Document text
National Center for Immunization & Respiratory Diseases
Current Epidemiology of Pediatric Pneumococcal
Disease, United States
Ryan Gierke, MPH
Advisory Committee on Immunization Practices
Feb 22, 2023
1
Pneumococcal carriage is precursor to pneumococcal disease
Noninvasive Disease
Invasive Disease More frequent
Less frequent
Bogaert, Lancet Infect Dis 2004;4:144-54 2
Outline
Invasive Pneumococcal Disease (IPD) in children
• Impact of Pneumococcal Conjugate Vaccines (PCVs) on IPD incidence and
serotype distribution
• IPD incidence caused by serotypes in PCV15 and PCV20
• Changes in IPD incidence and serotype distribution post-COVID19
Acute Otitis Media (AOM)
• Impact of PCV13
• Incidence Estimates
Pneumonia in children • Impact of PCV13 on all-cause and pneumococcal pneumonia
• Incidence Estimates
3
Impact of PCVs on Invasive Pneumococcal Disease
(IPD) Incidence and Serotype Distribution among
Children in the U.S.
4
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 people)
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Incidence rates of invasive pneumococcal disease (IPD) among children < 5
years old, 1998–2019
0 10 20 30 40 50 60 70 80 90 100 Cases per 100,000 persons All IPD PCV13+6C Non-PCV13 PCV7 introduction
PCV13 introduction
children *
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year
*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine 6
Incidence rates of invasive pneumococcal disease (IPD) among children < 5
years old, 2007 – 2021
25
20 15
10
5
0
2007 2008 2009 2010 2011 2012 2013 2014
Year 2015 2016 2017 2018 2019 2020 2021 Cases per 100,000 ALL IPD
PCV13 + 6C
Non-PCV13 PCV13: children
COVID-19 *
7
*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine
Incidence rates of IPD among children < 5 years old, 2011 – 2021,
by PCV13+6C*serotypes
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Year 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Cases per 100,000 population 001 005
PCV7 (except 19F) 19F
06C 003
07F 19A % of PCV13+6C serotypes
2018-2019 2020-2021
003 46% 18%
19F 32% 60%
19A 14% 18%
06C 4% 0%
COVID-19
*Serotype 6C was grouped with PCV13 serotypes due to cross protection from 6A antigen in the vaccine 8
Current Pediatric Pneumococcal Disease Incidence Caused by
Serotypes in PCV15 and PCV20
9
Serotypes contained in current and new pneumococcal
vaccines
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
For analysis purposes:
• PCV13+6C : includes serotype 6C with PCV13 types due to cross
protection from 6A antigen
• PCV15 non-PCV13 : includes serotypes 22F and 33F
• PCV20 non-PCV15 : includes serotypes 8, 10A, 11A, 12F, and 15B
• PPSV23 non-PCV20 : includes serotypes 2, 9N, 17F, and 20
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Incidence rates of IPD among children <5 years old,
2011 – 2021, by vaccine type
14
12 10
8 6 4 2
0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 PCV13+6C PCV15/ non-PCV13 PCV20/ non-PCV15
PPSV23/ non-PCV20 Non-Vaccine Type
COVID-19 Proportion of IPD
2018-2019 2020-2021
Non-Vaccine Type 46% 52%
PPSV23/ non-PCV20 1% 4%
PCV20/ non-PCV15 15% 13%
PCV15/ non-PCV13 17% 15%
PCV13+6C 21% 16%
Year Cases per 100,000 population
PCV15 non-PCV13 serotypes: 22F, 33F P
CV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15B
PPSV23 non-PCV20 serotype: 2, 9N, 17F ,20 11
Incidence rates of IPD among children 5 -18 years old,
2011 – 2021, by vaccine type Cases per 100,000 population
0.0 0.5 1.0 1.5 2.0 2.5
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 PCV13+6C PCV15/ non-PCV13 PCV20/ non-PCV15
PPSV23/ non-PCV20 Non-Vaccine Type % of IPD
2018-2019 2020-2021
Non-Vaccine Type 32% 36%
PPSV23/ non-PCV20 5% 5%
PCV20/ non-PCV15 13% 16%
PCV15/ non-PCV13 16% 9%
PCV13+6C 34% 34%
COVID-19
Year
PCV15 non-PCV13 serotypes: 22F, 33F PCV20 non-PCV15 serotypes: 8, 10A, 11A, 12F, 15B PPSV23 non-PCV20 serotype: 2, 9N, 17F ,20 12
IPD incidence among children with
immunocompromising conditions, 2015-2019*
Children < 5 years Children 5-17 years
10000 10000 Rate Ratio=231
Rate Ratio=29
1 Cases Per 100,000 persons
(Log scale) 1000
Cases Per 100,000 persons
(Log scale) 1000
Rate Ratio=71
100 100
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Sickle Cell Diseaseˆ 10
1
Hematologic Malignancy Sickle Cell Diseaseˆ
Condition No condition Condition No condition
CDC
unpublished data, IPD cases identified from ABCs
*Hematologic Malignancy Data only available from 2015-2018 for children age <5 years
ˆ IPD rates for those with and without sickle cell disease are among African American children 13
Acute Otitis Media (AOM) i n Children
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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 2021
3Casey et al Clin Pediatr 2014;
4Kaur et al. EJCMID 2022 15
Incidence of acute otitis media among children
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
AOM incidence highest
among children age <5 years
1 Ton g et al. BMC 2018
2 Hu et al. BMC 2022
3Unpublishe d analysi s courtesy o f Laura King, U C Berkeley 16
Pneumonia in Children
17
Evidence of PCV13 impact on pneumonia in children
Reduction in incidence of all-cause and pneumococcal pneumonia among in
children following PCV13 introduction1,2,3
• 17-35% reduction in all cause-pneumonia1
• 40% and 51% reduction in inpatient pneumococcal pneumonia among ages <1
and 5-17 years, respectively; no reductions in ages 2-4 years2
1Tong et al. BMC 2018
2 Simonsen et al. Lancet 2014
18 3King et al. ASHE 2021
Pneumonia incidence among children
Age (years) All-cause pneumonia (frequency per
100,000 person years)1 , 2014 All-cause inpatient pneumonia (cases
per 100,000 population)2 , 2018–19
< 1 2,250 680
1 3,990 480
2–4 3,390 290
5–17 1,280 87
1 Tong et al. BMC 2018
2 National Inpatient Sample, 2018-2019
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Conclusions
• Use of PCVs (PCV7, PCV13) significantly decreased the incidence of pneumococcal
disease in U.S. children
• Risk of disease remains higher in children with immunocompromising conditions 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
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Questions
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.