Respiratory Infections

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Respiratory Infections

Pneumococcal Disease

Causative Agent

Streptococcus pneumoniae is the bacterium responsible for causing pneumococcal infection. It is characterised by its outer coat (capsular polysaccharide), and in a process known as serotyping, different strains can be distinguished. There are about 90 different types of pneumococci, and about a quarter of which cause serious illness.

Clinical Description

Pneumococcal infections are defined as invasive or non-invasive according to the body site they affect. Invasive pneumococcal disease (IPD) is caused by infection of normally invasive sites e.g. blood and cerebrospinal fluid (CSF). IPD is a major cause of morbidity and mortality, especially amongst the very young, the elderly, and those with impaired immunity. Non-invasive forms of the infection commonly cause middle ear infection (otitis media), exacerbations of bronchitis, and pneumonia. As with most infectious respiratory diseases, the numbers of cases of pneumococcal infection peak in winter.


As a commonly carried pathogen. the role of person to person transmission is unclear. Many people (up to 50%) carry pneumococci in their nose and throat without developing serious infection.

Surveillance in Scotland

IPD is not a statutorily notifiable disease, therefore surveillance is based on the local and reference laboratory reports of S. pneumoniae from invasive body sites (i.e. blood and CSF mainly). In 1999, an enhanced surveillance scheme was introduced, and is jointly managed by HPS and the Scottish Meningococcus and Pneumococcus Reference Laboratory (SMPRL).

Trends in Scotland (2000-2012)

In 2012 there were 482 cases of invasive pneumococcal disease reported to SPIDER, this compares to 499, 540 and 580 cases in 2011, 2010 and 2009 respectively.


Annual reports of invasive pneumococcal disease in Scotland by year

Year Reported IPD cases (of which were under five years of age)
559 (54)
597 (68)
614 (59)
790 (83)
631 (89)
719 (95)
753 (61)
629 (26)
606 (34)
580 (39)
540 (28)
499 (36)
482 (34)


Since the introduction of pneumococcal conjugate vaccine (PCV) in 2006, there has been a reduction in the number of cases reported in the under 5s, with 95 cases in 2005, reducing to 34 cases in 2012.


Cases of IPD reported to SPIDER by quarter and by age group 1999-2012*



Two pneumococcal vaccines are available that help to protect against pneumococcal disease.

The pneumococcal polysaccharide vaccine is recommended for many of the same people who receive an annual flu vaccination. Unlike the flu vaccine which is given every year, the pneumococcal vaccine is only usually given once. 2003 saw the introduction of pneumococcal immunisation for all people aged 65 years and over, and for those aged under 65, at increased risk of disease due to impaired immunity. This vaccine protects against 23 serotypes of IPD.

Pneumococcal conjugate vaccine (PCV-7) was introduced into the routine childhood immunisation schedule in September 2006. In spring 2010, PCV-7 was replaced with PCV-13 to provide broader protection against more serotypes of S. pneumoniae. The new vaccine follows the same three dose immunisation schedule at two and four months of age followed by a booster at 12-13 months. PCV-13 offers protection against the following 13 serotypes of S. pneumoniae: 1, 3, 4, 5, 14, 6A, 6B, 7F, 9V, 18C, 19A, 19F and 23F.

Vaccine uptake


Cumulative number of IPD cases reported to SPIDER 2008-2012*


Further Information

Public Health etc (Scotland) Act

The Public Health etc (Scotland) Act 2008 provides a statutory framework for public health action to protect the people of Scotland from infectious disease, contamination and other such hazards.

Under the Act Streptococcus pneumonia (from blood, cerebrospinal fluid or other normally sterile site) is a notifiable organism.

Pneumococcal vaccination

Page last updated 17 May 2013