Pneumococcal Vaccine (Pneumonia)

Pneumococcal disease is caused by a bacterium called Streptococcus pneumoniae, which many people carry harmlessly in the nose and throat. Sometimes it spreads and causes illness: ear and sinus infections, pneumonia, or invasive infection in which the bacteria reach the bloodstream or the fluid around the brain and spinal cord. The Canadian Immunization Guide notes that invasive pneumococcal disease is most common among very young children and adults aged 65 and older.

What pneumococcal disease is, and what it is not

Pneumonia and pneumococcal disease are not the same thing. Pneumonia is an infection of the lung tissue and it can be caused by many different bacteria and viruses. Pneumococcal disease means illness caused specifically by Streptococcus pneumoniae, and only some of it is pneumonia. Invasive pneumococcal disease is the term used when the bacteria are found in a normally sterile site such as blood or the fluid around the brain and spinal cord. Someone can have pneumococcal pneumonia without it ever becoming invasive, and Canada counts only the invasive cases in national surveillance.

It is also not an infection that arrives from outside every time. Carrying the bacterium in the nose and throat is common and usually causes nothing at all. Illness happens when it moves somewhere it does not belong, which is more likely at the extremes of age, after a viral infection, or when the immune system or the spleen is not working normally.

Signs and symptoms

• Sudden fever, chills or shaking
• Cough, sometimes bringing up rust-coloured or bloody phlegm
• Chest pain that is worse when breathing in
• Shortness of breath, or fast breathing
• Severe headache, a stiff neck or sensitivity to light, which can signal meningitis
• Confusion or unusual drowsiness, especially in older adults
• Ear pain, or a bulging or draining ear, in children

Presentation differs by age. In older adults, sudden confusion or a fall can be the most obvious sign, while fever and cough may be mild or absent.

What raises the risk

Some things cannot be changed:

• Being aged 65 and older, or being a child under 2
• Long-term conditions including asthma, COPD, heart disease, diabetes, kidney disease and liver disease
• Having no spleen or a poorly functioning spleen, sickle cell disease, or a weakened immune system from illness or treatment
• Cochlear implants or cerebrospinal fluid leaks

Others can often be worked on, usually with support from a health care team:

• Smoking tobacco, and exposure to second-hand smoke
• Heavy alcohol use
• Crowded or congregate living settings, including long-term care and shelters

How pneumococcal disease is diagnosed in Canada

Invasive pneumococcal disease is confirmed by growing Streptococcus pneumoniae from a normally sterile site, most often a blood culture or a sample of cerebrospinal fluid obtained by lumbar puncture. Pneumonia itself is assessed with a chest X-ray, blood tests, a measurement of oxygen in the blood, and sometimes a sputum culture or a urine antigen test. Isolates from across the country are sent to the National Microbiology Laboratory for serotyping and antibiotic susceptibility testing, which is how Canada tracks which strains are circulating and how resistance is changing.

Treatment and management, including immunisation

Clinical research for Pneumococcal Vaccine (Pneumonia) is enrolling. See the current studies ↓

Pneumococcal illness is treated as an infection, urgently when it is invasive, and Canada also runs childhood and adult immunisation programmes aimed at it. Depending on where the infection is, how unwell someone is and what the laboratory finds, a health care team may discuss:

• Antibiotics chosen according to the site of infection and to Canadian resistance patterns tracked by the National Microbiology Laboratory
• Hospital care for severe infection, including supplemental oxygen, intravenous fluids and antibiotics, and intensive care when needed
• Drainage procedures for complications such as fluid collections around the lung, and follow-up imaging
• Pneumococcal conjugate vaccines authorised in Canada: Pneu-C-10 (Synflorix), Pneu-C-13 (Prevnar 13), Pneu-C-15 (Vaxneuvance), Pneu-C-20 (Prevnar 20) and Pneu-C-21 (Capvaxive). The polysaccharide vaccine Pneu-P-23 (Pneumovax 23) was discontinued in Canada as of August 2025
• Publicly funded infant and adult pneumococcal immunisation programmes, which differ by province and territory

In its statement dated 15 November 2024, the National Advisory Committee on Immunization states that adult pneumococcal immunisation programmes in Canada should include at least one of Pneu-C-20 or Pneu-C-21, and that at the individual level one dose of either should be given to adults aged 65 and older, and to adults under 65 at increased risk of invasive pneumococcal disease, regardless of earlier pneumococcal vaccination. Eligibility and funding still vary by province and territory, and these are decisions for you and your own clinician rather than anything this page can settle.

When to talk to a doctor

• Call 911 if there is severe difficulty breathing, chest pain, a stiff neck with fever and severe headache, a rash that does not fade when pressed, confusion, or someone cannot be woken.
• Seek medical care the same day for a high fever with a cough and breathlessness, for fast breathing, or if an older adult becomes suddenly confused or unsteady.
• Contact your clinician if a chest infection is not improving after a few days, or if you have a long-term lung, heart, kidney or immune condition and develop fever and cough.

Why clinical research matters for pneumococcal disease

Invasive pneumococcal disease in Canada returned to pre-pandemic levels in 2022, serotypes 4 and 9V have risen significantly since 2019, and multidrug resistance is increasing, so the mix of strains circulating keeps shifting away from what current vaccines were designed around. Adult coverage also remains well below the national goal. Research now underway includes higher-valency and protein-based pneumococcal vaccines designed to cover more serotypes, studies of serotype replacement after programme changes, new antibiotic options for resistant strains, and work on improving adult uptake in primary care and long-term care.

Because the bacterium keeps changing, this is a field that depends on continuing study. Taking part in one is voluntary, the study is explained to you in full during informed consent, and you can withdraw at any time without affecting the care you get from your own doctor or your access to publicly funded immunisation. No one can say in advance whether a study will help you personally.

Learn more from Canadian sources

• Canadian Immunization Guide: pneumococcal vaccines
• NACI: recommendations on pneumococcal vaccines in adults
• Government of Canada: provincial and territorial immunization information
• Public Health Agency of Canada: Adult National Immunization Coverage Survey