Facts About Pneumococcal Disease and Prevention in Adults

Pneumococcal Disease Epidemiology and Disease Burden

  • Pneumococcal disease is caused by Streptococcus pneumoniae, which is transmitted through respiratory droplets.
  • Its most serious clinical manifestations are bacteremia, meningitis, and pneumonia.
  • Annual estimated US incidence:
    • Pneumonia: 900,000 or more cases
    • Bacteremia: 50,000
    • Meningitis: 3,000-6,000
  • Pneumococcal disease death rates:
    • Pneumonia: 5 to 7 percent
    • Bacteremia: 15 to 20 percent
    • Meningitis: 16 to 37 percent
  • Pneumococcal disease has high associated morbidity.
    • Pneumococcal meningitis can cause hearing loss, seizures, blindness, and paralysis. Concurrent cardiac events are common among patients hospitalized with pneumococcal pneumonia.
  • Symptoms develop suddenly and vary by clinical presentation:
    • Pneumonia: fever, shaking chills, cough, shortness of breath, chest pain
    • Meningitis: stiff neck, fever, disorientation, sensitivity to light
    • Bacteremia: similar to meningitis and pneumonia, with muscle and joint pain
    • In the elderly, symptoms may be atypical and might include weakness or confusion without the presence of a fever or other more common symptoms

Pneumococcal Vaccination
Two pneumococcal vaccines are recommended by the Centers for Disease Control and Prevention (CDC) for adults: a 13-valent pneumococcal conjugate vaccine (PCV13) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23).

CDC recommends both PCV13 and PPSV23 for:
        • All adults age 65 years and older
        • Adults age 19-64 years with:
            o Immunocompromising conditions or treatments (such as: HIV, lymphoma, leukemia, or Hodgkin disease, chronic kidney disease, radiation therapy, long-term systemic corticosteriods, or biologics)* 
            o Functional or anatomic asplenia* 
            o Cochlear implants or cerebrospinal fluid (CSF) leaks

*Revaccination with PPSV23 required five years after the first dose of PPSV23.

CDC recommends only PPSV23 for the following adults age 19 to 64 years:
        • Those with chronic conditions such as asthma, diabetes, lung, heart, or liver disease, or alcoholism
        • Cigarette smokers
        • Residents of nursing homes or other long-term care facilities

PPSV23 Revaccination: Those who received one dose of PPSV23 before age 65 years for any indication should receive one dose of PCV13 and another dose of PPSV23 at age 65 years or older. For  

For more information on recommended intervals for pneumococcal vaccination, refer to the Adult Pneumococcal Vaccination Guide for HCPs or visit: www.cdc.gov/vaccines/vpd-vac/pneumo/.

  • Mild side effects include redness or pain at the injection site. In rare cases fever, muscle aches, or more severe site reactions may develop.
  • Vaccination can be administered any time of year and one pneumococcal vaccine (either PCV13 or PPSV23, as indicated) can be given at the same time as influenza vaccine.

Vaccination Rates and Ethnic and Racial Disparities

    Coverage rates with the newer PCV13 are not yet available. Coverage rates in this section are for PPSV23 only.
    • The vaccination coverage in persons age 65 years and older is 60 percent; the US public health goal is 90 percent. 
        o Coverage rates are higher in whites (64 percent) compared with blacks (46 percent), Hispanics (43 percent), Asians (41 percent), and those who indicate another race (45 percent).
    • The vaccination coverage in adults age 19 to 64 years with risk conditions is 20 percent; the goal is 60 percent. 
        o Coverage rates are similar among non-Hispanic whites and blacks (about 21 percent) 
        o Coverage rates are lower in Hispanics (14 percent) and Asians (13 percent)

For more information, visit www.adultvaccination.org

July 2015

©National Foundation for Infectious Diseases