What is it?
Pneumococcal disease is caused by infection with the bacteria Streptococcus pneumoniae (pneumococcus), which can live in the nose and throat (nasopharynx). In most cases it is considered part of the normal flora and generally does not cause illness or disease. However, in some cases the bacteria may grow and spread to other parts of the body that would normally be sterile, causing invasive pneumococcal disease (IPD), severe infections and complications. The bacteria can also cause non-invasive pneumococcal disease (non-IPD), for example, conjunctivitis and pneumonia.
There are more than 95 different recognised serotypes of Streptococcus pneumoniae that have a distinct polysaccharide capsule (encapsulated strains). The capsule protects the bacteria from being easily destroyed by the body’s immune system. Encapsulated strains are almost exclusively the cause of IPD. Non-encapsulated strains can also cause IPD; however, this is more likely in immunocompromised individuals.
What to look for
The incubation period of pneumococcal disease is 1 to 3 days.
Symptoms will vary depending on the site of infection and can include:
- fever
- headaches and sinus pain
- earache
- cough and coryza (runny nose).
Clinical signs and symptoms of pneumococcal disease cannot be distinguished from other bacterial infections without laboratory testing.
Pneumococcal infection can lead to sinusitis, otitis media (ear infections) and pneumonia (lung infections). Sometimes infection can result in meningitis (inflammation of the tissue surrounding the brain and spinal cord), pneumonia with empyema (pus collection), septicaemia (blood infection), osteomyelitis (bone infection) and joint infections. IPD can have long-term consequences, such as hearing loss, kidney failure, loss of limbs or intellectual disability.
How is it transmitted?
Pneumococcal is spread by direct contact with the respiratory droplets (e.g. saliva or mucus) produced from coughing or sneezing, for example. Contact with contaminated items such as tissues can also be a source of infection.
Pneumococcal bacteria can live harmlessly at the back of the nose or throat (asymptomatic nasopharyngeal colonisation). This means individuals can be asymptomatic carriers and may transmit the bacteria to others without knowing. From 20–40% of all children and from 5–10% of all adults are asymptomatic carriers of pneumococcal bacteria. Whether the presence of pneumococcal bacteria leads to IPD depends on the virulence of the specific serotype and the individual’s immune response.
The infectious period is presumed to last until secretions no longer contain the bacteria in significant numbers, or for 24 to 48 hours after commencing antibiotics. Note that some strains of pneumococci bacteria are resistant to antibiotics.
Epidemiology
Pneumococcal disease is a leading cause of serious illness and death among Australian children under 2 years of age and older people. Aboriginal and Torres Strait Islander children in central Australia have the highest reported rates of IPD worldwide.
The introduction of vaccines has led to large decreases in pneumococcal disease incidence. Despite this, the global burden remains significant; it is estimated that around one million people die from pneumococcal disease worldwide every year. Much of the IPD burden results from serotypes not targeted by current vaccines.
Immunocompromised individuals, (such as people with functional asplenia or people taking immunosuppressant medications) and individuals with congenital heart disease, are at the highest risk of IPD. A full list of at-risk conditions can be found in The Australian Immunisation Handbook: Risk conditions for Pneumococcal Disease.
Prevention
There are two conjugate pneumococcal vaccines available for different age groups on the National Immunisation Program (NIP) in Australia:
- Prevenar 20 targets 20 different serotypes of pneumococcal (1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F).
- It is recommended and funded on the NIP for children and adolescents (< 18 years).
- Capvaxive targets 21 serotypes of pneumococcal (3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, deOAc15B, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B). It also offers cross-protection against the serotype 15C.
- It is recommended and funded on the NIP for adults (≥18 years).
Pneumococcal vaccines are administered intramuscularly. They can be co-administered (given on the same day) as other vaccines.
Pneumococcal vaccine guidance for children and adolescents (includes children requiring catch-up)
Table: NIP pneumococcal vaccine guidance for children and adolescents aged < 18 years
WordPress Tables PluginAge at presentation Risk category Vaccine brand, dose, schedule and route Prevenar 20
0.5 mL
IM< 6 weeks ≥ 6 weeks to
< 12 monthsNon-Indigenous children
with no medical risk condition*3 doses
(6 weeks, 4 months and 12 months)First Nations children and/or
children with an at‑risk medical condition*^
(regardles of state/territory)4 doses
(6 weeks, 4 months, 6 months and 12 months) #Ω≥ 12 months to
< 18 yearsChildren with a newly diagnosed at‑risk medical condition*^ Single dose at diagnosis/as soon as practical #Ω * If > 5 years and not up to date with NIP recommendations, refer to the Children requiring catch-up section below.
^ For at-risk conditions, refer to Table. Risk conditions for pneumococcal vaccination and eligibility for NIP funding.
# No more than 4 lifetime doses of Prevenar 20.
Ω Children who receive Prevenar 20 when < 18 years due to an at-risk condition should receive Capvaxive once they turn 18 years/12-months has elapsed (whichever is later).
shaded boxes not recommended for use in this age group.Children requiring catch-up
Children under 5 years who are not up to date with the NIP schedule are recommended to follow a catch-up schedule. For specific advice refer to:
- Table. Catch-up schedule for 20vPCV for Aboriginal and Torres Strait Islander children living in ACT, NSW, Tas or Vic, born before 1 March 2025, and children from all states/territories who do not have risk condition(s) for pneumococcal disease, aged <5 y
- Table. Catch-up schedule for 20vPCV for Aboriginal and Torres Strait Islander children (including those living in ACT, NSW, Tas or Vic who were born after 1 March 2025), and all children with risk condition(s) for pneumococcal disease, aged <5 years
Pneumococcal vaccine guidance for adults
Table: NIP pneumococcal guidance for adults ≥ 18 years (1 July 2026 onwards)
WordPress Tables PluginAge Risk category Vaccine brand, dose, schedule and route Capvaxive*
0.5 mL
IM≥ 18 years All adults with an at‑risk medical condition 1 dose at time of diagnosis/
as soon as practical^#Ω≥ 25 years First Nations adults with no medical risk condition 1 dose^# ≥ 65 years Non-Indigenous adults with no medical risk condition 1 dose^# * From 1 July 2026 Capvaxive replaces Prevenar 13 and Pneumovax 23 on the NIP refer to Adult pneumococcal vaccination – see Program advice for health professionals for more information.
^ A 12-month interval is recommended between Capvaxive and other pneumococcal vaccines.
# Adults who have previously received a dose of Capvaxive do not need another dose.
Ω Adults who received Prevenar 20 in childhood (when < 18 years) due to an at-risk condition should receive Capvaxive once they turn 18 years/12-months has elapsed (whichever is later).Table: NIP pneumococcal guidance for adults ≥ 18 years (up until 30 June 2026)
WordPress Tables PluginAge at presentation Risk category Prevenar 13 (13vPCV)*
0.5 mL
IMPneumovax 23 (23vPPV)*
0.5 mL
IMAt any age All adults with an at‑risk medical condition^ 1 dose at time of diagnosis/as soon as practical β 2 doses, minimum of 5 years apart β § ∞ ≥ 50 years First Nations adults with no medical risk condition 1 dose β 2 doses, minimum of 5 years apart β § ∞ ≥ 70 years Non-Indigenous adults with no medical risk condition 1 dose β * From 1 July 2026 Capvaxive replaces Prevenar 13 and Pneumovax 23 on the NIP refer to Adult pneumococcal vaccination – see Program advice for health professionals for more information.
^ For at-risk conditions, refer to Table. Risk conditions for pneumococcal vaccination and eligibility for NIP funding.
β If 23vPPV is inadvertently given prior to required dose of 13vPCV, wait 12 months before administering 13vPCV.
§ No more that 2 lifetime doses of 23vPPV.
∞ 23vPPV must be minimum of 8 weeks after last dose of 13vPCV.
shaded boxes not recommended for use in this age group.
Precautions
There is minimal data on the use of Capvaxive in pregnancy. Instead, it should be administered prior to conception or after delivery. Capvaxive may be administered to people who are breastfeeding.
Vaccine side effects
Common side effects after receiving a pneumococcal vaccine include fever, irritability, lethargy, injection site reactions (ISRs) and body aches.
In children, ISRs are commonly reported as occurring within 24 to 48 hours following immunisation. In adults, Prevenar 13 is associated with delayed-onset ISRs (occurring more than 3 days after vaccination), particularly in those who have previously received Pneumovax 23.
ISRs are not a sign of allergy or local infection. Therefore, antihistamines, steroids or antibiotics are not required.
A history of ISRs following previous pneumococcal vaccines is not a contraindication to further doses.
Refer to the MVEC: Injection site reactions reference page for further information.
Resources
- Australian Immunisation Handbook: Pneumococcal disease
- Australian Immunisation Handbook: List. Risk conditions for pneumococcal disease
- MVEC: Catch-up immunisations
- National Immunisation Program: Adult pneumococcal vaccination – Program advice for health professionals
- Human Vaccines and Immunotherapeutics: Coadministration of 13-valent pneumococcal conjugate and quadrivalent inactivated influenza vaccines in adults previously immunized with polysaccharide pneumococcal vaccine 23: a randomized clinical trial
Authors: Mel Addison (SAEFVIC Research Nurse, Murdoch Children’s Research Institute), Georgina Lewis (Clinical Manager SAEFVIC, Murdoch Children’s Research Institute), Rachael McGuire (MVEC Education Nurse Coordinator), Teresa Lazzaro (Paediatrician, the Royal Children’s Hospital)
Reviewed by: Rachael McGuire (MVEC Education Nurse Coordinator)
Date: June 2026
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information on this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.