PORTSMOUTH — It is that time of year when everyone seems to have a nasty cough from the common cold, but how do you know if that cough is a sign of something more serious — like pneumonia?

Dr. Mary Valvano, medical director of emergency services at Portsmouth Regional Hospital, said a persistent cough, fever and difficulty breathing are signs of an infection of the lungs and may indicate pneumonia.

“If it’s not getting better as people would expect, they should always err on the side of getting a cough checked,” Valvano said.

According to the Centers for Disease Control and Prevention, each year in the United States about 1 million people have to seek care in a hospital due to pneumonia. About 50,000 Americans die from the disease.

Valvano said the people most at risk include those over the age of 65, people with lung disease and small children.

The CDC recommends adults over 65 get vaccinated for pneumonia. Officials estimate that close to 70 percent of people within that age group have gotten the vaccine.

Since pneumonia is still the leading infectious cause of death in children younger than 5 years old worldwide, they should not be exposed to people who have an infection of the lungs.

Valvano said smoking and drinking to the point of intoxication also increase a person’s chances of contracting pneumonia because those activities suppress the body’s immune system.

Being around other sick people at this time of year may be unavoidable, so that is why people need to be careful about germs.

“I just tell people to wash their hands and then wash them again because the germs are out there,” Valvano said.