Pneumococcal disease

Key disease facts

Pneumococcal disease includes a wide range of infections caused by different types of pneumococcus bacteria (Streptococcus pneumoniae).

These bacteria are the most common cause of pneumonia, a serious illness which can affect people of any age. In the UK, around 40,000 people a year are hospitalised with pneumococcal pneumonia. Even with the use of antibiotics, pneumonia still causes death in up to 20% of cases. Worldwide, pneumonia is the leading cause of death in children. According to the World Health Organization, pneumonia killed over 920,000 children in 2015, and accounts for 16% of all deaths of children under 5 years old. Pneumonia can be caused by a number of different bacteria, viruses and fungi. However, it is estimated that at least two thirds of all cases of bacterial pneumonia are caused by Streptococcus pneumoniae bacteria.

Certain types of pneumococcus bacteria can also infect normally sterile areas of the body such as the blood and the brain. This is called invasive pneumococcal disease, and causes life-threatening diseases including septicaemia (blood poisoning) and meningitis. Around 15% of children with pneumococcal meningitis die, and 25% will have severe, lasting effects, including loss of hearing, loss of sight, learning and language disabilities, or seizures. Invasive pneumococcal disease particularly affects very young babies, elderly people and those with weakened immune systems. People with cochlear implants, cerebrospinal fluid (CSF) leaks, skull defects or fractures of the skull can sometimes get repeated infections.

Pneumococcal disease can also cause ear infections (otitis media) and sinusitis.

In the short film below, Dr Andrew Prendergast talks about pneumococcal disease and why it is important to vaccinate against the disease.

Pneumococcal meningitis - Sam's story

Sam Willis had pneumococcal meningitis when he was 9 months old, before the vaccine was available. In this film, made when Sam was 11 years old, his father talks about the lasting effects of the disease and the impact on the whole family.

What are the symptoms?

These are the most serious symptoms of pneumococcal disease:


  • makes the lungs become inflamed and fill with fluid, so they do not work properly and not enough oxygen can get into the bloodstream.
  • Typical symptoms in children under five include fever, cough, pain in the chest and fast or difficult breathing.
  • Other symptoms can include headaches, fatigue, feeling sick or vomiting, wheezing, joint and muscle pain, and feeling confused and disorientated (particularly in elderly people).
  • Symptoms can appear very suddenly, or take several days to develop.


  • is the inflammation of the outer covering of the brain and spinal cord.
  • is very difficult to spot in the early stages.
  • Early symptoms are usually fever, vomiting, headache and feeling unwell, just like in many mild illnesses (but in babies under 3 months old there may be no sign of fever).
  • Other symptoms include high-pitched screaming in babies, being difficult to wake, and tense or bulging soft spot on head.
  • When meningitis is caused by pneumococcal bacteria, the reddish-purple non-blanching rash usually does not appear. (A non-blanching rash does not disappear when pressed with a glass, which many people think of as a classic sign of meningitis.)
  • The disease progresses very quickly, and can kill in a matter of hours.


  • is a serious form of blood poisoning
  • produces a rash in most cases, which is typically non-blanching (but not always, especially in the early stages)
  • may cause joint and limb pain
  • causes shock
  • can lead to skin scarring or limb amputations

See the Meningitis Research Foundation website for more detailed information on the signs and symptoms of meningitis.

How is it passed on?

It is spread by water droplets coughed into the air by an infected person. The number of cases peaks in winter each year, because people tend to be in closer contact with each other for longer periods, and this spreads the disease more easily. It is also possible that common viral infections in winter make people more susceptible.

Some types of pneumococcal bacteria can be carried in the back of the throat without causing any symptoms.

What protection is available?

The recommended way to protect against pneumococcal disease is vaccination. In the UK there are two vaccines for different age groups:

Pneumococcal vaccines are also recommended for people of all ages with some health conditions who are at greater risk of complications from pneumococcal disease. See the PCV page and the PPV page for more information.

More information about the disease

Before the introduction of childhood pneumococcal vaccination, one child in every 200 in the UK was admitted to hospital for pneumococcal pneumonia during the first five years of life. Read how pneumococcal disease affected one family before the introduction of the vaccine.

In 2006 the PCV was introduced to the UK schedule. In the first 30 months of that programme, it is estimated that the vaccine prevented around 1,000 cases of invasive pneumococcal disease, and saved around 50 lives. The first vaccine, introduced in the UK in 2006, covered 7 types of pneumococcal bacteria and these 7 types are almost never seen in young children today. A new vaccine covering 13 types replaced the first one in 2010 and the further 6 types have now started to disappear.

However there are many other types of pneumococcal bacteria that can cause infections, and it remains a major cause of serious disease. Every year there are 5,000-6,000 cases of invasive pneumococcal disease (meningitis and septicaemia), and around 40,000 hospitalisations due to pneumococcal pneumonia in children and adults. Many of the types which cause invasive disease are becoming resistant to antibiotics. The adult vaccine, PPV, protects against 23 types of pneumococcal bacteria, but this vaccine does not work well in babies. There is therefore a need for improved vaccines to protect children against more types of bacteria.

In recent years, there have been several changes to the pneumococcal vaccination schedule in the UK:

  • 2002: a pneumococcal conjugate vaccine protecting against 7 types of pnemococcal bacteria (PCV7) was recommended for
    immunisation of babies and children in at-risk groups under the age of two years
  • 2003: pneumococcal polysaccharide (PPV) immunisation was recommended for all people aged 65 and over
  • 2004: PCV7 was extended to at-risk babies and children under five years of age
  • 2006: PCV7 was added to the routine childhood immunisation programme
  • 2010: a pneumococcal conjugate vaccine protecting against 13 types of pnemococcal bacteria (PCV13) replaced PCV7.
Page last updated: 
Monday, June 18, 2018