Who Is at Greatest Risk of Invasive Pneumococcal Infection?

Medically Reviewed on 10/13/2021
invasive pneumococcal disease
Pneumococcal infection and further invasive pneumococcal disease risk factors include people 65 years of age, those with immunity issues, and children under two years.

Pneumococcal infections, caused by the bacteria Streptococcus pneumoniae, can affect anyone. However, some people are at a greater risk of the infection than others, such as the following people:

  • Adults 65 years of age or older
  • Children aged younger than two years
  • People with certain underlying conditions that reduce immunity, such as human immunodeficiency virus (HIV) infection

Children with HIV infection, functional or anatomic asplenia (absence of spleen), and sickle cell disease are more likely to develop the invasive pneumococcal disease than other children of the same age without these conditions.

Other risk factors for developing pneumococcal infections include the following people:

  • Young children attending childcare
  • People with
    • Decreased immunity from disease or drugs
    • Functional or anatomic asplenia
    • Chronic conditions that include
    • Heart diseases
    • Lung diseases
    • Liver diseases
    • Renal diseases
  • Cigarette smokers
  • Alcoholics
  • Those with a cerebrospinal fluid leak (leakage of the fluid present around the brain and spinal cord)
  • People with a cochlear implant
  • Children of certain racial and ethnic groups
    • Alaska Natives
    • African Americans
    • Native Americans

How common is pneumococcal infection?

According to the Centers for Disease Control and Prevention, over 150,000 hospitalizations from pneumococcal pneumonia occur every year in the United States. Complications of pneumonia include empyema, pericarditis, and respiratory failure with about five to seven percent of people dying from the disease. People 65 years of age or older have an even higher rate of death due to pneumococcal infections.

What is invasive pneumococcal disease?

Invasive pneumococcal diseases mean that the bacteria pneumococcus has invaded the parts of the body that are normally free from germs (such as blood, cerebrospinal fluid, and the fluid around the lungs or pleural fluid). The infection typically requires hospitalization, and the disease causes further complications.

What are the invasive pneumococcal diseases?

The major invasive pneumococcal diseases are pneumonia, meningitis, and otitis media. Pneumococcal infection may cause generalized infection, such as bacteremia and sepsis.


If a person has pneumococcal pneumonia, they may suffer from symptoms that include abrupt onset of fever and chills or rigors.

Other common symptoms include:


If a person has pneumococcal meningitis, they may experience symptoms that may include:

In babies, meningitis may cause problems, such as:

  • Poor eating and drinking
  • Drowsiness
  • Vomiting

Some people with meningitis may have pneumonia.

Pneumococcal meningitis causes the death of about 1 in 12 children and one in seven older adults.

Otitis media (middle ear infection)

Symptoms of middle ear infections (otitis media) caused by pneumococcal bacteria include:

  • Ear pain
  • A red, swollen eardrum
  • Fever
  • Excessive sleepiness

Ear infections are usually mild but more common than other conditions caused by pneumococcus.

Bacteremia (blood infection)

If a person has bacteremia caused by pneumococcus, they may experience:

  • Fever
  • Chills
  • Drowsiness


Pneumococcus can cause a widespread infection that results in multiorgan damage. If a person develops it, they may present with signs and symptoms that include:

  • Confusion or disorientation
  • Shortness of breath
  • Rapid heart rate
  • Fever, shivering, or feeling very cold
  • Extreme pain or discomfort
  • Clammy or sweaty skin


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Medically Reviewed on 10/13/2021
Sanchez E. Pneumococcal Infections (Streptococcus pneumoniae). Medscape. https://emedicine.medscape.com/article/225811-overview

Centers for Disease Control and Prevention. Pneumococcal Disease: Risk Factors. https://www.cdc.gov/pneumococcal/clinicians/risk-factors.html

Sexton DJ. Invasive Pneumococcal (Streptococcus pneumoniae) Infections and Bacteremia. UpToDate. https://www.uptodate.com/contents/invasive-pneumococcal-streptococcus-pneumoniae-infections-and-bacteremia