National Center for Immunization & Respiratory Diseases

Current Epidemiology of Pediatric PneumococcDisease, United States

Advisory Committee on Immunization PracticesFeb 22, 2023Ryan Gierke, MPH
Bogaert, Lancet Infect Dis 2004;4:144-54

Noninvasive D

Invasive Dis

Pneumococcal carriage is precursor to pneumococcal 
Outline

 Invasive Pneumococcal Disease (IPD) in children

• Impact of Pneumococcal Conjugate Vaccines (PCVs) on IPD 

serotype distribution 

• IPD incidence caused by serotypes in PCV15 and PCV20• Changes in IPD incidence and serotype distribution post-CO

 Acute Otitis Media (AOM) 

• Impact of PCV13• Incidence Estimates 

 Pneumonia in children

• Impact of PCV13 on all-cause and pneumococcal pneumon• Incidence Estimates 
Impact of PCVs on Invasive Pneumococcal Dis

(IPD) Incidence and Serotype Distribution amChildren in the U.S.
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 r

labs and grouped for analysis by vaccine type

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

denominators

 Overall and serotype-specific IPD incidence rates (cases per 100,000 pe
0

102030405060708090

100

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 201

Cases per 100,000 persons

Year

All IPD PCV13+6C Non-PC

Incidence rates of invasive pneumococcal disease (IPD) among c

years old, 1998–2019

PCV7 introduction 

PCV13 introduction 

children 

*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine

*
0

5

10152025

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2

Cases per 100,000

Year

ALL PCVNon

Incidence rates of invasive pneumococcal disease (IPD) among c

years old, 2007 – 2021

PCV13: children

C

*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine
0.0

0.51.01.52.02.53.03.54.04.55.0

2011 2012 2013 2014 2015 2016 2017 2018 2019 

Cases per 100,000 population

Year

001 005PCV7 (except 19F) 19F06C 00307F 19A

% 

2

003 

19F 

19A 

06C 

Incidence rates of IPD among children < 5 years old, 201

by PCV13+6C serotypes

*

*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine
Current Pediatric Pneumococcal Disease Incidence 

Serotypes in PCV15 and PCV20
Serotypes contained in current and new pneum

vaccines

For analysis purposes:• PCV13+6C: includes serotype 6C with PCV13 types due to cr

protection from 6A antigen 

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

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

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

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

C

19A

19F

23F

22F

33F

8 10

A

11A

12F

PCV13PCV15PCV20PPSV23
Incidence rates of IPD among children <5 ye

2011 – 2021, by vaccine type

02468

101214

2011 2012 2013 2014 2015 2016 2017 2018 2019 20

Cases per 100,000 population

Year

PCV13+6C PCV15/ non-PCV13 PCV20/ non-PCV15PPSV23/ non-PCV20 Non-Vaccine Type

COV

PCV15 non-PCV13 serotypes: 22F, 33FPCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15BPPSV23 non-PCV20 serotype: 2, 9N, 17F ,20 

Non-Vaccin

PPSV23/ non

PCV20/ nonPCV15/ non

PCV13+
0.0

0.51.01.52.02.5

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 

Cases per 100,000 population

Year

PCV13+6C PCV15/ non-PCV13 PCV20/ non-PCV15PPSV23/ non-PCV20 Non-Vaccine Type

Non-Vaccine 

PPSV23/ non-P

PCV20/ non-PPCV15/ non-P

PCV13+6

Incidence rates of IPD among children 5 -18 y

2011 – 2021, by vaccine type

COVI

PCV15 non-PCV13 serotypes: 22F, 33FPCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15BPPSV23 non-PCV20 serotype: 2, 9N, 17F ,20 
1

10

100

1000

10000

Sickle C

Cases Per 100,000 persons 

(Log scale)

Condition No 

1

10

100

1000

10000

Hematologic Malignancy Sickle Cell Diseaseˆ

Cases Per 100,000 persons 

(Log scale)

Condition No condition

IPD incidence among children with 

immunocompromising conditions, 2015-2

Children < 5 years Childre

Rate Ratio=231

Rate Ratio=29

Rate 

*Hematologic Malignancy Data only available from 2015-2018 for children age <5 yearsCDC unpublished data, IPD cases identified from ABCsˆ IPD rates for those with and without sickle cell disease are among African American children
Acute Otitis Media (AOM) in Children
PCV13 impact on acute otitis media in children

 AOM is a major cause of childhood morbidity1,2,3

• Pneuococcus is a common bacterial cause of AOM

• S. pneumoniae accounted for an estimated 24%

4

 AOM incidence decreased after PCV13 introduction

• 11%-14% decrease, depending on age group and study years1,2

1 Tong et al. BMC 2018

2 King et al. ASHE 20213Casey et al Clin Pediatr 2014; 

4Kaur et al. EJCMID 2022 
AOM visits per 100,000 Person Years

20141 2014-20182 2016-20183

<1 43,180 -- --

1 year 47,860 -- --

<2 years -- 76,880 49,050

2-4 years 29,980 41,030 31,970

5-17 years 9,060 9,180 5,680

1 Tong et al. BMC 2018

2 Hu et al. BMC 2022

3Unpublished analysis courtesy of Laura King, UC Berkeley

Incidence of acute otitis media among chi

AOM incidence highest 

among children age <5 years
Pneumonia in Children
Evidence of PCV13 impact on pneumonia in 

 Reduction in incidence of all-cause and pneumococcal pneumo

children following PCV13 introduction1,2,3

• 17-35% reduction in all cause-pneumonia

1

• 40% and 51% reduction in inpatient pneumococcal pneumonia 

and 5-17 years, respectively; no reductions in ages 2-4 years

2

1Tong et al. BMC 2018

2 Simonsen et al. Lancet 2014

3King et al. ASHE 2021 
Pneumonia incidence among children

1 Tong et al. BMC 20182National Inpatient Sample, 2018-2019

Age (years) All-cause pneumonia (frequency per 100,000 person years)1, 2014 All-cause inpatient pneum

per 100,000 population)2

< 1 2,250 680

1 3,990 480

2–4 3,390 290

5–17 1,280 87
Conclusions

• Use of PCVs (PCV7, PCV13) significantly decreased the incidence of pn

disease in U.S. children

• Risk of disease remains higher in children with immunocompromising 

compared to children without

• In 2018–2019, the proportion of IPD caused by vaccine serotypes was

• PCV20, non-PCV13: ~30% of IPD• PCV15, non-PCV13: ~15% of IPD
For more information, contact CDC

1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.govThe 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