What are the symptoms of pneumococcal disease?

If people are infected with pneumococci bacteria, it does not always make them feel ill. However, they do carry the bacteria in their nose and throat for several months. This is called pneumococcal carriage. Very few carriers (under 1 in 100) become ill from the pneumococci. Most people get rid of the bacteria on their own. If children who have the bacteria do become ill, it usually takes the form of an ear infection, sinus infection and/or bronchitis. People over 60 usually develop pneumonia from pneumococci. Pneumonia caused by pneumococci usually starts very suddenly.

The bacteria can sometimes end up in the bloodstream or cause meningitis. In these cases, people can become seriously ill. This is called invasive pneumococcal disease.

What are the symptoms of invasive pneumococcal disease?

A person with invasive pneumococcal disease usually becomes seriously ill within a short time period. Children under 5 years old usually get blood poisoning or meningitis. People over 60 usually develop severe pneumonia.

Symptoms may vary depending on the type of infection. They could include:

• fever
• low body temperature
• shortness of breath
• chest pain while breathing
• headache
• stiff neck
• confusion
• loss of consciousness

Additional symptoms that may occur specifically in babies:

• nappy rash
• irritability
• drowsiness
• pallor

Who has a higher risk of becoming very ill from pneumococcal disease?

The following groups are more likely to become ill from a pneumococcal infection, and more likely to develop serious illness:

• children under 5 years
• adults aged 60 years and older
• people whose immune system does not work very well (such as people with leukaemia)
• people with impaired spleen function or without a spleen
• people with a cochlear implant (a special hearing aid surgically implanted in the ear)
• people with a brain fluid leak (CSF leak)
• people whose lungs were damaged following a SARS-CoV-2 infection (COVID-19)

A vaccination against pneumococcal disease is advised for children, people over 60 and people in various medical risk groups (information in Dutch). If you are not in one or more of these groups, but would still like to be protected against pneumococcal disease, you can be vaccinated at your own request (information in Dutch). You will need to pay for it yourself.

How does pneumococcal disease spread?

Pneumococcal disease is contagious; the bacteria can be transmitted through saliva, cuddling or kissing, or by touching someone after coughing or sneezing. People in close proximity are more likely to become infected with the bacteria. Up to 70% of all young children and up to 30% of all adults have pneumococci in their nose or throat, without any symptoms. However, they can pass the bacteria on to others.  If a person becomes ill from a pneumococcal infection, they often already had a viral infection.

How can I prevent pneumococcal disease?

Vaccination offers the best protection against pneumococcal disease. By vaccinating young children, there is a significant drop in severe pneumococcal disease – in children and adults. That is why babies are vaccinated against pneumococcal disease in their first year of life through the National Immunisation Programme. This vaccine was updated in 2024 (information in Dutch), following an advisory opinion by the Health Council of the Netherlands, and now offers protection against fifteen different types of pneumococcal bacteria.

People over 60 years are also vaccinated against pneumococcal disease. The types of pneumococci that cause illness in older people are usually not the types that children are vaccinated against. That is why people over 60 receive a different vaccination against pneumococcal disease, not the same as the children. This vaccination protects them against the 20 most common types of pneumococci that could make them ill.

Vaccination protects against the various types of pneumococci that cause most forms of pneumococcal disease. It does not prevent all pneumococcal disease.

In addition to vaccination, good hygiene (information in Dutch) is also important. Wash your hands regularly. Cough and sneeze into your elbow and use paper tissues.

Is there any treatment for pneumococcal disease?

People with pneumococcal disease are treated with antibiotics. After 2 days of treatment, they are no longer contagious. People with invasive pneumococcal disease are treated in hospital, using IV antibiotics. If needed, they also receive supplementary oxygen or are put on respiratory support. About 20% to 25% of older adults with invasive pneumococcal disease need treatment in ICU. About 10% of children under 5 years end up in ICU.

Most people recover after having pneumococcal disease. However, not everyone recovers fully. For example, some older adults may have permanent heart and/or lung problems. Children who develop meningitis could also have permanent symptoms, such as hearing loss, epilepsy or motor disabilities. Patients with invasive pneumococcal disease could die; this happens in about 10% of cases.

How common is pneumococcal disease in the Netherlands?

More than 8000 people in the Netherlands end up in hospital every year with some form of pneumococcal disease. These patients include people of all ages.

Between June 2023 and May 2024, more than 2000 people developed invasive pneumococcal disease. All of these patients were admitted to hospital. It is likely that less serious cases of pneumococcal disease that do not require hospitalisation happen much more often, but there is insufficient data on those cases at this time.

Can a person with pneumococcal disease go to childcare, school or work?

Children and adults with mild symptoms caused by pneumococcal disease can go to childcare, school or work as usual, if they feel well enough. People with invasive pneumococcal disease are often too ill to go to childcare, school or work. They can return once they feel well again.