The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: A systematic review and meta-analysis
Related Experiment Video
Updated: Feb 8, 2026
Capsular Serotyping of Streptococcus pneumoniae Using the Quellung Reaction
Published on: February 24, 2014
Evelyn Balsells1, Ron Dagan2, Inci Yildirim3
1Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK.
Insights
Pneumococcal conjugate vaccines (PCV) effectiveness varies by serotype. Some serotypes like 1, 7F, and 12F are more invasive in young children, while others are less so, impacting vaccine development.
Area of Science:
- Microbiology
- Epidemiology
- Vaccinology
Background:
- The burden of pneumococcal disease is linked to the prevalence and invasiveness of specific Streptococcus pneumoniae serotypes.
- Understanding serotype-specific invasive disease potential is crucial for assessing the impact of pneumococcal conjugate vaccines (PCV).
Purpose of the Study:
- To estimate the invasive disease potential of different pneumococcal serotypes in children under 5 years of age.
- To combine data from various settings with routine PCV immunization to provide a comprehensive analysis.
Main Methods:
- Conducted a systematic review and incorporated unpublished data on pneumococcal serotype carriage and invasive pneumococcal disease (IPD).
- Estimated invasive disease potential using the ratio of IPD to carriage (odds ratio) via meta-analysis, comparing serotypes to 19A.
- Analyzed data for children aged 0-23 months, 24-59 months, and by invasive clinical syndromes using a random effects model.
Main Results:
- Serotypes 1, 7F, and 12F demonstrated significantly higher invasive disease potential than serotype 19A across all IPD and clinical syndromes in children aged 0-59 months (OR > 5).
- Several non-vaccine types (NVTs) such as 6C, 15A, 15BC, 16F, and 23B showed lower invasive potential (OR 0.1-0.3) compared to 19A.
- NVTs 8, 12F, 24F, and 33F were found at the higher end of the invasiveness spectrum.
Conclusions:
- Significant variation exists in the capacity of pneumococcal serotypes to cause IPD and influence disease presentation, affected by age and time since PCV introduction.
- Ongoing surveillance of IPD and pneumococcal carriage is essential for evaluating the long-term effectiveness of current PCVs.
- This data is critical for guiding the development of next-generation pneumococcal vaccines.
Objectives:
Burden of pneumococcal disease depends on the prevalence and invasive disease potential of serotypes. We aimed to estimate the invasive disease potential of serotypes in children under 5 years of age by combining data from different settings with routine immunisation with pneumococcal conjugate vaccines (PCV).
Methods:
We conducted a systematic review, supplemented by unpublished data, to identify data on the frequency of pneumococcal serotypes in carriage and invasive pneumococcal disease (IPD). We estimated the invasive disease potential of serotypes as the ratio of IPD in relation to carriage (odds ratio and 95%CI) compared with 19A (reference serotype) by meta-analysis. We report results based on a random effects model for children aged 0-23, 24-29, and 0-59 months and by invasive clinical syndromes.
Results:
In comparison with 19A, serotypes 1, 7F, and 12F had a significantly higher invasive disease potential in children aged 0-23 and 0-59 months for all IPD and clinical syndromes (OR > 5). Several non-vaccine types (NVTs) (6C, 15A, 15BC, 16F, 23B, in these two age groups) had a lower invasive disease potential than 19A (OR 0.1-0.3). NVTs 8, 12F, 24F, and 33F were at the upper end of the invasiveness spectrum.
Conclusions:
There is substantial variation among pneumococcal serotypes in their potential to cause IPD and disease presentation, which is influenced by age and time after PCV introduction. Surveillance of IPD and carriage is critical to understand the expected effectiveness of current PCVs (in the longer term) and guide the development of future vaccines.
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