National Center for Immunization & Respiratory Diseases

Current Epidemiology of Pneumococcal Disease, 

United States- 2019 updates

Advisory Committee on Immunization Practices

June 25th, 2021

Ryan Gierke, MPH
Impact of PCV13 on Invasive Pneumococcal Disease 

(IPD) Incidence and Serotype Distribution in the U.S.
Serotypes contained in current pneumococcal vaccines

1 3 4 5 6

A

6

B

7 

F

9

V

14 18

C

19

A

19

F

23

F

2 8 9

N

10

A

11

A

12

F

15

B

17

F

20 22

F

33

F

PCV13

PPSV23

For analysis purposes: 

• PCV13+6C: Included serotype 6C with PCV13 types due to cross 

protection from 6A antigen 

• PPSV23 non-PCV13: 11 unique serotypes not in PCV13 
Methods

 Active Bacterial Core surveillance (ABCs): 

 Active laboratory and population-based 

surveillance, 10 sites

 Pneumococcus isolation from sterile site

 Isolates serotyped by whole genome sequencing, Quellung, or PCR at reference 

labs and grouped for analysis by vaccine type

 US Census Bureau race-bridged post-census population estimates used as 

denominators

 Overall and serotype-specific IPD incidence rates (cases per 100,000)

4
0

5

10

15

20

25

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

ALL IPD

PCV13 + 6C

Non-PCV13

Incidence rates of invasive pneumococcal disease (IPD) 

among children < 5 years old, 2007 - 2019

PCV13 introduction for 

children

2007-08 vs 2017-18 

% Change (95%CI)

2007-08 vs 2018-19 

% Change (95%CI)

All IPD -68 (-73, -61) -67 (-72, -61)

PCV13+ 6C -89 (-92, -84) -89 (-92, -84)

Non-PCV13 -30 (-45, -12) -27 (-42, -7)
0

5

10

15

20

25

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

ALL IPD

PCV13 + 6C

PPSV23 non-PCV13

Non-vaccine type

Incidence rates of IPD among adults 19-64 years old, 2007-2019

PCV13 introduction for 

children

0

5

10

15

20

25

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

ALL IPD

PCV13 + 6C

PPSV23 non-PCV13

Non-vaccine type

19-49 years old 50-64 years old

PCV13 introduction for 

children

2007-08 vs 2017-18 

% Change (95%CI)

2007-08 vs 2018-19 

% Change (95%CI)

All IPD -47 (-52, -42) -45 (-50, -40)

PCV13+6C -70 (-75, -65) -68 (-73, -63)

PPSV23 non-PCV13 -11 (-24, 4) -10 (-24, 6)

Non-vaccine type -33 (-47, -17) -29 (-42, -13)

2007-08 vs 2017-18 

% Change (95%CI)

2007-08 vs 2018-19 

% Change (95%CI)

All IPD -21 (-27, -14) -24 (-30, -17)

PCV13+6C -55 (-60, -48) -57 (-63, -51)

PPSV23 non-PCV13 20 (4, 39) 19 (3, 38)

Non-vaccine type 5 (-11, 26) 5 (-11, 24)
0

5

10

15

20

25

30

35

40

45

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

ALL IPD PCV13+6C PPSV23 non-PCV13 Non-vaccine type

Incidence rates of IPD among adults >65 years old, 2007 - 2019

PCV13 introduction 

for children

PCV13 introduction 

for adults >65 

2007-08 vs 2017-18 

% Change (95%CI)

2007-08 vs 2018-19 

% Change (95%CI)

All IPD -38 (-43, -33) -41 (-45, -36)

PCV13+6C -67 (-71, -62) -68 (-72, -64)

PPSV23 non-PCV13 -12 (-24, 1) -14 (-26, 1)

Non-vaccine type -5 (-18, 9) -12 (-24, 1)
Incidence rates of IPD among children < 5 years old, 2011 – 2019, 

by PCV13+6C serotypes

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

001 005

PCV7 (except 19F) 19F

06C 003

07F 19A 2017-2018 % of 

PCV13+6C 

serotypes

2018-2019 % of 

PCV13+6C 

serotypes

003 42% 46%

19F 28% 32%

19A 22% 14%

06C 3% 4%
Incidence rates of IPD among adults >65 years old, 2011 – 2019, 

by PCV13+6C serotypes

0

2

4

6

8

10

12

14

16

2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

001 005

PCV7 (except 19F) 19F

06C 003

07F 19A

PCV13 introduction for 

adults >65 years old

2017-2018 % of 

PCV13+6C 

serotypes

2018-2019 % of 

PCV13+6C 

serotypes

003 60% 62%

06C 14% 12%

19F 10% 9%

19A 9% 10%
Remaining PCV13-type* disease among adults age 19-64 

years old

 Similar trends in PCV13 serotypes observed in adults aged 19-64 years old 

 Top PCV13+6C serotypes 2018-2019 (% of PCV13+6 serotypes) 

– 19-49 years old: 

• 003 (39%), 004 (26%), 19A (11%), 19F (11%)

– 50-64 years old: 

• 003 (53%), 004 (12%), 19A (11%), 19F (11%)

 Serotype 4 increasing in recent years in adults age 19-64 years old 

– Primarily among adults experiencing homelessness1

1Beall, et al (2020). Upsurge of Conjugate Vaccine Serotype 4 Invasive Pneumococcal Disease Clusters Among Adults Experiencing Homelessness in 

California, Colorado, and New Mexico, The Journal of Infectious Diseases

*Includes serotype 6C
Current Pneumococcal Disease Burden Caused by Serotypes 

in PCV15 and PCV20
Serotypes contained in current and new pneumococcal 

vaccines

For analysis purposes:

• PCV15 non-PCV13: includes serotypes 22F and 33F

• PCV20 non-PCV15: includes serotypes 8, 10A, 11A, 12F, and 15B/C

• PPSV23 non-PCV20: includes serotypes 2, 9N, 17F, and 20

1 3 4 5 6A 6B 7 F 9V 14 18

C

19

A

19

F

23

F

22

F

33

F

8 10

A

11

A

12

F

15

B

2 9N 17

F

20

PCV13

PCV15

PCV20

PPSV23
0

2

4

6

8

10

12

14

16

2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

PCV13+6C PCV15 non-PCV13 PCV20 non-PCV15

2018-2019 

cases per 

100,000

Incidence rates of IPD among adults 19-64 years old, 

2011 – 2019, by conjugate vaccine type

3

2

2018-2019 

cases per 

100,000

5

PCV15 non-PCV13 serotypes: 22F, 33F

PCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15B/C

0.8

0.6

1.5

19-49 years old 50-64 years old

0

2

4

6

8

10

12

14

16

2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

PCV13+6C PCV15 non-PCV13 PCV20 non-PCV15
Incidence rates of IPD among adults >65 years old, 

2011 – 2019, by conjugate vaccine type

3.2

3.6

2018-2019 

cases per 

100,000

6.4

PCV15 non-PCV13 serotypes: 22F, 33F

PCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15B/C

0

5

10

15

20

25

2011 2012 2013 2014 2015 2016 2017 2018 2019

Cases per 100,000

Year

PCV13+6C PCV15 non-PCV13 PCV20 non-PCV15
21

32 29 27

17

12

13 15

22

18 17 14

1

15

13

8

38

23

27

36

0

10

20

30

40

50

60

70

80

90

100

<5 19-49 50-64 65+

Pecent IPD

Age group (Years)

PCV13+6C PCV15 non-PCV13 PCV20 non-PCV15 PPV23 non-PCV20 NVT

Proportion of IPD by vaccine-type and age group in 2018-2019

PCV15 non-PCV13 serotypes: 22F, 33F

PCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15B/C

PPSV23 non-PCV20 serotype: 2, 9N, 17F ,20 
Pneumonia vaccine-type burden among adults ≥65 years old

4.2

2.8

1.3

1.0

1.6

1.1

0.9

0.8

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Oct 2013 - Sept 2016 Nov 2019 - Dec 2020

% All Cause CAP

Time Period

PCV13+6C PCV15 non-PCV13 PCV20 non-PCV15 PPSV23 non-PCV20

N=63471 N=9322

ST3: 0.9% ST3: 1.2%

US Prospective, Multicenter Surveillance Study of Hospitalized Community Acquired Pneumonia Using SSUAD, Courtesy of Pfizer, Inc. 

1Isturiz et al. CID 2021*

2Unpublished Pfizer data *Pfizer funded study
Conclusions

 2019 data has not changed conclusions

– Among children and adults, overall and PCV13-type IPD incidence 

plateaued since 2013-2014

– Incidence of invasive disease caused by PCV15 and PCV20 serotypes 

has also remained stable

– There are opportunities to prevent additional 30% IPD burden among 

adults through new PCV use
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Questions