Pneumococcal meningitis

On this page you’ll find an overview of meningitis caused by pneumococcal bacteria, including symptoms, treatment and prevention. 

• Pneumococcal meningitis is one of the most life-threatening causes of bacterial meningitis. 
• Pneumococcal meningitis is the most common cause of bacterial meningitis in some countries. 
• Children under two years of age, older adults and people with conditions that affect their immune systems are most at risk from pneumococcal meningitis. 
• There are vaccines available that offer protection against pneumococcal meningitis. 

What is pneumococcal meningitis?

Pneumococcal meningitis is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. The bacteria Streptococcus pneumoniae (more commonly known as pneumococcal bacteria) causes pneumococcal meningitis. 

Pneumococcal meningitis occurs when pneumococcal bacteria invade the body and enter the cerebrospinal fluid (CSF), which surrounds and cushions the brain and spinal cord. In the CSF, bacteria can rapidly multiply and release poisons, causing inflammation and swelling in the meninges. This increases pressure on the brain, producing symptoms of meningitis. 

What are the symptoms of pneumococcal meningitis?

The symptoms of pneumococcal meningitis can progress rapidly, and early diagnosis and treatment will increase the chances of a full recovery. 

Early symptoms of pneumococcal meningitis can look like milder, more common infections.

Symptoms may include: 

• Fever.
• Vomiting.
• Severe headache.
• Stiff neck (less common in young children).
• Dislike of bright lights.
• Seizures (fits).
• Confused / delirious.
• Very sleepy / vacant /difficult to wake.

Symptoms in babies and very young children can be slightly different. Their symptoms may include: 

• High temperature (warning: could be normal or low in babies under three months old).
• Irritability.
• Vomiting / refusing to feed.
• A high-pitched cry.
• A stiff body with jerky movements or else floppy and lifeless.
• Very sleepy / staring expression / too sleepy to wake up.
• Tense or bulging soft spot on the top their head.

Not everyone with meningitis will get all these symptoms. 

People with pneumococcal meningitis will get worse fast. Check regularly on someone who is unwell. Always trust your instincts and get medical help straight away if you or someone you know is seriously ill. 

Read more information about the symptoms of meningitis. 

How do you get pneumococcal meningitis?

Pneumococcal meningitis is caused by pneumococcal bacteria, which are commonly found living in the back of our noses and throats. This is called carriage.  

Carriage of the bacteria is completely harmless most of the time. Studies from the UK and the Netherlands found that around half of pre-school children carry pneumococcal bacteria in the back of their nose or throats without becoming sick.^3,4 Carriage rates in children from low- and middle-income countries are even higher. 

The bacteria pass between people through coughing, sneezing and close physical contact like kissing. 

In a susceptible person, pneumococcal bacteria may overcome the body’s defences and cause disease. This can range from fairly minor bronchitis and ear and sinus infections to more serious conditions such as pneumonia, septic arthritis, meningitis, and less frequently sepsis. 

Who can get pneumococcal meningitis?

Pneumococcal meningitis can affect anyone, but some people are more at risk than others. This includes: 

• Babies and young children under two years of age.
• Adults over the age of 65.
• People with medical conditions or who are having treatment that affects their immune system.

Other conditions and factors can also increase the risk of developing pneumococcal meningitis, such as: 

• If you don't have a spleen, or your spleen doesn’t function properly.
• Chronic respiratory disease.
• Chronic heart, kidney or liver disease.
• Diabetes.
• Cochlear implants (with the highest risk being during the time of surgery).
• Cerebrospinal fluid leaks.
• Occupational risks, such as for welders breathing in welding or metal fumes.

How is pneumococcal meningitis treated?

Pneumococcal meningitis must always be treated urgently with antibiotics. 

Meningitis can kill quickly, so if you suspect that you have this disease you should seek immediate medical care. Prompt recognition and hospital treatment offer the best chance of a good recovery. 

When you get to hospital the doctor may do a lumbar puncture (LP) to help diagnose meningitis. A lumbar puncture involves taking a sample of cerebrospinal fluid from the spinal canal (the space through the back bones which contains the spinal cord). A lumbar puncture is important to confirm the diagnosis of meningitis. It will also show which germ is causing the illness so doctors can choose the most appropriate treatment. 

You may be given antibiotics intravenously (directly into the vein). Steroids may also be given to reduce swelling around the brain. 

If you are very unwell you might be transferred to a special ward in the hospital where you can be regularly monitored by hospital staff. In the UK this is known as an Intensive Care Unit. 

Read more information about the treatment of bacterial meningitis.

What are the after-effects of pneumococcal meningitis?

Pneumococcal meningitis affects everyone differently. Most people make a full recovery without any lasting problems. But in some cases, it can cause ongoing problems which may need further treatment and support.

The possible after-effects of pneumococcal meningitis include:

• Learning and intellectual disabilities such as memory loss, lack of concentration or issues with thinking and problem solving.
• Clumsiness and co-ordination problems.
• Headaches.
• Deafness, hearing problems, tinnitus, dizziness or loss of balance.
• Epilepsy or seizures.
• Weakness, paralysis or spasms.
• Loss of sight or vision problems.
• Hydrocephalus (fluid on the brain).
• Mental health issues and changes to personality or behaviour.
• Difficulties with sleep.
• Fatigue.
• Anxiety and depression.

Approximately one third of survivors of pneumococcal meningitis around the world have some type of after-effect.⁵ The risk of after-effects can vary by country.

Hearing loss and neurological after-effects are more common in survivors of pneumococcal meningitis than in other forms of bacterial meningitis.^5,6,7 

Long term after-effects of meningitis are usually identified while you are still in hospital. For very young babies it might not be possible to tell if they have any long-term effects until they get older. 

Is there any follow-up care after recovery from pneumococcal meningitis?

Ideally, you should be given information about what to expect during recovery before you leave the hospital. The follow-up care you receive will be different depending on where you are in the world, and the guidelines that your local doctors follow. You may have further treatment involving different teams of doctors and specialists. 

In some countries (including the UK) doctors will arrange at least one follow-up appointment so they can check for longer term after-effects. This is particularly important for children, as some long-term neurodevelopmental complications can't always be identified immediately after their illness. 

Read more about the follow-up care after recovery from meningitis.

Can we prevent pneumococcal meningitis?

Yes, many cases of pneumococcal meningitis can be prevented. Vaccines are available that protect against some of the most common harmful circulating strains of pneumococcal bacteria. 

There are two types of vaccine available: 

• Pneumococcal conjugate vaccines (often abbreviated to PCV) protect you from carrying and becoming unwell from the types (serotypes) of bacteria targeted by the vaccine. The PCVs that are currently available protect against between 10 and over 20 different serotypes of pneumococcal bacteria, depending on the version of the vaccine. 
• Pneumococcal polysaccharide vaccine (often abbreviated to PPV) is sometimes given to older adults and certain people who have a high risk of infection. The current version of this vaccine protects against 23 different serotypes of pneumococcal bacteria. PPV does not work well in young children. 

There is no pneumococcal vaccine currently available that will protect against all the different serotypes of pneumococcal bacteria that can cause meningitis, so being aware of the symptoms of the disease remains important. 

Can I get a vaccine to protect me against pneumococcal meningitis?

Whether you can get a free pneumococcal vaccine depends on:  

• Your age.
• Where you live.
• Whether you have any underlying health conditions which put you at higher risk of disease.

Most, but not all, countries across the world routinely immunise babies and young children with pneumococcal conjugate vaccines (PCVs).  

The World Health Organisation (WHO) recommends that all countries introduce PCVs into their routine childhood immunisation programmes.² Young children are the most vulnerable to disease and often carry pneumococcal bacteria. Vaccinating this age group stops them from carrying the bacteria and makes it harder for the bacteria to pass from person to person. This means everyone is better protected, even those who are not vaccinated. 

Some countries also routinely immunise older adults and high-risk groups with pneumococcal vaccines, but this is much more common in high-income compared to low-income countries.⁸ 

You can find out about your own country’s pneumococcal immunisation programme on the WHO Immunization Data Portal. 

Vaccination in the UK and Ireland 

The UK and Ireland routinely immunise children, adults and high-risk groups with pneumococcal vaccines. There are two types of pneumococcal vaccine available: 

• The Pneumococcal Conjugate Vaccine (PCV) is usually given to children under two years old and protects against 13 common strains of pneumococcal bacteria.  
• The Pneumococcal Polysaccharide Vaccine (PPV) is usually given to adults aged 65 and over and to people at a higher risk of infection. It protects against 23 strains of pneumococcal bacteria.  

Read more in our factsheet about pneumococcal vaccination in the UK.