In those with decreased immune response, there may be a decrease in the activity of the surface mucosal defence mechanism, together with a failure to recognise the antigenic properties of the pneumococcus. Community action to diminish the incidence of influenza by a programme of vaccination will do much to decrease the spread and morbidity associated with pneumococcus. Combining a pneumococcal vaccination campaign with the annual influenza vaccination programme is justifiable in terms of cost and professional time. Pneumonia causes some 25,000 deaths annually in the over-65 age group. Disruption of natural barriers to the penetration by pneumococcus is a major cause of infection.
Skull fractures can raise the risk of pneumococcal meningitis.
Heart failure which results in poor blood perfusion of the lungs and pulmonary oedema leads to an excellent culture medium for the pneumococcus in the alveoli and increased risk of pneumonia. In young children, who have not yet developed full immune response mechanisms, pneumococcus may result in otitis media. Symptoms of pneumococcal pneumonia are not particularly different from those of other bacterial chest infections. Pneumonia is defined as an inflammation of lung tissues and is characterised by a productive cough with fever and malaise developing over seven to ten days. First-line treatment should be rehydration and penicillin.