Invasive Pneumococcal Disease at Eight Children's Hospitals in the United States, 2018-2023

The 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in the United States in 2010. We describe invasive pneumococcal disease (IPD) in children at 8 children's hospitals in the United States from 2018 to 2023, when PCV20 was licensed.

Children with IPD occurring from 2018 to 2023 were identified from a database of a prospective study. Demographic and clinical data were recorded on case report forms. Isolate serotypes were determined in a central laboratory. Antibiotic susceptibilities were determined by minimal inhibitory testing.

During 2018-2023, PCV13 serotypes accounted for 32% (128/404) and 28% (66/234) of IPD isolates from children <5 and ≥5 years old, respectively. Nearly all were serotypes 3, 19A and 19F. The 7 new PCV20 serotypes accounted for 25% of IPD in children <5 and 19% among children ≥5 years old. Other common non-PCV13 serotypes were 35B (9.2%) and 23B (7.5%). Underlying conditions were recorded for 45.5% (184/404) and 66.7% (156/234), respectively, for children <5 years of age and ≥5 years of age with an isolate available ( P < 0.001). Among 109 meningitis isolates, 11 (10.1%) were nonsusceptible to ceftriaxone.

PCV13 serotypes (especially 3, 19A and 19F) continue to account for 30% of IPD in US children 8-13 years after PCV13 was introduced. Vancomycin should still be included in empiric treatment of bacterial meningitis in children. The introduction of PCV20 for routine administration to infants could result in further reductions in IPD in children.