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This section is part 7 of the PHE pneumococcal guideline summary.

Contents included in this summary


Cases of invasive pneumococcal disease (IPD)

Any case of invasive pneumococcal infection or lobar pneumonia believed to be due to S. pneumoniae should prompt a review of the patient’s medical history to establish whether they are in a recognised risk group and whether they have been appropriately immunised. Unimmunised or partially immunised at risk individuals should be vaccinated upon discharge from hospital whenever possible.

Cases in small children under five years of age

Clinicians should ensure that children diagnosed with IPD have completed the recommended national immunisation schedule. Infants who are younger than 12 months of age at the time of IPD and who are unvaccinated or partially vaccinated should complete the recommended immunisation schedule.

Immunised children who subsequently develop IPD caused by one of the pneumococcal vaccine serotypes should be assessed for possible underlying immune deficiency. If the child falls into one of the clinical risk groups in Table 1, then additional vaccinations should be offered as recommended in this chapter.

Isolates from all cases of IPD should be referred to the national reference laboratory for serotyping. All new cases of IPD in children in aged <5 years England and Wales, regardless of serotype, will be followed up by Public Health England (for England and Wales) and Health Protection Scotland. Some cases may require serotype-specific antibody and/or additional pneumococcal vaccination testing depending on the pneumococcal vaccination status of the child and the infecting pneumococcal serotype.


Close contacts of pneumococcal meningitis or other invasive pneumococcal disease are not normally at an increased risk of pneumococcal infection and therefore antibiotic prophylaxis is not indicated. Clusters of invasive pneumococcal disease should be discussed with local health protection teams.


Outbreaks of pneumococcal respiratory disease in hospitals and residential care homes need prompt investigation. Control measures including vaccination may be appropriate; these should be agreed in discussion with local health protection or infection control teams. For further information see the interim UK guidelines for the public health management of clusters of serious pneumococcal disease in closed settings.

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full guideline available from…


Public Health England. Pneumococcal: the green book, chapter 25. January 2018.

Contains public sector information licensed under the Open Government Licence v3.0.

First included: May 2019.

PHE pneumococcal guideline (Green Book chapter 25)