Pneumococcal Vaccine
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Pneumococcal Vaccine

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What Is Pneumococcal Disease?

Pneumococcal disease is an infection caused by the bacterium Streptococcus pneumoniae. It can lead to pneumonia, bacteremia (infection of the blood), middle ear infection, or bacterial meningitis, which especially affects children under one year. Each year, it's estimated that 200 children die from pneumococcal disease.

Streptococcus pneumoniae is spread through contact with a person who has pneumococcal disease or who carries the bacteria in his or her throat. This most often occurs through respiratory droplets from the nose or mouth of someone with the infection.

This infection is most common in infants and young children, specifically, children under the age of two, and those in daycare. It also occurs in those who have certain illnesses (eg, sickle cell disease, HIV infection, and chronic heart or lung conditions). These people are at higher risk of getting pneumococcal disease. Also, Alaskan Natives, Native Americans, and African Americans are more likely than other ethnic groups to get the infection.

Symptoms of meningitis include:

  • High fever
  • Headache
  • Stiff and sore neck
  • Nausea and vomiting
  • Difficulty looking into bright lights
  • Confusion
  • Sleepiness
  • In infants, slowness or inactivity, irritability, vomiting, and/or poor feeding

Symptoms of pneumonia include:

  • Chills
  • Fever
  • Shortness of breath
  • Chest pain worsened by breathing deeply
  • Productive cough
  • In infants and young children, fever, cough, rapid breathing, and/or grunting

Symptoms of middle ear infection include:

  • Pain in the ear
  • Red, swollen eardrum
  • Sleepiness
  • Fever
  • Irritability

Symptoms of bacteremia include:

  • Nonspecific symptoms, including fevers and irritability

Pneumococcal disease is treated with antibiotics.

What Is the Pneumococcal Vaccine?

There are two types of pneumococcal vaccines, both made from inactivated bacteria: the pneumococcal polysaccharide vaccine (PPV) and the pneumococcal conjugate vaccine (PCV). PPV is recommended for older children and adults, while PCV is approved for infants and toddlers.

The vaccine, which must be stored in the refrigerator, is given by injection under the skin or into the muscle, usually in the arm or thigh.

Who Should Get Vaccinated and When?

PPV is recommended for all adults 65 years of age or older. It is also recommended for people over the age of two who have certain health problems, including:

In addition, people over the age of two who are taking medications that lower the body's resistance to infection, including long-term steroids, certain cancer drugs, and radiation therapy, are advised to get PPV. Finally, Alaskan Natives and certain Native American populations should receive the vaccine.

PCV is recommended for children under two years of age. It is taken in four doses, at two, four, six, and 12-15 months. PCV, in one dose, is also recommended for children between 24-59 months who have not completed or started the vaccine series. PPV is recommended to children more than 2 years old with underlying medical conditions.* Children at high risk include those who take medications that affect the immune system or have the following conditions:

  • Heart, lung, or liver disease
  • Sickle cell disease
  • Diabetes
  • HIV infection or AIDS
  • Damaged spleen or no spleen

Finally, PCV should be considered for children who are under three years of age, are of Alaskan Native, American Indian, or African American descent, or attend group daycare. The number of doses for these children depends on their age.

What Are the Risks Associated With the Pneumococcal Vaccine?

PPV is a very safe vaccine. Half of the people who get the vaccine have mild side effects, such as redness or pain near the injection site. Less than 1% will develop a fever, muscle aches, or more severe local reactions. In rare cases, there have been reports of severe allergic reactions and other serious problems, even death. However, developing pneumococcal disease is much more likely to cause serious problems than getting the vaccine.

For PCV, studies have shown that about 25% of infants have redness, tenderness, or swelling around the injection site. About a third have a fever over 100.4ºF, and one in 50 has a higher fever (over 102.2ºF). There have also been reports of drowsiness and a loss of appetite. While there have been no reports of serious reactions from PCV, all vaccines are associated with a very small risk of serious problems, including severe allergic reactions that may result in death.

Who Should Not Get Vaccinated?

Because the safety of PPV in pregnant women has not been studied, pregnant women should consult their doctor before being vaccinated.

Also, certain children should not get PCV. These include those who have had a life-threatening allergic reaction to a previous dose of PCV, or those who have a severe allergy to one of the vaccine's components.

Children who have minor illnesses (eg, a cold) can be vaccinated, but those who are moderately or severely ill should wait until they recover to get the vaccine.

What Other Ways Can Pneumococcal Disease Be Prevented Besides Vaccination?

Avoiding close contact with people who have infections can prevent pneumococcal disease. Also, washing your hands regularly can reduce your risk of infection.

What Happens in the Event of an Outbreak?

In the event of a pneumococcal disease outbreak, all people who are eligible for a vaccine should receive it. The key to preventing outbreaks is for everyone who is at risk to receive a vaccination.


National Immunization Program
Centers for Disease Control and Prevention


National Immunization Program. US Centers for Disease Control and Prevention website. Available at:

Parents’ guide to childhood immunization. Centers for Disease Control and Prevention website. Available at: Accessed February 18, 2008.

Vaccine information for the public and health professionals—pneumoccocal vaccine: questions and answers. Immunization Action Coalition website. Available at: Accessed February 18, 2008.

*Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by DynaMed's Systematic Literature Surveillance Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years—United States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at: Updated January 10, 2008. Accessed January 28, 2008.

Last reviewed February 2008 by David Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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