Surveillance and Reporting

Trends

Invasive pneumococcal disease dramatically declined in both children and adults following the introduction of pneumococcal conjugate vaccines in the United States (see figures below). CDC first recommended PCV7 in 2000 and PCV13 in 2010.

From 1998 through 2018, overall, invasive pneumococcal disease rates among children less than 5 years old decreased by 93%.  Invasive pneumococcal disease caused by the 13 serotypes covered by PCV13 decreased by 98% in children less than 5 years during this same time period.

Invasive pneumococcal disease caused by the serotypes covered by 23-valent pneumococcal polysaccharide vaccine (PPSV23) also declined during this time. However, these reductions were due to declines in invasive pneumococcal disease caused by serotypes in common with PCV13. PPSV23 has been available since 1984.

Visit Bact Facts Interactive to analyze and visualize CDC’s pneumococcal disease trends data.

Figure 1.

On This Page

Doctors consider some pneumococcal infections to be “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs. Invasive pneumococcal disease includes infections of the lining of the brain and spinal cord (meningitis) and blood (bacteremia).

Trends in invasive pneumococcal disease among children aged <5 years old, 1998-2018

Figure 1 shows changes in the incidence of invasive pneumococcal disease (IPD) among children <5 years old from 1998 through 2018 in the United States. Rates of IPD expressed as cases per 100,000 population are shown on the y-axis, and calendar year of surveillance on the x-axis. Blue bars represent overall IPD incidence, while the grey bars represent IPD incidence caused by serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13). Pneumococcal 7-valent conjugate vaccine (PCV7), containing serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, was introduced for use among children <5 years old in 2000. PCV13, containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F, was introduced for use among children <5 years old in 2010. The overall IPD incidence declined from 95 cases per 100,000 in 1998 to 7 cases per 100,000 in 2018; IPD caused by PCV13 serotypes declined from 88 cases per 100,000 in 1998 to 1 case per 100,000 in 2018.

PCV13 was introduced in 2012 for use among adults 19 years or older with immunocompromising conditions and in 2014 for all adults 65 years or older. However, declines in invasive pneumococcal disease were seen as early as 2001 among adults between the ages of 19 and 64 years old (see Figure 2 below) and adults 65 years or older (see Figure 3 below) because of the use of pneumococcal conjugate vaccines in children (herd protection). Overall, invasive pneumococcal disease in adults 19 through 64 years old decreased from 16 cases per 100,000 people in 1998 to 8 cases per 100,000 people in 2018. Invasive pneumococcal disease caused by the 13 serotypes included in PCV13 decreased in adults 19 through 64 years old from 11 cases per 100,000 in 1998 to 2 cases per 100,000 people in 2018.

Figure 2.

Trends in invasive pneumococcal disease among adults aged 19-64 years old, 1998-2018

Figure 2 shows changes in the incidence of invasive pneumococcal disease (IPD) among adults 19 through 64 years of age from 1998 through 2018 in the Unites States. Rates of IPD expressed as cases per 100,000 population are shown on the y-axis, and calendar year of surveillance on the x-axis. Blue bars represent overall IPD incidence, orange bars represent IPD incidence caused by serotypes included in the 23-valent pneumococcal polysaccharide vaccine (PPSV23), while the grey bars represent IPD incidence caused by serotypes included in the 13-valent pneumococcal conjugate vaccine. PPSV23, containing serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F, has been available since 1984 and recommended for all adults 65 years or older and for people 2 years or older with chronic medical conditions. Pneumococcal 7-valent conjugate vaccine (PCV7), containing serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, was introduced for use among children <5 years old in 2000. Pneumococcal 13-valent conjugate vaccine (PCV13) containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F, replaced PCV7 for use among children <5 years old in 2010, and was introduced for adults 19 years or older with immunocompromising conditions in 2012, and for all adults 65 years or older in 2014. The overall IPD incidence declined from 16 cases per 100,000 in 1998 to 8 cases per 100,000 in 2018; IPD caused by PCV13 serotypes declined from 11 cases per 100,000 in 1998 to 2 cases per 100,000 in 2018. IPD caused by PPSV23 serotypes also declined from 14 cases per 100,000 in 1998 to 6 cases per 100,000 in 2018, but these reductions were due to declines in IPD caused by serotypes in common with PCV13.

Figure 3.

Trends in invasive pneumococcal disease among adults aged &gt;65 years old, 1998-2018

Figure 3 shows changes in the incidence of invasive pneumococcal disease (IPD) among adults 65 years or older from 1998 through 2018 in the Unites States. Rates of IPD expressed as cases per 100,000 population are shown on the y-axis, and calendar year of surveillance on the x-axis. Blue bars represent overall IPD incidence, orange bars represent IPD incidence caused by serotypes included in 23-valent pneumococcal polysaccharide vaccine (PPSV23), while the grey bars represent IPD incidence caused by serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13). PPSV23, containing serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F, has been available since 1984 and recommended for all adults 65 years or older and for people 2 years or older with chronic medical conditions. Pneumococcal 7-valent conjugate vaccine (PCV7), containing serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, was introduced for use among children <5 years old in 2000. Pneumococcal 13-valent conjugate vaccine (PCV13), containing serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F, replaced PCV7 for use among children <5 years old in 2010, and introduced for adults 19 years older with immunocompromising conditions in 2012, and for all adults 65 years or older in 2014. The overall IPD incidence declined from 61 cases per 100,000 in 1998 to 24 cases per 100,000 in 2018; IPD caused by PCV13 serotypes declined from 45 cases per 100,000 in 1998 to 5 cases per 100,000 in 2018. IPD caused by PPSV23 serotypes also declined from 53 cases per 100,000 in 1998 to 15 cases per 100,000 in 2016, but these reductions were due to declines in IPD caused by serotypes in common with PCV13.

Surveillance

Invasive pneumococcal disease is a reportable condition in all states, with cases immediately reported to the appropriate health department. CDC tracks invasive pneumococcal disease through two systems: National Notifiable Diseases Surveillance System (NNDSS) and Active Bacterial Core surveillance (ABCs).

CDC does not track non-invasive pneumococcal disease, like ear and sinus infections, through either surveillance system.

National Notifiable Diseases Surveillance System

State health departments report invasive pneumococcal disease to CDC through NNDSS. Health departments should report both suspected and confirmed cases.

Bact Facts Interactive
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Analyze and visualize ABCs S. pneumoniae data using Bact Facts Interactive.

Active Bacterial Core surveillance

Some regions in the United States also track invasive pneumococcal disease cases through ABCs. ABCs is an active, laboratory- and population-based surveillance system for invasive bacterial pathogens of public health importance. Researchers and public health professionals use ABCs data to track disease trends, including the decline in pneumococcal disease following the introduction of the pediatric pneumococcal conjugate vaccine.

Page last reviewed: September 1, 2020