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Adult Pneumococcal Disease Prevention

CE / CME

Elucidating the Rapid Changes in Pneumococcal Disease Prevention in Adults

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: June 09, 2026

Expiration: June 08, 2027

Richard Colgan
Richard Colgan, MD
CME/CE Information

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Burden of Pneumococcal Disease in Adults

Pneumococcal disease remains a major burden on the United States healthcare system, as it is a leading cause of pneumonia, bacteremia, and meningitis. In adults, it remains one of the most common causes of infectious disease hospitalization.1,2

As with urinary tract infections and other infectious diseases, antimicrobial resistance creates additional challenges in management. Therefore, effective implementation of preventive strategies and vaccines is especially important for reducing disease burden.1,2

Effective prevention can be lifesaving for older adults, as the risk of disease and case fatality rates increase with age.1,2

Pneumococcal infections may range in severity, but invasive pneumococcal disease (IPD) is associated with substantial morbidity and mortality. Survivors may experience long-term complications, including neurologic deficits, reduced lung function, and functional decline.1,2

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Burden of CAP and Invasive Pneumococcal Disease in US Adults

The burden of community-acquired pneumonia (CAP) and IPD in US adults is substantial. The annual incidence of CAP per 100,000 adults is high, particularly among older adults. Hospitalization for CAP is associated with decreased quality of life after discharge.3,4

The burden of IPD is also significant. Among adults 65 years of age or older, the annual incidence is approximately 23-24 cases per 100,000 persons, with mortality rates reaching up to 20.8%.5,6

Several factors are associated with increased mortality from IPD, including advanced age, chronic disease, immunosuppression, and nursing home residence. Nursing home populations may also face increased challenges related to antimicrobial resistance.6

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Streptococcus pneumoniae Serotypes

More than 100 Streptococcus pneumoniae serotypes have been identified, although 23 serotypes are responsible for most IPD.7

Different vaccines cover different combinations of serotypes, and the development of these conjugate vaccines has led to marked decreases in infections caused by these serotypes. However, over time, different serotypes gradually become predominant, including some not covered by vaccines.8,9

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Invasive and Noninvasive Disease Manifestations

When considering invasive and noninvasive disease manifestations, the burden of noninvasive disease is often underestimated because it is more difficult to quantify. Severe manifestations such as bacteremia, sepsis, meningitis, and death are more readily captured in surveillance studies, whereas outpatient-treated infections may not be consistently documented.10

For example, pneumococcal bronchitis treated in the outpatient setting may not undergo microbiologic confirmation or formal reporting. Nonbacteremic pneumonia represents a substantial proportion of pneumococcal disease cases and may be difficult to confirm microbiologically because sputum cultures are not always obtained. As a result, the true burden of pneumococcal disease may be greater than reported surveillance estimates suggest.10

Ultimately, although many cases of acute bronchitis and sinusitis are viral, persistent or worsening symptoms should prompt consideration of bacterial etiology.

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Risk Factors for Severe Pneumococcal Disease in Adults

Several chronic health conditions increase the risk of severe pneumococcal disease. These include chronic obstructive pulmonary disease, asthma, diabetes mellitus, chronic cardiac, hepatic, or renal disease, and immunocompromising conditions.11

Patients with a CSF leak or cochlear implant should also be recognized as being at increased risk for severe pneumococcal disease.11

Age is another important risk factor. Adults 65 years of age or older are at substantially increased risk for severe outcomes. As the population of older adults continues to grow in the United States, increased efforts must be made to improve vaccine uptake among these individuals.11

Certain demographic and social factors are also associated with increased risk for severe disease, including African American and Alaska Native racial and ethnic groups, living in communal settings, cigarette smoking, and alcohol use disorder.11

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