In short: Pneumococcal disease is caused by the bacterium Streptococcus pneumoniae and ranges from ear and sinus infections to pneumonia, meningitis and sepsis. In the UK, babies are offered a pneumococcal conjugate vaccine at 16 weeks and one year of age, and adults aged 65 and over and people with certain long-term conditions are offered a single dose. Since early 2026 the NHS adult programme has been moving from the older 23-valent polysaccharide vaccine (PPV23) to a 20-valent conjugate vaccine (PCV20).

This guide, written by a Ready Health prescribing pharmacist and checked against the UKHSA Green Book, explains who is most at risk, the symptoms to look out for and who is eligible for vaccination.

What is pneumococcal disease?

Streptococcus pneumoniae (the pneumococcus) often lives harmlessly in the nose and throat, especially in young children. It spreads through coughs, sneezes and close contact. Sometimes it invades other parts of the body and causes illness, including:

middle ear infections and sinusitis
pneumonia (a lung infection)
bacteraemia and sepsis (infection in the bloodstream)
meningitis (infection of the lining of the brain and spinal cord)

When the bacteria reach the blood, brain or other normally sterile sites, this is called invasive pneumococcal disease. It is a medical emergency.

Who is most at risk?

babies and young children
adults aged 65 and over
people with no spleen or a spleen that does not work properly, including sickle cell disease
people with long-term heart, lung, kidney or liver disease, or diabetes
people with weakened immune systems, for example from chemotherapy, HIV or medicines that suppress immunity
people with a cochlear implant or a cerebrospinal fluid leak
people who smoke, and some people with occupational exposure to metal fumes (such as welders)

What are the symptoms of pneumococcal infection?

Symptoms depend on where the infection is.

Pneumonia: fever, chills, cough (sometimes with discoloured phlegm), breathlessness, chest pain that is worse when breathing in, and new confusion in older people.
Meningitis: fever, severe headache, stiff neck, dislike of bright lights, vomiting, drowsiness or confusion, and sometimes seizures. Babies may be floppy, irritable, refuse feeds or have a bulging soft spot.
Sepsis: very high or low temperature, fast breathing, a racing heart, mottled or pale skin, and feeling extremely unwell.

Call 999 or go to A&E if you suspect meningitis or sepsis. For other worrying symptoms, contact your GP or NHS 111.

How is pneumococcal disease treated?

Bacterial pneumococcal infections are treated with antibiotics. Serious infections need hospital care. Some strains are resistant to certain antibiotics, which is one reason prevention through vaccination matters.

Who can get the pneumococcal vaccine on the NHS?

Group	What is offered (England, 2026)
Babies	PCV13 at 16 weeks and a booster at one year (on or after the first birthday). This 16-week timing replaced the previous 12-week dose from 1 July 2025.
Adults aged 65 and over	A single dose. PCV20 is replacing PPV23 as stocks of PPV23 are used up during 2026.
Children aged 2 and over and adults under 65 in a clinical risk group	Usually a single dose (PCV20 as it becomes available). Some people, such as those with severe immunosuppression, may need a different schedule.
Children under 2 with no working spleen, complement disorders or severe immunosuppression	Extra doses according to the Green Book, now usually with PCV20.

Your GP practice will normally invite you if you are eligible. Schedules in Scotland, Wales and Northern Ireland are similar, but check local NHS information.

What is the difference between PCV20 and PPV23?

PPV23 covers 23 pneumococcal types but is a polysaccharide vaccine, which tends to give shorter-lived protection, particularly in older adults. PCV20 is a conjugate vaccine covering 20 types. Conjugate vaccines generally produce a stronger immune memory. Following advice from the Joint Committee on Vaccination and Immunisation, PCV20 is now being used for the adult and risk-group programmes in England.

Is the pneumococcal vaccine safe? What side effects can it cause?

Pneumococcal vaccines have been used in the UK for many years. Common side effects include a sore, red or swollen arm, mild fever, tiredness, headache and aching muscles, usually settling within a few days. Serious allergic reactions are very rare, and vaccinators are trained to manage them. The vaccines do not contain live bacteria and cannot cause pneumococcal disease.

Do I need the pneumococcal vaccine for travel?

Pneumococcal vaccine is not usually a specific travel vaccine. However, travel is a good prompt to check you are up to date with routine vaccines. If you are 65 or over or have a long-term condition, it is sensible to make sure you have had your pneumococcal vaccine before you go, particularly if you will be far from good medical care.

Frequently asked questions

How many times do I need the pneumococcal vaccine as an adult?

Most adults need only one dose. A small number of people with particular conditions may be advised to have additional doses; your clinician will advise using the Green Book.

I had PPV23 a few years ago. Do I need PCV20 now?

Not routinely. If you have already had your pneumococcal vaccine, you are not usually called again. People with certain conditions should ask their GP or specialist.

Can I have the pneumococcal vaccine with my flu or COVID-19 vaccine?

Yes. Pneumococcal vaccines can generally be given at the same appointment as other vaccines.

Can I have the vaccine privately if I am not eligible on the NHS?

Private vaccination may be possible for some people who are not eligible on the NHS, after an individual assessment by a clinician to decide whether it is appropriate.

Key takeaways

Pneumococcal infection can cause pneumonia, meningitis and sepsis, especially in the very young, older adults and people with certain health conditions.
Babies now receive PCV13 at 16 weeks and one year.
Adults aged 65 and over and people in risk groups are offered a single dose, now moving to PCV20.
Seek emergency help for symptoms of meningitis or sepsis.

Sources and further reading

Last reviewed: October 2026 by Shamir Patel, Independent Prescribing Pharmacist, Ready Health. This article is general information and does not replace advice from your own clinician.

Not sure if you are protected? Ready Health in Standish, near Wigan, Chorley and Bolton, can review your vaccination history and travel plans at a vaccination consultation, where a clinician will advise whether any vaccine is suitable for you. You can book online.