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Date of preparation: March 2018

Where are the most likely sites of pneumococcal infection; and what are the most common symptoms? 

Pneumococcal infection and disease can affect a variety of organ systems, resulting in a number of disease syndromes. Pneumococcal disease can invade more sterile areas of the body, such as the blood or meninges. Additionally, contiguous spread from the nasopharynx may cause diseases such as Otitis media and sinusitis. 1 Below are some examples of symptoms related to areas of infection;

Pneumococcal pneumonia


Pneumococcal pneumonia (lung infection) is the most common serious form of pneumococcal disease. According to the World Health Organization, pneumonia should be diagnosed by the identification of alveolar consolidation or pleural effusion on the chest X-ray. 2 Symptoms, among others include rapid breathing. 3


Worldwide, approximately, 920,136 children under the age of 5 years died due to pneumonia in 2015, accounting for 16% of all deaths in infants under 5 years of age. 4

Complications of pneumococcal pneumonia include empyema, pericarditis and endobronchial obstruction, with atelectasis and abscess in the lungs. 3

Pneumococcal meningitis


Pneumococcal meningitis is an infection of the covering of the brain and spinal cord. Symptoms include: 356

  • Stiff neck
  • Fever and headache
  • Sensitivity to light
  • Confusion
  • Vomiting
  • Rash

In babies, meningitis may cause loss of appetite, low alertness and vomiting.


Meningitis is the most severe type of invasive pneumococcal disease. Of children younger than 5 years old who get pneumococcal meningitis, about 1 in 10 die of the infection and others may have long-term problems, such as hearing loss or developmental delay due to neurological sequelae. 35The case fatality rate of pneumococcal meningitis is around 20%, but it could increase to around 60% in elderly patients. 5

Acute otitis media (AOM)


AOM is one of the most frequent bacterial infections in infancy and early childhood, with approximately 80% of children having had at least one episode of AOM by the time they are 3 years old. Pneumococcus bacteria and Non-typeable haemophilus influenza (NTHi), causes approximately 60-70% of acute otitis media cases. 7

Symptoms include: 3

  • Ear pain
  • A red, swollen ear drum
  • Fever and sleepiness


Acute otitis media is usually mild and much more common than the more severe forms of pneumococcal disease. However, some children develop recurrent otitis media and may need ventilating ear tubes. 3

Although AOM can occur at any age, it is principally a disease of the young, with the most common infections happening between 3 months and 3 years. By the age of 1 year, 17% of children will have suffered at least three episodes of OM. 8

Chronic suppurative OM is defined as a chronic inflammation of the middle ear and mastoid cavity, which presents with recurrent ear discharges or otorrhoea through a tympanic perforation. 9 The global estimated incidence rate of chronic suppurative OM is 4.76 per thousand people for a total of 31 million cases, with approximately 23% of these cases occurring in children under 5 years of age. 10

OM with effusion (fluid in the middle ear with no evidence of ear infection) is associated with mild hearing loss in around 50% of children and moderate hearing loss in 5–10% of children. 11

Disease varies depending on the pneumococcal serotype

Although most Streptococcus pneumoniae serotypes have been shown to be able to cause serious disease, prior to the introduction of pneumococcal conjugate vaccines, 6–11 serotypes accounted for 70% of all IPD occurring in children worldwide. 12


  1. WHO. Pneumococcal vaccines WHO position paper – 2012. Weekly epidemiological record 2012; 87:129-44. Available at: [Last accessed June 2015].
  2. World Health Organization Pneumonia Vaccine Trial Investigators’ Group. Standardization of interpretation of chest radiographs for the diagnosis of pneumonia in children. 2011. Available at: [Last accessed June 2015].
  3. Centers for Disease Control and Prevention. Pneumococcal Disease. Symptoms & Complications. Available at: [Last accessed June 2015].
  4. WHO Pneumonia Fact Sheet No 331 November 2014. Available at: [Last accessed June 2015]
  5. CDC. Chapter 16: Pneumococcal Disease. In: Atkinson W, Wolfe S, Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases [Pink Book]. 12th edn. Washington, DC: Public Health Foundation; 2012e: 233–48.
  6. NHS Choices. Meningitis. Available at: [Last accessed June 2015].
  7. Sierra A, et al. Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in Colombian children: a prospective study. BMC Infect Dis 2011; 11: 4.
  8. Leibovitz E. Acute otitis media in pediatric medicine: current issues in epidemiology, diagnosis, and management. Paediatr Drugs. 2003;5 Suppl 1:1-12.
  9. WHO. Chronic suppurative otitis media. Burden of Illness and Management Options. Available at: [Last accessed June 2015].
  10. Monasta L, et al. Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates. PLoS One 2012; 7: e36226.
  11. Roberts J, et al. Otitis Media, hearing loss, and language learning: controversies and current research. J Dev Behav Pediatr 2004; 25:110–22.
  12. Johnson HL, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the pneumococcal global serotype project. PLoS Med 2010; 7: e1000348.