Pneumococcal disease is a bacterial infection that can affect different parts of your body. If you’re over the age of 50, it may be a bigger threat to your health than you realize.
“Just because it has ‘pneumococcal’ in its name does not necessarily mean it only causes pneumonia,” says Yoshua Quinones, MD, a board-certified internist with Medical Offices of Manhattan in New York City.
This bacteria can also cause sinus and ear infections, as well as serious and sometimes life-threatening complications like bacteremia (bloodstream infection) and meningitis (infection of your brain and spinal cord).
Here’s why being older raises your risk for pneumococcal disease, plus the steps you can take to stay healthy.
What Is Pneumococcal Disease?
A type of bacteria called Streptococcus pneumoniae (S. pneumoniae or pneumococcus) causes pneumococcal disease. So far, experts have identified over 100 strains of it.
Pneumococcus is transmitted from person to person through tiny respiratory droplets. “[These are] the same things that transmit flu and other respiratory viruses and require close contact,” says Trish Perl, MD, a professor of internal medicine at UT Southwestern Medical Center in Dallas, Texas.
You could also be a natural carrier of the bacteria. Five percent to 10% of adults and 20% to 60% of school-aged kids have pneumococcus in their noses and throats. “Just because you're a carrier doesn't mean you're going to get the disease,” Perl says. Sometimes, the pneumococcus just hangs out, without causing harm, in your body. But if your immune system fails to keep it in check, it can begin to grow and spread, and enough may get into your bloodstream to develop into disease.
What Happens If You Get Pneumococcal Disease?
Symptoms of pneumococcal disease usually appear one to three days after you’re exposed. They depend on which part of your body is infected.
Noninvasive pneumococcal disease means that the bacteria doesn’t spread to your organs or blood. It causes less serious illness.
Ear and sinus infections are an example. You could have symptoms like:
- Ear pain
- Headache
- Runny or stuffed up nose
- Sinus pressure
- Sore throat
- Fever
Invasive pneumococcal disease affects your blood, organs, and bones. It can cause symptoms like:
- Sweating
- Fever
- Chills
- Headache
- Rapid heart rate
- Trouble breathing
- Chest pain
- Confusion
- Stiff neck
- Light sensitivity
Complications from invasive pneumococcal disease can include hearing and vision loss, seizures, stroke, paralysis, loss of limbs, and brain damage. In some cases, it can be fatal.
“What we see in hospitalized cases is pretty dramatic,” Perl says.
- Pneumococcal pneumonia is fatal for 1 of every 20 people.
- Pneumococcal bacteremia is fatal for 1 of 8 people.
- Pneumococcal meningitis is fatal for 1 out of every 6 older adults who are diagnosed.
Why Are Older Adults at Risk?
When you’re 50 or older, your risk for pneumococcal disease rises for a few reasons.
Your immune system doesn’t work as well
“As we get older, our immune system becomes less effective at fighting infections, and this is when Streptococcus pneumoniae can take the opportunity to cause illness,” Quinones says.
For instance, as you age:
- Neutrophils, which help your body fight germs, don’t function as well.
- Antibodies have a harder time attaching to and targeting harmful germs.
- Macrophages, white blood cells that digest bacteria like pneumococcus, work more slowly.
Over the years, chronic low-grade inflammation also naturally builds up in your body. Doctors call this “inflammaging.” It can damage your cells, make you more frail, and contribute to many age-related conditions.
You may have other health issues
Once you're over 50, you’re more likely to have other illnesses that increase your risk of pneumococcal disease. These include health issues such as:
- Diabetes
- Heart disease
- Lung disease
- Liver disease
- Kidney disease
- Long-term effects of sickle cell disease
- Cerebrospinal fluid leak
- Conditions that weaken your immune system, like cancer and HIV
“If you look at people who are over 50, 90% of them have [another] condition that increases your risk of pneumococcal disease,” Perl says.
Other factors that can affect your risk
You’re also more likely to get pneumococcal disease if you:
- Are a certain race or ethnicity, including Black or African-American, Alaska Native, or American Indian
- Have obesity
- Use tobacco or used it in the past
- Drink excess amounts of alcohol
- Have a cochlear implant (an implant that helps you hear)
- Have had your spleen removed
Stay Safe From Pneumococcal Disease
“The best prevention is to stay up-to-date with your vaccines, including those for pneumococcus,” Quinones says. “Vaccines help your immune system recognize and fight bacteria before they cause serious illness.”
There are several types of pneumococcal vaccines. The initial vaccine only covered eight strains of pneumococcus. “Now, we’re up to 21 strains and, importantly, some of the newer vaccines actually cover strains that are known to be resistant to certain antibiotics,” Perl says.
Ask your doctor if you’re due for a pneumococcal vaccine. The type and number of doses you have will depend on several things, including the vaccines you’ve had in the past and the health issues that you currently manage.
“The biggest side effect is [the vaccine] may hurt in your arm,” Perl says. “But … the benefits are huge.”
If you help care for young children, make sure that they’re up-to-date on their vaccines, too.
Get a flu shot
The influenza (flu) virus weakens your immune system. It can also disrupt the cells that make up the lining of your lungs. “Organisms can then get into your lungs and cause pneumonia and even enter your bloodstream,” Perl says.
Pneumococcus is responsible for about 35% of infections that happen at the same time as the flu.
Practice good hygiene
Wash your hands often, especially after you cough, sneeze, or blow your nose. If soap and running water aren’t available, use hand sanitizer. Clean shared surfaces, like kitchen counters and doorknobs, on a regular basis. Avoid close contact with people who are sick.
Wearing a mask can give you an extra layer of protection from germs like pneumococcus. You might consider one if a respiratory virus is going around your neighborhood, you’re at high risk for getting sick, or you’re recovering from another illness.
Quit tobacco
Smoking damages your respiratory tract and reduces how well your immune system works. Medications, nicotine replacement like gum and patches, and therapy can all help you quit. Ask your doctor what your first step should be.
Get — and stay — physically active
Exercise helps flush germs out of your lungs and airways. It can also help antibodies and infection-fighting white blood cells move faster through your bloodstream.
Each week, aim for at least 150 minutes of moderate exercise like brisk walking, as well as two days of strength-training (activities that make your muscles stronger).
How Is Pneumococcal Disease Diagnosed and Treated?
If your doctor thinks you have S. pneumoniae, they can check for it in your blood, urine, mucus, or spinal fluid. But extremely sensitive tests that rapidly deliver results aren’t widely available. “To me, that's one of the important diagnostic challenges,” Perl says.
About 40% of invasive pneumococcal disease in the U.S. is resistant to at least one type of antibiotic. That means that you’ll probably have to go into the hospital if you’re diagnosed, and it could take time to find the right medications to treat you.
“There's emerging evidence that two drugs are better than one drug in certain settings, and you have to have the right group of drugs,” Perl says.
Despite new antibiotics and strategies to treat pneumococcal disease, “the mortality rate [associated with it] really hasn't changed over the past 20 years,” Perl says.
When to Call Your Doctor
Contact your doctor right away if you think you may have pneumococcal disease. For instance, maybe you thought you had a cold but your symptoms have hung around for a while. Or you started feeling better, but now you feel worse.
“This is one of the hallmarks [of pneumococcal disease],” Perl says. “You had your flu, you got over it, you got better, but then those little pneumococcus got into your lungs, and now you have a secondary pneumonia.”
Check in with your doctor, too, if your symptoms don’t line up with what’s expected with a regular cold. For instance, maybe you’re running a high fever, feel confused, or get dizzy when you stand up. In other words, “you just know when something's wrong,” Perl says.
Getting diagnosed with pneumococcal disease as soon as possible is important.
“Better outcomes are associated with early treatment,” Perl says.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
Trish Perl, MD, MSc, professor, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Yoshua Quinones, MD, board-certified internist, Medical Offices of Manhattan, New York, New York.
CDC: “About Pneumococcal Disease,” “Clinical Overview of Pneumococcal Disease,” “Pneumococcal Disease Symptoms and Complications,” “Morbidity and Mortality Weekly Report: Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices —United States, 2024,” “Manual for the Surveillance of Vaccine-Preventable Diseases: Chapter 11: Pneumococcal," “Trends in Multiple Chronic Conditions Among US Adults, By Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023,” "Pneumococcal Disease in Adults and Vaccines to Prevent It,” “Masks and Respiratory Viruses Prevention,” “How To Quit Smoking,” “What You Can Do to Meet Physical Activity Recommendations.”
Medline Plus: “Pneumococcal Infections,” “Exercise and immunity,” “Pneumococcal Disease Tests.”
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National Foundation for Infectious Diseases: “What is Pneumococcal Disease?”
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Vaccines: “Toward Universal Protection: A Comprehensive Review of Pneumococcal Disease, Emerging Vaccination Challenges and Future Perspectives.”
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Harvard Health: “How ‘inflammaging’ shapes our health.”
Cleveland Clinic: “Pneumococcal Disease.”
Influenza and Other Respiratory Viruses: “The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis.”
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