Pneumonia (pneumococcal)

• pneumococcal pneumonia is caused by Streptococcus pneumoniae, an encapsulated gram-positive organism often preceded by a viral infection (1)
• accounts for up to 80% of community-acquired pneumonia (CAP) in adults and 90% of acute bacterial pneumonias in non-immunocompromised children (2)
• over 100 capsular serotypes exist; higher-numbered types disproportionately affect the extremes of age and immunocompromised individuals (1, 2)
• transmission occurs via respiratory droplets or direct contact
• recovery classically occurs around day 10, coinciding with host immunoglobulin production

Clinical Features

• acute onset with high fever, rigors, pleuritic chest pain, and "rusty" sputum
• systemic signs include tachypnoea, tachycardia, confusion in older adults, and herpes labialis
• focal chest signs indicate lobar consolidation (bronchial breathing, dullness, crackles)
• severe cases may progress to bacteraemic pneumonia, septicaemia, or meningitis

Risk Groups for Immunisation

• adults aged 65 years and over (1)
• asplenia or splenic dysfunction (e.g., sickle cell disease, thalassaemia major, coeliac disease, splenectomy)
• chronic organ disease: severe asthma/COPD, heart failure, CKD (stages 4–5/dialysis), or liver cirrhosis
• immunosuppression (chemotherapy, HIV, steroids, bone marrow transplant), diabetes on medication, and Down syndrome
• high-risk cohorts: CSF leaks, cochlear implants, homelessness, and welders

Vaccination Schedule (UK Guidance)

• infant routine: PCV13 at 16 weeks and 1 year (1+1 schedule) (1)
• adult and risk groups: transition from PPV23 to PCV20 for clinical risk groups (>=2 years) and adults turning 65
• dosing: single dose of PCV20 for most risk groups; 2 doses (4 weeks apart) for severe immunocompromise
• 5-year booster policy: PCV20 re-immunisation every 5 years is restricted to asplenia/splenic dysfunction and CKD (1)

Management

• severity triage: use CRB-65 score in primary care to determine admission vs. outpatient care
• first-line treatment: oral amoxicillin for mild-to-moderate CAP; macrolides or doxycycline in penicillin allergy
• post-IPD care: check vaccination status post-recovery and vaccinate eligible patients prior to discharge (1)

Reference:

1. UK Health Security Agency (UKHSA). Pneumococcal: the green book, chapter 25. UKHSA Guidance. Updated 16 October 2026.
2. European Centre for Disease Prevention and Control (ECDC). Pneumococcal disease. ECDC Surveillance Report, 2023.