cigarettes are also at increased risk for pneumococcal disease.

Chronic lung illnesses that increase an adult’s risk for pneumococcal disease include chronic obstructive lung disease, emphysema, and asthma.

Which vaccines help prevent pneumococcal disease in adults?

There are two types of vaccines used in the United States to help prevent pneumococcal disease in adults: conjugate and polysaccharide vaccines. CDC recommends pneumococcal conjugate vaccination (PCV15 or PCV20) for all adults 65 years or older and adults 19 through 64 years old at increased risk for pneumococcal disease if they have never received a pneumococcal conjugate vaccine before. If PCV15 is used, this should be followed by a dose of polysaccharide vaccine (PPSV23).

In addition, getting an influenza (flu) vaccine every year can help because having flu can increase your chances of getting pneumococcal disease.

What are the risks of pneumococcal vaccination?

Pneumococcal vaccines are safe, but side effects can occur. Adults receiving pneumococcal conjugate and polysaccharide vaccines have reported mild side effects such as redness, pain, and swelling at the injection site. Mild fever, fatigue, headache, chills, or muscle pain have also been reported. Life-threatening allergic reactions from either type of vaccine are rare.

Bacteria called Streptococcus pneumoniae, or pneumococcus, can cause many types of infections. Some of these infections can be life threatening.

Doctors consider some of these infections “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs. When this happens, disease is usually very severe, requiring care in a hospital and even causing death in some cases.

Children at Risk for Pneumococcal Disease

Children at increased risk for pneumococcal disease include those younger than 2 years old and those with:

• Sickle cell disease, no spleen, HIV infection, cancer, or another condition thatweakens the immune system

• Diabetes
• Nephrotic syndrome
• Chronic heart, lung, or kidney disease
• Cochlear implants
• Cerebrospinal fluid (CSF) leaks (escape of the fluid that surrounds the brain and spinal cord)

Adults at Risk for Pneumococcal Disease

Adults 65 years or older are at increased risk for pneumococcal disease.

Adults of all ages are also at increased risk for pneumococcal disease if they have:

• Sickle cell disease, no spleen, HIV infection, cancer, or another condition that weakens the immune system
• Diabetes
• Nephrotic syndrome
• Chronic heart, lung, kidney, or liver disease
• Cochlear implants
• CSF leaks
• Alcoholism

Adults who smoke cigarettes are also at increased risk for pneumococcal disease.

Chronic lung illnesses that increase an adult’s risk of pneumococcal disease include chronic obstructive lung disease, emphysema, and asthma.

If you’re at increased risk for pneumococcal disease, talk to your doctor about which pneumococcal vaccines you need and when.

People spread pneumococcal bacteria to others through direct contact with respiratory secretions, like saliva or mucus. Many people, especially children, have the bacteria in their nose or throat at one time or another without being ill. Doctors call this “carriage” and do not know why it only rarely leads to sickness.

Pneumococcal disease can include many different types of infections. Symptoms depend on the part of the body that is infected. Most pneumococcal infections are mild. However, some can be deadly or result in long-term problems.

Pneumonia

Symptoms of pneumococcal pneumonia, a lung infection, include:

• Fever and chills
• Cough
• Rapid breathing or difficulty breathing
• Chest pain

Older adults with pneumococcal pneumonia may experience confusion or low alertness, rather than the more common symptoms listed above.

Complications of pneumococcal pneumonia include:

• Infection of the space between membranes that surround the lungs and chest cavity (empyema)
• Inflammation of the sac surrounding the heart (pericarditis)
• Blockage of the airway that allows air into the lungs (endobronchial obstruction), with collapse within the lungs (atelectasis) and collection of pus (abscess) in the lungs

Pneumococcal pneumonia kills about 1 in 20 who get it.

Meningitis

Symptoms of pneumococcal meningitis, an infection of the lining of the brain and spinal cord, include:

• Stiff neck
• Fever
• Headache
• Photophobia (eyes being more sensitive to light)
• Confusion

In babies, meningitis may cause poor eating and drinking, low alertness, and vomiting.

About 1 in 12 children and 1 in 7 older adults who get pneumococcal meningitis dies of the infection. Those who survive may have long-term problems, such as hearing loss or developmental delay.

Blood Infection

Symptoms of pneumococcal bacteremia, a blood infection, include:

• Fever
• Chills
• Low alertness

About 1 out of 30 children with pneumococcal bacteremia die of it. Pneumococcal bacteremia kills about 1 out of 7 adults who get it. For those who survive, pneumococcal bacteremia can lead to loss of limb(s).

Sepsis

Symptoms of sepsis, the body’s extreme response to an infection, include:

• Confusion or disorientation
• Shortness of breath
• High heart rate
• Fever, shivering, or feeling very cold
• Extreme pain or discomfort
• Clammy or sweaty skin

Complications of sepsis include kidney failure and damage to the brain, lungs, or heart.

Call your clinician right away if you think you or your child might have a serious pneumococcal infection

Middle Ear Infection

Symptoms of middle ear infections (otitis media), which pneumococcal bacteria commonly cause, include:

• Ear pain
• A red, swollen ear drum
• Fever
• Sleepiness

Ear infections are usually mild and are more common than the more severe forms of pneumococcal disease. However, some children develop repeated ear infections and may need ear tubes.

Sinus Infection

Symptoms of sinus infections include:

• Headache
• Stuffy or runny nose
• Loss of the sense of smell
• Facial pain or pressure
• Postnasal drip (mucus building up in the back of the throat or nose)

Complications are rare, but include infection of the tissue surrounding the eyes, bone infection, and a painful collection of pus (abscess).

If doctors suspect serious pneumococcal disease, like meningitis or bloodstream infections, they will collect samples of cerebrospinal fluid or blood. Cerebrospinal fluid is fluid near the spinal cord. View the lumbar puncture illustration to see how a doctor collects this fluid. Doctors then send the samples to a laboratory for testing.

Growing the bacteria in a laboratory helps identify the specific type of bacteria causing the infection. Knowing the cause helps doctors choose the right treatment, including which antibiotic will work best.

Doctors can use a urine test to help make a diagnosis of pneumococcal pneumonia in adults. Doctors usually diagnose ear and sinus infections based on a history and physical exam findings that support pneumococcal infection.

Doctors use antibiotics to treat pneumococcal disease. However, some pneumococcal bacteria have become resistant to certain antibiotics used to treat these infections. Available data show that pneumococcal bacteria are resistant to one or more antibiotics in 3 out of every 10 cases.

Antibiotic treatment for serious pneumococcal infections typically includes ‘broad-spectrum’ antibiotics until results of antibiotic sensitivity testing are available. Antibiotic sensitivity testing shows which antibiotics will be most successful at treating a bacterial infection. Broad-spectrum antibiotics work against a wide range of bacteria. Once the sensitivity of the bacteria is known, clinicians may choose a more targeted (or ‘narrow-spectrum’) antibiotic.

The number of antibiotic-resistant pneumococcal infections has decreased due to the success of the pneumococcal conjugate vaccine. In addition to the vaccine, appropriate use of antibiotics may also slow or reverse drug-resistant pneumococcal infections.

Some Streptococcus pneumoniae (pneumococcus) are resistant to one or more antibiotics. Resistance can lead to treatment failures.

Background

Until 2000, pneumococcal infections caused 60,000 cases of invasive disease each year. According to Active Bacterial Core surveillance (ABCs) data, up to 40% of these infections were caused by pneumococcal bacteria that were resistant to at least one antibiotic. These numbers have decreased greatly following:

• The introduction of pneumococcal conjugate vaccines for children
• A change in definition of non-susceptibility (resistance) to penicillin in 2008

In 2019, ABCs estimated there were about 30,300 cases of invasive pneumococcal disease. Available data show that pneumococcal bacteria are resistant to one or more antibiotics in more than 30% of cases. How common drug-resistant Streptococcus pneumoniae (DRSP) is varies throughout the United States.

State and local health departments have reported outbreaks of DRSP in

• Long-term care settings
• Institutions for people living with HIV
• Childcare centers

Trends

Prior to 2000, seven serotypes (6A, 6B, 9V, 14, 19A, 19F, and 23F) accounted for most DRSP in the United States. In 2000, CDC began recommending 7-valent pneumococcal conjugate vaccine (PCV7) for all U.S. children. PCV7 protected against most of the serotypes that caused DRSP at the time but not 19A. After PCV7 introduction, serotype 19A emerged to cause most DRSP. The United States began using 13-valent pneumococcal conjugate vaccine (PCV13), which protects against 19A, in 2010. Since then, rates of disease caused by serotype 19A have greatly decreased.

Both PCV7 and PCV13 prevented many infections due to drug-resistant pneumococcal serotypes.

In 2022, CDC began recommending a 15-valent or 20-valent pneumococcal conjugate vaccine for all adults aged 65 years and older and adults at increased risk for pneumococcal disease. The impact these higher valency vaccines will have on drug-resistant pneumococcal serotypes is yet to be determined.

Costs

DRSP is associated with increased costs compared to infections caused by non-resistant (susceptible) pneumococcus. This is because of

• The need for more expensive antibiotics, new antibiotic drug development, and for surveillance to track resistance patterns
• Repeat disease due to treatment failures
• Educational requirements for patients, clinicians, and microbiologists

Risk Groups

People who attend or work at childcare centers are at increased risk for infection with DRSP. People with pneumococcal infections who recently used antibiotics are more likely to have a resistant infection than those who have not.

Surveillance

CDC funds ABCs, an active, population-based surveillance system in 10 states. All types of invasive pneumococcal disease (including DRSP) are included in the national public health surveillance system, National Notifiable Diseases Surveillance System (NNDSS). These surveillance data are used to estimate how many cases of invasive pneumococcal disease (including DRSP) occur each year in the United States.

Several private-sector systems also track DRSP.

Prevention: Challenges and Opportunities

There are several factors that create challenges for preventing emerging drug resistance of pneumococcus, including

• Widespread overuse of antibiotics
• Spread of resistant serotypes
• Underuse of recommended vaccines for adults with indications
• Lack of adoption by some clinical laboratories of standard methods (NCCLS guidelines) for identifying and defining DRSP
• Lack of vaccine availability to protect against all serotypes of pneumococcus

Improving judicious use of antibiotics and expanding use of vaccines may slow or reverse emerging drug resistance. Prevention of infections could improve through expanded use of recommended vaccines (PCV13, PCV15, PCV20, PPSV23).

Vaccines are the best way to prevent pneumococcal disease. Learn what else you can do to help protect yourselves and others from pneumococcal disease.

Vaccination

There are two kinds of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccines (PCV13, PCV15, or PCV20)
• Pneumococcal polysaccharide vaccine (PPSV23)

These vaccines protect against many, but not all types of pneumococcal bacteria. Also, the protection from these vaccines is good but not perfect (or 100%). For these two reasons, there is still a chance someone can develop pneumococcal disease after vaccination.

It is also important to get an influenza vaccine every year because having the flu increases the likelihood of getting pneumococcal disease.

Preventive antibiotics

CDC does not recommend that close contacts of someone with pneumococcal disease receive antibiotics to prevent them from getting sick. Experts call this prophylaxis. Generally, people do not develop pneumococcal disease after exposure to someone with a pneumococcal infection.

Re-infection

People can get pneumococcal disease more than once. A previous pneumococcal infection will not protect you from future infection. Therefore, CDC recommends pneumococcal vaccination even if someone has had pneumococcal disease in the past.