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Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
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Current Epidemiology of Pneumococcal Disease
among Adults, United States
February 2024, ACIP Meeting
February 29, 2024
Ryan Gierke, MPH
Outline
Background on pneumococcal disease
Pneumococcal vaccine coverage in adults
Pneumonia incidence estimates in adults
Invasive pneumococcal disease (IPD)
–Impact of COVID- 19
–Incidence by vaccine type
–Serotype distribution
2
Bogaert, Lancet Infect Dis 2004;4:144 -54Pneumococcal carriage is precursor to pneumococcal disease
More frequent
Less frequent
3
Bogaert, Lancet Infect Dis 2004;4:144 -54Noninvasive Disease
Invasive DiseasePneumococcal carriage is precursor to pneumococcal disease
More frequent
Less frequent
4
PCV20 coverage: 12%
–Ranged from 9% (adults aged ≥85 years) to 25% (adults aged 65 years)
PCV15 coverage: 0.2%
–Less than 1% across all agesPCV15 and PCV20 coverage among Medicare Part A/B
beneficiaries aged ≥65 years1, Oct 1, 2021 − Dec 31, 2023
1.Based on age at the end of 2022
Unpublished data courtesy of CDC ISD. Based on CMS data from January 17, 2024.
Estimated proportion of adults who ever received any pneumococcal
vaccination, National Health Interview Survey, 2021
Age group % (95% CI)
Overall (≥65 years) 65.8 (64.4 -67.2)
Overall (19 –64years with risk -based indication ) 22.2 (21.0 -23.5)
White 23.3 (21.7 -24.9)
Black 22.6 (19.2 -26.4)
Hispanic 19.0 (15.9 -22.6)*
Asian 16.9 (12.0 -23.2)*
Other 22.7 (16.3 -30.7)
*p<0.05 for comparisons with white as the referencehttps://www.cdc.gov/vaccines/imz -managers/coverage/adultvaxview/pubs -
resources/vaccination -coverage- adults -2021.html#summary
Estimated incidence of pneumococcal disease in adults
aged ≥65 years
Disease Estimated incidence
(per 100,000 population)
All-cause hospitalized pneumonia1847–3,365
Hospitalized noninvasive pneumococcal
pneumonia2105
Invasive pneumococcal disease (IPD)3 24
1. McLaughlin et al. Vaccine 2020 (limited to studies that collected data during or after 2010)
2. Gierke et al. IDweek 2020. CDC’s Surveillance for NonInvasive Pneumococcal Pneumonia ( SNiPP ), 2017
3. CDC ABCs, 2018 –2019 Case fatality ratio from IPD: 14%3
Kobayashi October 2022 ACIP meeting presentation 7
IPD Incidence and Serotype Distribution Among
Adults in the United States
8
Methods
Active Bacterial Core surveillance (ABCs):
Active laboratory and population- ba sed
surveillance, 10 sites
Pneumococcus is olation from sterile site
Isolates serotyped by whole -ge nome sequencing, Quellung, or PCR at reference
labs and grouped for analysis by vaccine type
US Census Bureau race -b ridged post -census population estimates used as
denominators
Overall and serotype -s pecific IPD incidence rates (cases per 100,000 population)
https://www.cdc.gov/abcs/methodology/surv-pop.html9
IPD incidence rates, by age group, 2007 − 2022
051015202530354045
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearAge <5 Age 19-49
Age 50-64 Age ≥65
10
051015202530354045
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearAge <5 Age 19-49
Age 50-64 Age ≥65IPD incidence rates, by age group, 2007 − 2022
PCV13: children
11
051015202530354045
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearAge <5 Age 19-49
Age 50-64 Age ≥65IPD incidence rates, by age group, 2007 − 2022
PCV13: adultsPCV13: children
12
051015202530354045
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearAge <5 Age 19-49
Age 50-64 Age ≥65IPD incidence rates, by age group, 2007 − 2022
PCV13: adultsPCV13: children
13COVID -19
051015202530354045
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearAge <5 Age 19-49
Age 50-64 Age ≥65IPD incidence rates, by age group, 2007 − 2022
PCV15 & PCV20:
adultsPCV13: adultsPCV13: children
PCV15: children
14COVID -19
Proportion of adult IPD cases, with a risk -based indication,
2018 − 2021
Among adult IPD cases, 82% – 87% had at least one risk -based
indication for pneumococcal vaccination
–Age 19- 49 years: 82%
–Age 50 -64 years: 87%
–Age ≥65 years: 87%
15
Serotypes contained in current and new pneumococcal vaccines
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV15
PCV20PPSV23PCV21
16
Serotypes contained in PCV20 and PCV21
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV20
PCV21
17
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV20
PCV21
For analysis purposes:
•PCV20 non- PCV21: includes serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
18Serotypes contained in PCV20 and PCV21
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0A1
1
A1
2
F1
5
B2 9
N17
F2
015
A1
5C16F23A23B24F3135B
PCV20
PCV21
For analysis purposes:
•PCV20 non- PCV21: includes serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
•PCV20 and PCV21: includes serotypes 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
19Serotypes contained in PCV20 and PCV21
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV20
PCV21
For analysis purposes:
•PCV20 non- PCV21: includes serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
•PCV20 and PCV21: includes serotypes 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
•PCV21 non- PCV20: includes serotypes 9N, 17F, 20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B
20Serotypes contained in PCV20 and PCV21
IPD incidence rates among adults 19 -64 years old, by vaccine type,
2011 – 2022
PCV15 & PCV20: adults19-49 years old 50-64 years old
02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 population
YearsPCV20/ non-PCV21 PCV20 and PCV21
PCV21/non-PCV20 Non-Vaccine Type
PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B 02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 population
YearsPCV20/ non-PCV21 PCV20 and PCV21
PCV21/non-PCV20 Non-Vaccine Type
*2022 estimates are not finalized
21COVID -19COVID -19
02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 population
YearsPCV20/ non-PCV21 PCV20 and PCV21
PCV21/non-PCV20 Non-Vaccine Type
02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 population
YearsPCV20/ non-PCV21 PCV20 and PCV21
PCV21/non-PCV20 Non-Vaccine TypeIPD incidence rates among adults 19 -64 years old, by vaccine type,
2011 – 2022
19-49 years old 50-64 years old
PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B *2022 estimates are not finalized
22COVID -19
COVID -19
0510152025303540
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 population
YearsPCV20/ non-PCV21 PCV20 and PCV21 PCV21/ non-PCV20 Non-Vaccine TypeIPD incidence rates among adults ≥65 years old, by vaccine type,
2011 – 2022
PCV15 & PCV20:
adultsPCV13: adults ≥65
PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B *
*2022 estimates are not finalized
23COVID -19
1345366
0102030405060708090100Percent IPD
PCV20/ non-PCV21 PCV20 and PCV21
PCV21/ non-PCV20 NVT747388
0102030405060708090100Percent IPD
PCV20/ non-PCV21 PCV20 and PCV21
PCV21/ non-PCV20 NVTProportion of IPD by vaccine -type among adults with a pneumococcal
vaccine indication, 2018 − 2022
PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B PCV21:
85% coverage
24PCV20:
54% coveragePCV21:81% coverage
PCV20:
58% coverage19-64 years old (with a risk -based indication) ≥65 years old
Conclusion
During the COVID- 19 pandemic, rates of IPD declined but are now returning
to pre -pandemic levels
>80% of adult IPD cases have a risk -based indication for vaccination
PCV21 has greater coverage of the serotypes causing IPD in adults compared
to PCV20
–PCV20 covers 54–58% of adult IPD
–PCV21 covers 81–84% of adult IPD
25
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.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.
Questions
Supplemental slides
27
Serotypes contained in current and new pneumococcal vaccines
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV15
PCV20PPSV23PCV21
For analysis purposes:
•PCV15+6C includes serotype 6C with PCV15 types due to cross protection from 6A
antigen
28
Serotypes contained in current and new pneumococcal vaccines
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV15
PCV20PPSV23PCV21
29For analysis purposes:
•PCV15+6C includes serotype 6C with PCV15 types due to cross protection from 6A
antigen
•PCV20/ non- PCV15: includes serotypes 8, 10A, 11A, 12F, and 15B
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV15
PCV20PPSV23PCV21
For analysis purposes:
•PCV15+6C includes serotype 6C with PCV15 types due to cross protection from 6A
antigen
•PCV20/ non- PCV15: includes serotypes 8, 10A, 11A, 12F, and 15B
•PPSV23/ non- PCV20: includes serotypes 2, 9N, 17F, and 20
30Serotypes contained in current and new pneumococcal vaccines
1 3 4 5 6
A6B7 F9V1418C19A19F23F22F33F8 1
0
A1
1
A1
2
F1
5
B2 9
N17
F2015
A1
5C16F23A23B24F3135B
PCV15
PCV20PPSV23PCV21
For analysis purposes:
•PCV15+6C includes serotype 6C with PCV15 types due to cross protection from 6A
antigen
•PCV20 non- PCV15: includes serotypes 8, 10A, 11A, 12F, and 15B
•PPSV23 non- PCV20: includes serotypes 2, 9N, 17F, and 20
•PCV21 non- PPSV23: includes serotypes 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B
31Serotypes contained in current and new pneumococcal vaccines
02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022Cases per 100,000 persons
YearPCV15+6C PCV20/ non-PCV15 PPSV23/ non-PCV20
PCV21/non-PPSV23 Non-Vaccine TypeIPD incidence rates among adults 19 -64 years old, by vaccine type,
2011 – 2022
PCV20 non- PCV15 serotypes: 8, 10A, 11A, 12F, 15B
PPSV23 non -PCV20 serotypes: 2, 9N, 17F, 20
PCV21 non- PPSV23 serotypes: 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 19-49 years old 50-64 years old
02468101214161820
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 persons
YearPCV15+6C PCV20/ non-PCV15 PPSV23/ non-PCV20
PCV21/non-PPSV23 Non-Vaccine Type
*2022 estimates are not finalized*
32
0510152025303540
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022*Cases per 100,000 persons
YearPCV15+6C PCV20/ non-PCV15 PPSV23/ non-PCV20 PCV21/non-PPSV23 Non-Vaccine TypeIPD incidence rates among adults ≥65 years old, by vaccine type,
2011 – 2022
PCV15 & PCV20:
adults
PCV20 non- PCV15 serotypes: 8, 10A, 11A, 12F, 15B
PPSV23 non -PCV20 serotypes: 2, 9N, 17F, 20
PCV21 non- PPSV23 serotypes: 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 PCV13: adults ≥65
*2022 estimates are not finalized
33
1345366
0102030405060708090100Percent IPD
PCV20/ non-PCV21 PCV20 and PCV21
PCV21/ non-PCV20 NVT421615216
0102030405060708090100Percent IPD
PCV15+6C PCV20/non-PCV15
PPSV23/non-PCV20 PCV21/non-PPSV23
NVTProportion of IPD by vaccine -type among adults aged 19 -64 years, with a
risk-based indication, 2018 -2022
PCV20/ non- PCV15 serotypes: 8, 10A, 11A, 12F, 15B
PPSV23/ non -PCV20 serotypes: 9N, 17F ,20
PCV21/ non- PPSV23 serotypes: 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 81%
coverage
58% coverage
PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 34
747388
0102030405060708090100Percent IPD
PCV20/ non-PCV21 PCV20 and PCV21 PCV21/ non-PCV20 NVT42129298
0102030405060708090100Percent IPD
PCV15+6C PCV20/ non-PCV15 PPSV23/ non-PCV20
PCV21/ non-PPSV23 NVTProportion of IPD by vaccine -type among adults age ≥65 years,
2018 -2022
PCV20/ non- PCV15 serotypes: 8, 10A, 11A, 12F, 15B
PPSV23/ non -PCV20 serotypes: 2, 9N, 17F ,20
PCV21/ non- PPSV23 serotypes: 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 PCV20/ non- PCV21 serotype: 1, 4, 5, 6B, 9V, 14, 18C, 19F, 23F, 15B
PCV20/ in -PCV21 serotypes: 3, 6A, 7F, 19A, 22F, 33F, 8, 10A, 11A, 12F, +6C
PCV21/ non -PCV20 serotypes: 9N, 17F ,20, 15A, 15C, 16F, 23A, 23B, 24F, 31, 35 PCV21:
85% coverage
PCV20:54% coverage
35