Factsheet Pneumococcal disease

Greta Hughson, Published October 2013

Key points

  • Pneumococcal infections are common in people with HIV.
  • Vaccination and HIV treatment reduce the risk reduces the risk of invasive pneumococcal disease (IPD).
  • Pneumococcal disease is treated with antibiotics.

Pneumococcal disease is caused by a bacterium called Streptococcus pneumoniae (pneumococcus). The bacteria enter the body through the nose and mouth, directly (when an infected person sneezes or coughs, or through close contact such as kissing) or indirectly (infected fluid is transferred to a hard surface; someone touches that surface, then touches their nose or mouth).

In the UK, pneumococcus has been found to be carried by over 40% of pre-school children and 8% of young adults at any one time. For over 95% of these people, the bacteria will not cause any harm.

Pneumococcus is a common cause of ill health in the general population. In most people, it causes relatively minor health problems (called ‘non-invasive’ infections) such as bronchitis, sinusitis (sinus inflammation) and middle-ear infections.

"A low CD4 cell count is a risk factor for developing pneumococcal disease in HIV-positive people."

Serious pneumococcal diseases include septicaemia (blood poisoning), meningitis (inflammation of the brain lining) or severe pneumonia.

Pneumococcal disease and HIV

Pneumococcal infections are common in people with HIV. Compared to the general population, people with HIV are more likely to develop severe forms of pneumococcal disease. These are often called 'invasive' pneumococcal disease (IPD), as they occur in a major organ or in the blood, and can lead to serious illness.

UK research published in 2011 showed that rates of severe pneumococcal disease were approximately 50 times higher in adults with HIV.

A low CD4 cell count is a risk factor for developing pneumococcal disease in HIV-positive people, especially in people who are not taking HIV treatment. Other risk factors for pneumococcal disease include: older age; smoking; heavy alcohol use; long-term lung conditions such as asthma; diabetes; and chronic heart, liver, or kidney disease.

Taking HIV treatment reduces the risk of IPD, strengthening the immune system and making it better able to fight infections. However, people who are on HIV treatment, even with a high CD4 cell count, are still at risk. In 2011, UK doctors found that rates of serious disease were still seven times higher in people on HIV treatment and with a CD4 cell count above 500, compared to the general population.

Diagnosing and treating pneumococcal disease

Symptoms of pneumococcal disease include fever, chills and sweats, headache, cough and a general feeling of being unwell. Mild cases of pneumococcal disease are likely to go away after a few days, without the need for any special treatment.

However, because of your HIV status – and especially if you have symptoms that don’t improve after a few days – it is wise to seek medical advice. This is particularly important if you:

  • have a constant high temperature
  • cough up yellow or green mucus, particularly streaked with blood
  • have chest pains or are breathing very fast
  • become drowsy or confused
  • experience breathing difficulties.

(If you experience the possible symptoms of bacterial meningitis, the most serious type of pneumococcal infection, dial 999 and ask for an ambulance. Early symptoms can include a high fever plus a severe headache or a stiff neck. Information on early warning signs is available on the NHS Choices website.)

Generally, your GP (family doctor) or HIV clinic will investigate further and prescribe any necessary treatment. Your doctor will ask you about your symptoms, examine you, and may order some tests.

Blood or urine tests are used to look for the presence of pneumococcus. A sputum sample will be examined if pneumococcal pneumonia is suspected; you may also have a chest X-ray. In some cases, a procedure called a lumbar puncture is used to check for infection in the cerebrospinal fluid (the fluid that surrounds the brain and spine).

Non-invasive pneumococcal disease, such as sinusitis, usually gets better without treatment. Resting, drinking plenty of fluids and taking over-the-counter painkillers will help.

Otherwise, pneumococcal disease is treated with antibiotics. These can cure the infection, and the symptoms usually start to go away 12 to 48 hours after treatment is started. It is important that you take the complete course of treatment. People with more serious disease may be treated with intravenous antibiotics; especially if your symptoms are more severe, you may be admitted to hospital.

Strains of pneumococcus that are resistant to antibiotics are becoming more common. Blood, urine and/or sputum tests will show if there is any drug resistance and help your doctor choose the most effective antibiotic.


The British HIV Association recommends that people living with HIV who have a CD4 cell count above 200 should be vaccinated against pneumococcal disease, and that vaccination should be considered for people with a CD4 cell count below this level.

Booster doses are recommended every five to ten years.

There are two types of pneumococcus vaccine: pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPV). The BHIVA recommendation concerns the PPV vaccine. Research published in 2008 involving HIV-positive men in the US showed that receiving this vaccine was associated with a one-third lower risk of pneumococcal disease.

This vaccine is available from your GP surgery. You could ask about having your flu vaccine at the same time. If you do not have a GP, or have not disclosed your HIV status (and are not considered at risk and therefore eligible for the vaccine), talk to your healthcare team at your HIV clinic.

The vaccine is administered via an injection into muscle. This can be uncomfortable, and you may have some pain and swelling around the injection site for a few days. The vaccine can also cause a mild, flu-like illness lasting a few days. Generally, only one dose is needed. (People with chronic kidney disease or who have reduced spleen function may benefit from a ‘booster’ dose after five years.) The vaccine is about 50 to 70% effective in preventing pneumococcal disease.

PCV, which is the type of vaccine used for childhood pneumococcal vaccination, is more effective than PPV and may be more suitable for preventing the infection in people with HIV. A new vaccine called Prevenar 13 (PCV-13), has recently become available in the UK. It targets 13 strains of pneumococcus. According to 2011 research, this vaccine would have covered 61% of all invasive pneumococcal infections diagnosed in people with HIV. The vaccine works well at all CD4 cell counts.

This vaccine has been approved in the UK for use by adults aged over 50 years. In a statement published in July 2013, the Department of Health’s Joint Committee on Vaccination and Immunisations confirmed its decision against its routine use in high-risk groups, recommending it only for adults with very severe immunosuppression. 

This factsheet has been produced with funding support from Pfizer UK. Pfizer UK has had no editorial contol over the content.

This factsheet is due for review in October 2016

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.