
Pneumonia is a lower respiratory tract infection that causes coughing, fever, chest pain, and, in severe cases, breathing trouble. It can be caused by bacteria, viruses, or fungi, with Streptococcus pneumoniae being the most common bacterial cause. This bacterium can lead to pneumococcal pneumonia, which is the most common type of bacterial pneumonia and the most common cause of community-acquired pneumonia. Pneumococcal pneumonia can be treated with antibiotics, but vaccination is the best way to protect against it. The pneumococcal vaccine is recommended for people based on their age or certain risk conditions, and it can prevent even mild infections. While there is no information on whether Queen Elizabeth II received the pneumococcal vaccine, she has publicly encouraged everyone to get vaccinated against COVID-19, describing it as quick, painless, and essential for protecting others. Additionally, the pneumococcal vaccine can help prevent pneumococcal bacteremia, a bloodstream infection caused by the same Streptococcus pneumoniae bacterium.
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What You'll Learn

Streptococcus pneumoniae bacteria
Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic member of the genus Streptococcus. It is a significant human pathogenic bacterium and is one of the leading causes of illness in young children. Streptococcus pneumoniae was recognised as a major cause of pneumonia in the late 19th century and continues to be the most prevalent disease caused by the bacterium.
The virulence and invasiveness of Streptococcus pneumoniae vary according to their serotypes, which are determined by their chemical composition and the quantity of CPS (capsular polysaccharide) they produce. The CPS acts as a defence mechanism against the host's immune system. Streptococcus pneumoniae expresses large amounts of capsule and pneumococcal surface protein A (PspA), which help the bacteria survive in the blood.
Streptococcus pneumoniae can cause many types of infections, including bloodstream infections (bacteremia), meningitis, sinusitis, and middle ear infections. The different illnesses caused by Streptococcus pneumoniae are referred to collectively as pneumococcal disease. Symptoms of pneumococcal disease vary depending on the specific illness the bacteria have caused. Pneumococcal pneumonia symptoms include fever, chest pain, cough, and shortness of breath. Bacteremic pneumonia accounts for 25-30% of invasive pneumococcal disease among children age 2 years or younger. Streptococcus pneumoniae can also cause invasive pneumococcal disease when it infects normally sterile locations. The two major types of invasive pneumococcal disease are bacteremia and meningitis.
Pneumococcal infections can be mild or severe. The most common types of infections are meningitis, sepsis, pneumonia, and ear and sinus infections. Streptococcus pneumoniae bacteria commonly live in the nose and throat and can be spread through direct person-to-person contact via respiratory droplets. The bacterium can be spread by healthy people who carry it in the back of their nose or throat, as well as by those who are ill.
Vaccines can prevent pneumococcal infections, and keeping up to date with recommended vaccines is the best protection against pneumococcal disease. There are two vaccines available: one for infants and young children, and another for people at high risk, including those over 65, those with chronic illnesses or weak immune systems, and those who smoke.
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Vaccination history
The bacterium pneumococcus was first isolated by Louis Pasteur in 1881 from the saliva of a patient with rabies. The association between pneumococcus and lobar pneumonia was first described in 1883, but pneumococcal pneumonia was often confused with other types of pneumonia until the development of the Gram stain in 1884. Efforts to develop effective pneumococcal vaccines began as early as 1911. The early years of vaccine development took place in the gold mines of South Africa, where vaccination with killed pneumococci was shown to be effective.
However, with the discovery of penicillin in the 1940s, interest in pneumococcal vaccination declined. It was assumed that the problem of pneumococcal infection would be largely eliminated by the use of this antibiotic. Yet, it was observed that many patients still died despite antibiotic treatment.
In 1945, the first polysaccharide vaccine (tetravalent) was developed. The current 23-valent polysaccharide vaccine (PPSV23), also known as Pneumovax 23, was developed in the 1980s and is recommended for adults. It includes the 23 most prevalent or invasive pneumococcal types of Streptococcus pneumoniae and has a reported 76% to 92% protective efficacy.
The first conjugate vaccine (heptavalent) reached the market in 2000. This vaccine, PCV7, was expanded to include protection against 13 strains in 2010 and was renamed PCV13. PCV13 is recommended for children as it protects against the bacterial strains responsible for the most severe childhood pneumococcal infections.
Pneumococcal vaccines are important as Streptococcus pneumoniae bacteria are one of the leading causes of illness in young children and can cause serious illness in adults as well. Pneumococcal infections can lead to pneumonia, bacteremia (bloodstream infection), meningitis, sinusitis, and middle ear infections, among other illnesses. These infections can be extremely serious and often require hospitalization.
While the pneumococcal vaccine helps protect against these serious illnesses, it is important to note that it does not provide complete protection. There is still a chance that an individual may get a pneumococcal infection even after being vaccinated.
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Antibiotic resistance
Streptococcus pneumoniae (pneumococcus) is the leading cause of community-acquired pneumonia and is considered a major cause of death in children under 5 years old worldwide. The bacterium was first isolated by Louis Pasteur in 1881, and the association between pneumococcus and lobar pneumonia was described in 1883.
Pneumococcal disease encompasses a range of illnesses caused by Streptococcus pneumoniae, including bacteremia (bloodstream infection), meningitis, sinusitis, and middle ear infection. Bacteremia can complicate localized infections, such as pneumonia, and is associated with high fever and shaking chills. It can also occur without a known site of infection, particularly in young children.
Antibiotics are used to treat pneumococcal disease, but the challenge of antibiotic resistance has emerged. Streptococcus pneumoniae has developed resistance to commonly used antibiotics, including penicillins, cephalosporins, and macrolides. This resistance can lead to treatment failures and increased costs compared to infections caused by non-resistant pneumococcus. The World Health Organization (WHO) identified pneumococcus as one of the nine bacteria of international concern regarding antibiotic resistance in a 2014 report.
The use of β-lactam antibiotics has been associated with penicillin-resistant pneumococcal infections. Studies have shown that prior exposure to certain classes of antibiotics and the duration of therapy influence the risk of developing resistance. The introduction of pneumococcal conjugate vaccines (PCVs) has helped reduce the incidence of resistant invasive pneumococcal disease (IPD) in the United States. However, the impact of newer PCVs on antibiotic-resistant pneumococcal serotypes is yet to be determined.
Improving appropriate antibiotic use and expanding pneumococcal vaccination coverage are crucial strategies to slow or reverse the emergence of antibiotic resistance in Streptococcus pneumoniae. Surveillance systems, such as those utilized by the CDC, play a vital role in monitoring and addressing the ongoing challenge of antibiotic resistance in pneumococcal infections.
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Vaccine efficacy
Pneumococcal disease is caused by Streptococcus pneumoniae bacteria, also called pneumococcal bacteria, pneumococci (plural), and pneumococcus (singular). It can cause serious illnesses, including pneumonia and meningitis, and bloodstream infections (bacteremia). Symptoms of pneumococcal disease vary depending on the specific illness the bacteria have caused. Pneumococcal pneumonia symptoms include fever, chest pain, cough, and shortness of breath.
Pneumococcal vaccines have been in development since as early as 1911. The first polysaccharide vaccine (tetravalent) was developed in 1945. The current 23-valent polysaccharide vaccine was developed in the 1980s and is called PPSV23 (brand name Pneumovax 23). It is most effective in adults and does not consistently generate immunity in children younger than two years old. The 13-valent pneumococcal vaccine (PCV13, brand name Prevnar 13) was introduced in 2010 and protects against the bacterial strains responsible for the most severe childhood pneumococcal infections.
The efficacy of the pneumococcal vaccine in older adults has been studied, with one study finding that receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia (hazard ratio, 0.56; 95% confidence interval, 0.33 to 0.93). However, the same study found a slightly increased risk of hospitalization for pneumonia (hazard ratio, 1.14; 95% confidence interval, 1.02 to 1.28). Another study found that pneumococcal vaccination did not alter the risk of outpatient pneumonia or any case of community-acquired pneumonia, whether or not it required hospitalization.
Overall, the pneumococcal vaccine is an important tool in preventing serious illnesses caused by pneumococcal disease, especially in high-risk groups such as babies, young children, and adults aged 65 and over. However, it is important to note that the vaccine does not provide complete protection against all strains of pneumococcal bacteria, and there is still a chance of infection even after vaccination.
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High-risk groups
Pneumococcal disease is caused by bacteria that commonly live in the nose and throat and can cause both mild and serious infections. Streptococcus pneumoniae (pneumococcus) bacteria can cause bloodstream infections (bacteremia), meningitis, sinusitis, and middle ear infections, among other illnesses.
The global burden of pneumococcal infection remains significant, especially for those at high risk, including the elderly and younger adults with comorbid conditions. The risk of infection will increase as the global population ages. The case fatality rate for those with pneumonia complicated by bacteremia is approximately 20%, but may be as high as 60% for elderly patients.
In the United States, pneumococcal bacteria cause more than 4,800 cases of invasive pneumococcal disease in children under five each year, with a 5% fatality rate. Bacteremic pneumonia accounts for 25-30% of invasive pneumococcal disease in this age group. Before the routine use of pneumococcal conjugate vaccines, children under one had the highest rates of pneumococcal meningitis, with approximately 10 cases per 100,000 population.
The CDC recommends pneumococcal vaccination for children and adults at increased risk of pneumococcal disease. The United States uses two types of pneumococcal vaccines, with each vaccine helping protect against different serotypes of pneumococcal bacteria. The CDC's recommendations include routine pneumococcal vaccination for all children younger than five years old.
Risk factors for pneumococcal disease include cigarette smoking, working in an area with toxic fumes or chemicals, and living in crowded conditions, such as nursing homes or military barracks. Individuals with sickle cell disease, certain immune deficiencies, or chronic renal disease, and those taking immunosuppressive drugs or using cochlear implants, are also at increased risk.
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Frequently asked questions
Pneumococcal bacteremia is a bloodstream infection caused by pneumococcal bacteria. It is one of the illnesses classified under pneumococcal disease.
The pneumococcal vaccine helps protect against serious illnesses like pneumonia and meningitis. It is recommended for people at higher risk, including babies and adults aged 65 and over.
The pneumococcal vaccine has been shown to be effective in reducing the risk of pneumococcal bacteremia. A study published in the New England Journal of Medicine found that receipt of the pneumococcal vaccine was associated with a significant reduction in the risk of pneumococcal bacteremia.







































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