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Pneumococcal infections are caused by the Streptococcus pneumoniae bacteria, and range from mild to severe.
There are more than 90 different strains of Streptococcus pneumoniae (S. pneumoniae) bacteria (known as serotypes), some of which cause more serious infection than others.
The symptoms of a pneumococcal infection can vary, depending on the type of infection you have. Common symptoms include:
Pneumococcal infections usually fall into one of two categories:
Non-invasive pneumococcal infections include:
Invasive pneumococcal infections include:
People with a weakened immune system are most at risk of catching a pneumococcal infection. This may be because:
Other at-risk groups include:
Read more about the causes of pneumococcal infections.
Cases of invasive pneumococcal infection usually peak in the winter, during December and January.
Non-invasive pneumococcal infections are usually mild and go away without the need for treatment. Rest, fluids and over-the-counter painkillers such as paracetamol are usually advised.
More invasive types of pneumococcal infections can be treated with antibiotics, either at home or in hospital.
Read more about how pneumococcal infections are treated.
There are two different types of pneumococcal vaccine used. These are:
The PCV protects against 13 types of S. pneumoniae bacteria, and the PPV protects against 23 types. It is thought that the PPV is around 50-70% effective at preventing more serious types of invasive pneumococcal infection.
The outlook for pneumonia in people who are otherwise healthy is good, but the infection can lead to serious complications in people who are very young, very old or have another serious health condition.
However, due to the introduction of the PCV in 2002, the number of people dying from complications that arise from pneumonia has fallen to around 7%.
The outlook for other types of invasive pneumococcal infections such as bacteraemia is generally good, although there is about a 1 in 20 chance that bacteraemia will trigger meningitis as a secondary infection.
Your symptoms will vary, depending on the type of pneumococcal infection you have.
Some common symptoms include:
You should contact your GP as soon as possible if you:
You should also contact your GP as soon as possible if your child is:
You should also see your GP if you have any of the risk factors that make you more vulnerable to developing a pneumococcal infection.
Read about the causes of pneumococcal infections for more information about these risk factors.
The most serious type of pneumococcal infection is bacterial meningitis, which requires immediate admission to hospital for emergency treatment.
Bacterial meningitis has a number of early warning signs that can occur earlier than the other symptoms.
As the condition gets worse it may cause:
The symptoms of bacterial meningitis are different in babies and young children. Possible symptoms include:
You should dial 999 immediately and request an ambulance if you think you or someone around you has bacterial meningitis.
Read more about the symptoms of meningitis.
There are more than 90 different strains of S. pneumoniae, and some are much more likely to cause serious infection (virulent) than others.
Some strains can be easily killed by the immune system, while others are resistant and likely to cause a more serious infection.
It's thought that between eight and 10 strains are responsible for two-thirds of serious infections in adults, and most cases in children.
It's important to emphasise that pneumococcal infections are far less contagious than a cold or flu. This is because most people's immune systems are able to kill the bacteria before they have the opportunity to cause an infection.
Outbreaks of pneumococcal infections can sometimes occur in environments where there are many people who have poorly functioning immune systems, such as in children's nurseries, care homes for the elderly and homeless shelters.
People with a weakened immune system, either due to their age or general health, are particularly at risk of developing a pneumococcal infection.
The bacteria can move from their throat to other parts of their body, such as the lungs, the blood or the brain. If this occurs, a more serious infection can develop.
The pneumococcal vaccine may be considered for people at higher risk, including:
You're considered to be at a higher risk of pneumococcal infection if you:
There are several ways to diagnose pneumococcal infections, and the tests you have will depend on your symptoms.
If a pneumococcal infection is suspected, your GP will listen to your chest with a stethoscope. The fluids produced during an invasive pneumococcal infection often cause a distinctive crackling sound.
You may have a blood test to check for the presence of bacteria. A high number of infection-fighting white blood cells may indicate the presence of an infection. The blood sample can be sent to a laboratory so the bacteria that caused the infection can be identified.
Several different types of imaging tests may be used, depending on your symptoms.
X-rays may be able to highlight the presence of fluid in the lungs, which would indicate a lung infection. An X-ray uses radiation to produce images of the inside of the body.
Other imaging tests that may be used to investigate a potential pneumococcal infection include:
Your blood pressure may be measured, as a serious infection can often lead to a decrease in blood pressure.
A lumbar puncture test involves taking a sample of cerebrospinal fluid (the fluid that surrounds the brain and spine) from the base of your spine and checking it for the presence of bacteria. A local anaesthetic will be used to numb the area. If the sample contains infection-fighting white blood cells and/or bacteria, it may indicate that you have meningitis.
A urinary antigen test is a relatively new type of test used to help diagnose a pneumococcal infection.
It involves taking a urine sample, then carrying out a technique known as an immunochromatographic assay. This can detect the distinctive protein molecules that make up the outer shell of the S. pneumoniae bacteria.
The treatment you receive depends on whether you have an invasive or non-invasive pneumococcal infection. Antibiotics are often used to treat a serious infection.
Non-invasive pneumococcal infections, such as sinusitis or bronchitis, will usually clear up within a week without the need for treatment.
Drinking plenty of fluids, getting plenty of rest and taking over-the-counter painkillers, such as paracetamol, should help relieve your symptoms.
Read more information about treating specific types of pneumococcal infection:
If you have an invasive pneumococcal infection, such as pneumonia, a decision will be made about whether you are well enough to be treated at home or need to be admitted to hospital.
Most GPs use a scoring system, known as the CRB-65 score, to assess the potential seriousness of a case of pneumonia.
Each of the above criteria is given a score of either 0 or 1, depending on whether or not it is applicable. The scoring system is explained below:
Hospital admission is also recommended for:
If you are being treated at home, you will usually be prescribed a seven-day course of antibiotics and asked to get plenty of rest and fluids.
It's very important to finish your course of antibiotics, even if you start to feel better. Not completing the full course of antibiotics could cause the pneumonia to return.
If your symptoms are moderate, you can usually be treated with antibiotic tablets.
If your symptoms are severe, you will usually be given antibiotics through a drip into your arm. You may also be given fluids to stop you becoming dehydrated, and oxygen to help you breathe.
Depending on how well you respond to treatment, it may be possible to switch from a drip to antibiotic tablets after a few days.
Most people who are treated in hospital require a 7-10 day course of antibiotics. The time it will take before you are well enough to return home will depend on your general state of health and whether you experience a more serious type of pneumococcal infection, such as meningitis.
It's usually recommended that you attend a follow-up examination six weeks after the start of your symptoms. This is to check that the infection has not caused any serious or permanent damage to the affected parts of your body, such as your lungs.
The follow-up examination usually involves taking a chest X-ray so the state of your lungs can be assessed.
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You can help prevent the spread of a pneumococcal infection by taking some simple hygiene precautions.
Pneumococcal vaccination is very effective at preventing pneumococcal infections.
There are two types of pneumococcal vaccination – one for children, known as the pneumococcal conjugate vaccine (PCV), and one for adults, known as pneumococcal polysaccharide vaccine (PPV).
They have three injections, which are usually given at:
The pneumococcal vaccination for children is entirely safe, although around one child in 10 will have some redness and swelling at the site of the injection, and symptoms of a mild fever. However, these side effects will pass quickly.
Speak to your GP or health visitor if you are not sure whether your child has received their pneumococcal vaccination.
Adults can have the pneumococcal vaccine or "pneumo jab" on the NHS if they are in a high-risk group for developing a pneumococcal infection.
Read more about who should have the pneumococcal vaccine.
If you are eligible, your GP surgery will contact you to arrange a vaccination. If they don't, contact your GP to arrange an appointment.
Healthy adults usually only need one dose of the pneumo jab. However, if you have a weakened immune system or spleen disorder, may need additional booster doses. Your GP can advise you about this.
After you've had the pneumo jab, you may experience some pain and inflammation at the site of the injection. This should last no longer than three days. Less commonly, some people report the symptoms of a mild fever. Again, this should pass quickly.
Read more about potential side effects of the pneumococcal vaccine.
There is an increasing body of evidence that suggests that people who drink excessive amounts of alcohol are at a greater risk of developing invasive pneumococcal infections.
Alcohol is known to suppress the immune system – the body's natural defence system that will attempt to prevent an invasive pneumococcal infection.
Therefore, the best way to lower your risk of developing a pneumococcal infection is to ensure that you stick to the recommended daily amounts of alcohol.
For men, the recommended daily amount of alcohol consumption is three to four units. For women, it's two to three units. A unit of alcohol is equal to about half a pint of normal-strength lager, a small glass of wine or a pub measure (25ml) of spirits.
Speak to your GP if you're finding it difficult to moderate your alcohol consumption. Counselling and medication are available for people with an alcohol misuse problem.
Smoking is the single biggest risk factor for developing an invasive pneumococcal infection in otherwise healthy adults.
Research has found that almost 60% of previously healthy people who develop an invasive pneumococcal infection are smokers.
It's not known exactly why smoking makes a person more vulnerable to an invasive pneumococcal infection. One theory is that the chemicals contained in tobacco smoke disrupt the normal workings of the immune system and make it less efficient.
As well as reducing your risk of developing an invasive pneumococcal infection, giving up smoking will help reduce your risk of developing other serious health conditions, such as cancer, heart disease and stroke.
If you want to give up smoking, a good first step is to see your GP. They will be able to provide help and advice about quitting, and can also refer you to an NHS Stop Smoking support service.
These services offer the most effective support for people who want to give up smoking. Studies show you are four times more likely to successfully give up smoking if you do it with the help of the NHS.
For more information, call the NHS Stop Smoking helpline on 0300 123 1044 (England only).
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