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Pediatric Pneumococcal Disease Prevention

CE / CME

Up to Date on Pneumococcal Disease and Prevention in Your Pediatric Patients

Pharmacists: 0.50 contact hour (0.05 CEUs)

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 0.50 Nursing contact hour

Released: July 13, 2026

Expiration: July 12, 2027

Robert H. Hopkins, Jr.
Robert H. Hopkins, Jr., MD
CME/CE Information

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Burden of Pneumococcal Disease in Children

Pneumococcal disease is a major cause of morbidity and mortality in adults and children. Streptococcus pneumoniae is the most common bacterial cause of acute otitis media, sinusitis, and invasive infections such as pneumonia, bacteremia, and meningitis.1

Transmission most commonly occurs by inhalation of  infected respiratory secretions that colonize the nasopharynx. Less commonly, pneumococci may be passed to another person via exposure to fomites. Transmission occurs readily within communities and group settings.2

From a healthcare perspective, antimicrobial-resistant pneumococcal strains present an additional challenge because resistant organisms are difficult or impossible to treat with standard antibiotics, leading to higher mortality rates, prolonged illness, and increased risk of transmission.1

Increasing prevalence of antimicrobial resistant strains highlights the importance of preventing new infections with vaccination.3

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Invasive and Non-invasive Disease Manifestations

Streptococcus pneumoniae causes both invasive and non-invasive infections. Invasive illnesses include bacteremia, meningitis, and pneumonia; while non-invasive infections include sinusitis and acute otitis media.4

Although non-invasive infections are generally less severe, they occur much more frequently than invasive infections and account for a substantial proportion of the overall disease burden. In many [most] cases, the causative pathogen is not microbiologically confirmed, which contributes to underrecognition of the burden of disease from non-invasive pneumococcal disease.4

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Key Streptococcus pneumoniae Virulence Factors

The virulence of Streptococcus pneumoniae is largely related to its polysaccharide capsule , and surface-associated proteins. Surface characteristics of pneumococcal bacteria are responsible for immune evasion, promote inflammatory responses, and facilitate colonization by enabling the organism to adhere to mucosal surfaces.5,6

The polysaccharide capsule is the foundation for all pneumococcal vaccines currently approved by the FDA.7 Proteins are conjugated (bound) to polysaccharide capsule materials to make pneumococcal conjugate vaccines.

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Streptococcus pneumoniae Serotypes

There are hundreds of pneumococcal serotypes, each with their own unique polysaccharide capsule. For this reason,  vaccines produced for specific pneumococcal serotypes provide protection  which is mostly serotype-specific.7

As the serotypes responsible for disease in adults and children have evolved, the types affecting adults and children have diverged; a difference that has grown more pronounced in recent years. As pediatric vaccination programs expanded, the prevalence of disease shifted from serotypes covered by vaccines to serotypes not covered by vaccines, a phenomenon known as serotype replacement.8-11

As a result, a broad range of pneumococcal serotypes now contributes to disease in both children and adults.12

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Risk Factors for Severe Pneumococcal Disease in Children

Pneumococcal disease can affect children of all ages, but younger children, particularly those in childcare settings, are at increased risk. Pneumococci are readily transmitted through close contact, so daycare environments and schools can be important settings for transmission. Earlier and longer term exposure in these settings contributes to higher carriage rates and a greater likelihood of infection.13,14

Certain demographic groups, including African American, Alaska Native, and Native American children, experience higher rates of pneumococcal disease.

Separately, household crowding and institutional living also may contribute to increased risk of severe disease.13,14

Certain medical conditions are also associated with increased risk of severe pneumococcal disease. Children with cochlear implants or cerebrospinal fluid (CSF) leaks are at elevated risk for meningitis because of the disruption of normal protective barriers to this compartment. Chronic lung disease, diabetes mellitus, cardiac disease, liver disease, and kidney disease are associated with increased susceptibility to infection. Neurologic disorders may impair airway clearance and increase the risk of respiratory infections.13,14

Immunocompromising conditions further increase risk, and similarly, malignancies and their treatments can compromise immune function and increase vulnerability to invasive pneumococcal disease. Organ transplant recipients also require immunosuppressive therapy that places them at higher risk for bacterial infections.13,14

Lastly, premature infants are also more vulnerable to infection.14

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