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Pneumococcal Disease Guide

Over 100 pneumococcal strains exist, but just a few cause most disease – learn how updated vaccination programs protect patients in 2025

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Key Summary

  • What it is: Pneumococcal disease, caused by Streptococcus pneumoniae (>100 serotypes), can cause mild illness (e.g. ear infections) or severe invasive disease such as pneumonia, meningitis, or septicaemia.
  • Symptoms: Vary by infection type – pneumonia (fever, cough, chest pain, confusion), meningitis (stiff neck, headache, seizures), septicaemia (fever, chills, low alertness), and otitis media in children (ear pain, fever, irritability).
  • High-risk groups: Children <5, adults ≥70, Aboriginal and Torres Strait Islander people (<5 and ≥50), aged-care residents, smokers, and people with chronic conditions.
  • Transmission: Spread via respiratory droplets; often colonises the nose/throat without symptoms before progressing to disease.
  • Vaccines:
    • Conjugate vaccines: Prevenar 13, Vaxneuvance (15vPCV), Prevenar 20 – from 6 weeks of age.
    • Polysaccharide vaccine: Pneumovax 23 – from age 2 and in adults.
  • Recommendations:
    • Children: Routine infant vaccination (schedule changing Sept 2025); extra doses for some Aboriginal and Torres Strait Islander children.
    • Adults: All non-Indigenous ≥70 get a conjugate vaccine. Aboriginal and Torres Strait Islander ≥50 and those with risk conditions get both conjugate and polysaccharide vaccines.
  • Effectiveness: Vaccination has greatly reduced invasive disease; conjugate vaccines provide strong, serotype-specific protection and herd immunity.
  • Prevention & safety: Vaccination is the best prevention. Vaccines are safe; side effects are mild and short-lived.

On This Page

About Pneumococcal Disease

Pneumococcal disease is caused by the Gram-negative bacterium, Streptococcus pneumoniae (pneumococcus). Infection usually starts with a colonising event in the nose and throat, which is asymptomatic, and most infections do not progress beyond colonisation. However, some infections spread locally or invasively to cause disease.


Certain pneumococcal diseases are non-invasive, such as middle ear infections (otitis media), sinusitis, or bronchitis.[1] Others are invasive, involving the blood or a major organ, and are potentially life-threatening. Examples of invasive pneumococcal diseases (IPDs) include septicaemia (sepsis), meningitis, or bacteraemic pneumonia.


Pneumococci usually possess a polysaccharide capsule, which appears as more than 100 serotypes,[2]and immunity to the organism is capsule-type specific. Although many serotypes cause disease, only a few cause most infections. The predominant serotypes vary with age, time, and geography.[3][4]

A PDF version of this guide is available to download here.

Transmission

Transmission occurs through respiratory droplets from people with pneumococcal disease or healthy carriers. If an infected person coughs or sneezes in close proximity to others, the infection may spread.

Following acquisition, the bacterium becomes established in the nasopharynx of the host, leading to asymptomatic colonisation. It may then spread to other parts of the body, causing disease. The bacteria’s polysaccharide capsule helps it resist phagocytosis. If no anti-capsular antibody pre-exists, alveolar macrophages cannot kill the pneumococci.[6][7][8][9]

Clinical Features

The major clinical syndromes of IPD are pneumonia, septicaemia, and meningitis.[10][11] Symptoms of pneumonia include fever, chills, coughing, rapid or difficult breathing, chest pain, rigors, tachycardia, rusty-coloured sputum, cough productive of mucopurulent material, dyspnoea, tachypnoea, hypoxia, or, in older patients, confusion or low alertness.

Meningitis, although the least common, is the most severe category of IPD and is often fatal.[12][13] Symptoms include a stiff neck, fever, lethargy, nuchal rigidity, cranial nerve signs, seizures, coma, headache, pain when looking into bright lights, confusion, or, in babies, poor feeding, low alertness, or vomiting.

Septicaemia is the most common IPD among young children. Symptoms include fever, chills, and low alertness. By 12 months, most children have also experienced otitis media. Pneumococcus is detected in 28 to 55% of middle ear aspirates from children with otitis media. Symptoms include ear pain, a red, swollen eardrum, fever, and sleepiness. Complications of otitis media may include mastoiditis and meningitis.[14][15][16]

Antibiotic Resistance

Pneumococcal disease is mainly treated using β-lactam antibiotics, though pneumococci are increasingly developing antibiotic resistance. Strains have variably become resistant to penicillin, cephalosporins, macrolides, tetracycline, clindamycin, and quinolones.[5]

Who Should Receive Pneumococcal Disease Vaccination

Infants and children

Infants and children are recommended to receive a pneumococcal conjugate vaccine.

Adults

Adults aged ≥70 years are recommended to receive pneumococcal conjugate vaccine.

Aboriginal and/or Torres Strait Islander people

Aboriginal and/or Torres Strait Islander children are recommended to receive pneumococcal conjugate vaccine.

Aboriginal and/or Torres Strait Islander adults aged ≥50 years are recommended to receive a pneumococcal conjugate vaccine and 23vPPV.

People with medical risk factors

Infants aged ≤12 months with a risk condition are recommended to receive pneumococcal conjugate vaccine.

Children and adolescents aged >12 months to <18 years with a risk condition are recommended to receive pneumococcal conjugate vaccine.

Adults aged ≥18 years with a risk condition are recommended to receive pneumococcal conjugate vaccine and 23vPPV.

Vaccine Type and Dosage

The type and number of doses of pneumococcal disease vaccination vary across age groups and risk categories. This can be quite complicated to follow, but it is summarised in the NIP Schedule and Australian Immunisation Handbook (AIH).

The Immunisation Coalition has developed the PneumoSmart Vaccination Tool (PTV), a digital tool  which identifies the vaccine type and dosage based on patient criteria. The PVT is based on the AIH and is intended for use by practitioners and nurse immunisers.  It is currently being updated to reflect the changes in the childhood vaccine schedule.

Diagnosis

Diagnosis of pneumococcal disease should be based on the following:

  • Clinical evaluation: Based on symptoms and physical examination.
  • Laboratory tests: Blood tests, sputum cultures, and urine tests to identify S. pneumoniae.
  • Imaging: Chest X-rays for pneumonia and CT scans for sinusitis or suspected meningitis.

Dosage And Administration

The dose of 13-valent pneumococcal conjugate vaccine (13vPCV) is 0.5 mL, to be given by IM injection in the opposite limb to other injectable vaccines, if possible. 13vPCV (Prevenar 13) is registered for use in people aged ≥6 weeks.[22]

The dose of 15-valent pneumococcal conjugate vaccine (15vPCV) is 0.5 mL, to be given by IM injection in the opposite limb to other injectable vaccines, if possible. 15vPCV (Vaxneuvance) is registered for use in people aged ≥6 weeks.[23]

The dose of 20-valent pneumococcal conjugate vaccine (20vPCV) is 0.5 mL, to be given by IM injection in the opposite limb to other injectable vaccines, if possible. 20vPCV (Prevenar 20) is registered for use in people aged ≥6 weeks.[24]

The dose of pneumococcal polysaccharide vaccine (23vPPV) is 0.5 mL, to be given by either IM or SC injection in the opposite limb to other injectable vaccines, if possible. The IM route is preferred, as a 3-fold greater rate of injection site reactions is found following administration of 23vPPV by the SC route. A vaccine dose administered subcutaneously does not need to be repeated. 23vPPV (Pneumovax 23) is registered for use in children aged ≥2 years and in adults. [25]

Childhood Vaccination Recommendations

Routine schedule for all children[29]

All children are recommended to receive 20vPCV (Prevenar 20®) in a 3-dose schedule at 2, 4 and 12 months of age.

  • The first dose may be given as early as 6 weeks of age, but the next dose should still be given at the routine 4-month visit.

Children who started their schedule with 13vPCV or 15vPCV should complete their course with 20vPCV.

Children who have already completed their full schedule with 13vPCV or 15vPCV do not require any additional 20vPCV.

20vPCV is funded through the National Immunisation Program (NIP) for all children aged <5 years.

Aboriginal and/or Torres Strait Islander children[27]

Aboriginal and/or Torres Strait Islander children are recommended to receive 20vPCV in a 4-dose schedule at 2, 4, 6 and 12 months of age.

  • The additional 6-month dose is recommended because of the higher burden of pneumococcal disease in this population.

Children who began their schedule with 13vPCV or 15vPCV should complete it with 20vPCV.

Additional recommendations:

In NT, QLD, WA and SA, Aboriginal and/or Torres Strait Islander children who completed their PCV schedule with 13vPCV or 15vPCV are recommended to receive:

  • A single dose of 20vPCV at 4 years of age or 12 months after their last PCV dose, whichever is later.
  • If they already received one dose of 23vPPV, they should instead receive a dose of 20vPCV at least 5 years later.
  • If they have already received two doses of 23vPPV, no further 20vPCV is required.

In ACT, NSW, Tas and Vic, Aboriginal and/or Torres Strait Islander children without risk conditions who completed their schedule with 13vPCV or 15vPCV do not require any supplementary 20vPCV.

20vPCV is funded through the NIP for all Aboriginal and/or Torres Strait Islander children aged <5 years.

Catch-up vaccination:

Children with risk conditions[28]

Infants aged ≤12 months with risk conditions are recommended to receive 20vPCV in a 4-dose schedule at 2, 4, 6 and 12 months of age.

Children aged >12 months to <18 years with risk conditions are recommended to receive a single dose of 20vPCV at least 2 months after any previous PCV and 12 months after any 23vPPV.

Children who began their schedule with 13vPCV or 15vPCV should complete it with 20vPCV.

If a child completed their PCV schedule with 13vPCV or 15vPCV:

  • They should receive a dose of 20vPCV at 4 years of age or 12 months after the last PCV dose, whichever is later.
  • If they already received one dose of 23vPPV, they should instead receive a dose of 20vPCV at least 5 years later.
  • If they have received two doses of 23vPPV, no supplementary 20vPCV is required.

Children with risk conditions who undergo haematopoietic stem cell transplantation should receive 3 doses of 20vPCV after transplantation, regardless of previous vaccine history.

20vPCV is funded through the NIP for infants and children with eligible risk conditions.

Adult Vaccination Recommendations

A single dose of a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) is recommended for adults at 70 years of age.[26]

13vPCV (Prevenar 13) is funded through the NIP for adults aged ≥70 years.[26]

Aboriginal and/or Torres Strait Islander adults aged ≥50 years are recommended to receive[27]:

  • a dose of a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) at age ≥50 years, and
  • a dose of 23vPPV 12 months later (2–12 months is acceptable),and
  • a 2nd dose of 23vPPV at least 5 years later

13vPCV (Prevenar 13) and the additional doses of 23vPPV (Pneumovax 23) are both funded through the NIP for all Aboriginal and/or Torres Strait Islander adults without risk conditions aged ≥50 years.[27]

People aged ≥18 years with a risk condition (see Table. Risk conditions for pneumococcal vaccination and eligibility for NIP funding) are recommended to receive:[28]

  • 1 dose of a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV), and
  • 1 dose of 23vPPV 12 months after a pneumococcal conjugate vaccine (13vPCV, 15vPCV or 20vPCV) (2–12 months is acceptable), and
  • a 2nd dose of 23vPPV at least 5 years after the 1st dose of 23vPPV

Note: Only 13vPCV (Prevenar 13) and the additional doses of 23vPPV (Pneumovax 23) are funded through the NIP for adults with risk conditions –  see table. 

Pregnancy And Breastfeeding

Pneumococcal vaccines are not routinely recommended during pregnancy.[30]

Patients with  risk condition(s) for pneumococcal disease are normally recommended to receive pneumococcal vaccine either:[30]

  • before a planned pregnancy, or
  • as soon as practicable after delivery

Give special consideration to vaccination during pregnancy for patients at the highest increased risk of pneumococcal disease who were not vaccinated before pregnancy but need vaccination before delivery.[30] (See List. Risk conditions for pneumococcal disease.)

Co-Administration With Other Vaccines

Infants can receive pneumococcal vaccines at the same time as other vaccines given in childhood. 

In adults, pneumococcal vaccines (any conjugate vaccine or 23vPPV) can be concurrently administered with herpes zoster vaccines, influenza vaccines, RSV vaccines, and COVID-19 vaccines using separate syringes and injection sites (refer to the Australian Immunisation Handbook).

References

  1. Weinberger DM, Harboe ZB, Sanders EA, et al. Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis. Clinical Infectious Diseases 2010;51:692-9.
  2. Bertran M et al. Invasive pneumococcal disease 3 years after introduction of a reduced 1 + 1 infant 13-valent pneumococcal conjugate vaccine immunisation schedule in England: a prospective national observational surveillance study  The Lancet Infectious Diseases May 2024 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00706-5/fulltext
  3. World Health Organization (WHO). 23-valent pneumococcal polysaccharide vaccine: WHO position paper. Weekly Epidemiological Record 2008;83:373- 84.
  4. Klugman KP, Dagan R, Malley R, Whitney CG. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, Edwards KM, eds. Plotkin’s vaccines. 7th ed. Philadelphia, PA: Elsevier; 2018.
  5. Roche PW, Krause V, Cook H, et al. Invasive pneumococcal disease in Australia, 2006. Communicable Diseases Intelligence 2008;32:18-30
  6. Kadioglu A, Weiser JN, Paton JC, Andrew PW. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nature Reviews Microbiology 2008;6:288-301.
  7. Centers for Disease Control and Prevention (CDC). Pneumococcal disease. In: Atkinson W, Wolfe C, Hamborsky J, eds. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, D.C.: Public Health Foundation, 2011.
  8. Black S, Eskola J, Whitney C, Shinefield H. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
  9. World Health Organization (WHO). 23-valent pneumococcal polysaccharide vaccine: WHO position paper. Weekly Epidemiological Record 2008;83:373- 84.
  10. Centers for Disease Control and Prevention (CDC). Pneumococcal disease. In: Atkinson W, Wolfe C, Hamborsky J, eds. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, D.C.: Public Health Foundation, 2011.
  11. File TM, Jr., Marrie TJ. Burden of community- acquired pneumonia in North American adults. Postgraduate Medicine 2010;122:130-41.
  12. CDC. Pneumococcal disease. In: Atkinson W, Wolfe C, Hamborsky J, eds. Public Health Foundation, 2011.
  13. Black S, Eskola J, Whitney C, Shinefield H. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
  14. CDC. Pneumococcal disease. In: Atkinson W, Wolfe C, Hamborsky J, eds. Public Health Foundation, 2011.
  15. World Health Organization (WHO). 23-valent pneumococcal polysaccharide vaccine: WHO position paper. Weekly Epidemiological Record 2008;83:373- 84.
  16. Eskola J, Kilpi T, Palmu A, et al. Efficacy of a pneumococcal conjugate vaccine against acute. otitis media. New England Journal of Medicine 2001;344:403-9.
  17. Black S, Eskola J, Whitney C, Shinefield H. Pneumococcal conjugate vaccine and pneumococcal common protein vaccines. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
  18. Menzies R, Turnour C, Chiu C, McIntyre P. Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia, 2003 to 2006. Communicable Diseases Intelligence 2008;32 Suppl:S2-67.
  19. Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. The Lancet 2009;374:1543-56. 
  20. Cook IF, Pond D, Hartel G. Comparative reatogenicixy and immunogenicity of 23 valent pneumococcal vaccine administered by intramuscular or subcutaneous injection in elderly adults. Vaccine 2007;25:4767-74.
  21. Australian Government Department of Health and Aged Care. Pneumococcal disease. In: Australian immunisation handbook. Canberra: Australian Government Department of Health and Aged Care; 2023. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#overview
  22. Prevenar 13® (Pneumococcal polysaccharide conjugate vaccine, 13-valent adsorbed) [Internet]. ebs.tga.gov.au. [cited 2024 Aug 26]. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-07066-3&d=20240826172310101
  23. VAXNEUVANCE® (Pneumococcal 15-valent Conjugate Vaccine [CRM197 Protein], adsorbed) [Internet]. ebs.tga.gov.au. [cited 2024 Aug 26]. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2022-PI-01039-1
  24. PREVENAR 20® (pneumococcal polysaccharide conjugate, 20-valent adsorbed) VACCINE [Internet]. ebs.tga.gov.au. [cited 2024 Aug 26]. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2022-PI-02385-1
  25. PNEUMOVAX® 23 Pneumococcal Vaccine Polyvalent Pneumococcal purified capsular polysaccharides Solution for Injection [Internet]. ebs.tga.gov.au. [cited 2024 Aug 26]. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-01558-3
  26. Australian Government Department of Health and Aged Care. Pneumococcal disease. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 Jun 25]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#adults
  27. Australian Government Department of Health and Aged Care. Pneumococcal disease: Women who are pregnant or breastfeeding. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 Sep 9]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#women-who-are-pregnant-or-breastfeeding
  28. Australian Government Department of Health and Aged Care. Pneumococcal disease: Aboriginal and Torres Strait Islander people. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 025 [cited 2025 Sep 09]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#aboriginal-and-torres-strait-islander-people
  29. Australian Government Department of Health and Aged Care. Pneumococcal disease: People with medical risk factors. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2025 [cited 2025 Sep 09]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#people-with-medical-risk-factors
  30. Australian Government Department of Health and Aged Care. Pneumococcal disease: Infants and children. In: The Australian Immunisation Handbook [Internet]. Canberra: Australian Government Department of Health and Aged Care; 2024 [cited 2025 Sep 9]. Available from: https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/pneumococcal-disease#infants-and-children

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