1299 - Epidemiology of Invasive Pneumococcal Disease (IPD) in the United States 2011-2019

Background: Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for U.S. children aged < 5 years in February 2010 and recommended in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults aged ≥ 65 years in 2014. PCV13 has led to dramatic reductions in invasive pneumococcal disease (IPD) burden. New, higher valency PCVs (PCV15, PCV20) are expected to be licensed for adults in late 2021. We examined remaining PCV13-type IPD among children and adults and assessed IPD burden potentially preventable through PCV15 and PCV20 use.

Methods:

IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998–2019. Isolates were serotyped by Quellung or whole genome sequencing. Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators.

Results:

After introduction of PCV13 in children, by 2013–2014, PCV13-type IPD declined 89% (from 15 to 2 cases/100,000) in children age < 5 years and 67% (from 19 to 7 cases/100,000) in adults age ≥ 65 years. During 2014–2019, rates of PCV13-type IPD in children and adults remained stable. In 2018–2019, among children age < 5 years, serotypes 3, 19F, 19A, and 6C accounted for most of the remaining PCV13-type IPD (46%, 32%, 14% and 4% respectively) (Figure 1). Among adults age ≥ 65 years, serotypes 3, 6C, 19A, and 19F accounted for most of the remaining PCV13-type IPD (62%, 12%, 10%, and 9% respectively) (Figure 1). During 2015–2019, rates of PCV15 and PCV20-type IPD have remained stable. In 2018–2019, among adults age ≥ 65 years, PCV15 non-PCV13-type IPD rates were 3.6 cases per 100,000 and accounted for 15% of all IPD. PCV20 non-PCV13-type IPD rates were 6.8 cases per 100,000 and accounted for 29% of all IPD (Figure 2). Among children age < 5 years, PCV15 non-PCV13-type IPD rates were 1.6 cases per 100,000 and accounted for 17% of all IPD. PCV20 non-PCV13-type IPD rates were 2.8 cases per 100,000 and accounted for 39% of all IPD (Figure 2). Figure 1. Incidence rates of IPD among children < 5 years old, by pneumococcal conjugate vaccine type and individual PCV13 serotypes, 2011–2019
Figure 2. Incidence rates of IPD among adults ≥ 65 years old, by pneumococcal conjugate vaccine type and individual PCV13 serotypes, 2011–2019

Conclusion: Following the dramatic reductions after PCV13 introduction, PCV13-type IPD has remained stable during the past five years. There are opportunities to prevent an additional 30% IPD burden among adults through new PCV use.

Presenting Author(s)

Ryan Gierke, MPH

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

MF

Monica M. Farley, MD

Professor
Emory University
Atlanta, Georgia, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WS

William Schaffner, MD

Director of Preventive Medicine
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Disclosure: VBI Vaccines (Consultant)
AT

Ann Thomas, MD, MPH

Public Health Physician
Oregon Public Health Division
Portland, Oregon, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AR

Art Reingold, MD

Professor and Division Head, Epidemiology
University of California, Berkeley
Berkeley, CA, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LH

Lee Harrison, MD

Professor of Medicine and Epidemiology
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
Disclosure: GSK, Merck, Pfizer, Sanofi Pasteur (Consultant)
CH

Corinne Holtzman, MPH

Epidemiologist Senior
Minnesota Department of Health
St. Paul, Minnesota, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KB

Kari Burzlaff, MPH

Emerging Infections Program Surveillance Officer
New York State Department of Health
Buffalo, New York, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SP

Susan Petit, MPH

Epidemiologist
Connecticut Department of Public Health
Hartford, Connecticut, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Meghan Barnes, MSPH

Epidemiologist
Colorado Department of Public Health and Environment
Denver, Colorado, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ST

Salina Torres, PhD, MPH

Active Bacterial Core Surveillance Project Coordinator
New Mexico Department of Health
Santa Fe, New Mexico, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BB

Bernard Beall, PhD

Director, Streptococcus Laboratory
Centers for Disease Control and Prevention
Atlanta, Georgia, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TP

Tamara Pilishvili, PhD

Epidemiologist
Centers for Disease Control and Prevention, Atlanta, GA, USA
Atlanta, Georgia, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.