Streptococcus Pneumoniae Invasive Disease  
Annual Summary of Reportable Diseases

Streptococcus pneumoniae is a bacteria that causes acute infection. Some infections are considered invasive when the infection occurs in parts of the body that are normally sterile, such as blood. In 2022, 473 (8.4 per 100,000) cases of invasive pneumococcal disease (IPD) were reported. By age group, annual incidence rates per 100,000 were 12.1 cases among children aged ≤5 years, 2.8 cases among children and adults aged 5-39 years, 8.6 cases among adults 40-64 years, and 21.7 cases among adults aged ≥65 years. 

Pneumonia occurred most frequently (53% of infections), followed by bacteremia without another focus of infection (12%), septic shock (11%), and meningitis (7%). Forty-eight (10%) cases died. Health histories were available for 47 deaths, of which 37 had an underlying health condition. The conditions most frequently reported were current tobacco smoker (17), diabetes (13), chronic kidney disease (11), solid organ malignancy (10), obesity (9), heart failure (9), current alcohol abuse (9), emphysema/chronic obstructive pulmonary disease (8), atherosclerotic cardiovascular disease/ coronary artery disease (6), cerebral vascular accident/ stroke (6), and cirrhosis (6). 

In 1999, the year before the pediatric pneumococcal conjugate vaccine (Prevnar [PCV-7]) was licensed, the rate of IPD among children <5 years of age in the metropolitan area was 111.7 cases/100,000. Over the years 2000-2002 there was a major downward trend in incidence in this age group (Figure 5). Rates in each of the subsequent 8 years were level or somewhat higher. Based on the distribution of serotypes among isolates from these cases, this increase was limited to disease caused by non-vaccine serotypes (i.e., serotypes other than the 7 included in PCV-7) (Figure 5). 

In March 2010, the U.S. Food and Drug Administration approved a 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. This vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of IPD cases among children <5 years of age was caused by the 6 new serotypes included in PCV-13 (Figure 5). Since 2011, the majority of IPD cases among children <5 years of age has been caused by serotypes not included in PCV-13. In 2022, 25% of cases with isolates available for testing were caused by 7 of the PCV-13- included serotypes: 3 (14%), 19F (8%), 19A (1%), 4 (1%), 18C (<1%), 7F (<1%), and 1 (<1%). 

In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults ≥65 years receive 1 dose of PCV-13 followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine 6 to 12 months later. Among adults ≥65 years, 15% of cases in 2021 had PCV-13 serotypes.

• For up to date information see: Streptococcus pneumoniae (Pneumococcal Disease)

In 2021, 309 (5.5 per 100,000) cases of invasive pneumococcal disease (IPD) were reported. By age group, annual incidence rates per 100,000 were 7.2 cases among children aged ≤5 years, 1.3 cases among children and adults aged 5-39 years, 7.9 cases among adults 40-64 years, and 13.1 cases among adults aged ≥65 years. 

Pneumonia occurred most frequently (48% of infections), followed by bacteremia without another focus of infection (16%), septic shock (11%), and meningitis (6%). Forty-six (15%) cases died. Health histories were available for 45 deaths, of which 40 had an underlying health condition. The conditions most frequently reported were current tobacco smoker (16), diabetes (14), solid organ Figure 6. Invasive Pneumococcal Disease Incidence Among Children <5 Years of Age, by Year and Serotype Group, Metropolitan Area malignancy (10), emphysema/chronic obstructive pulmonary disease (10), current alcohol abuse (9), obesity (9), atherosclerotic cardiovascular disease/ coronary artery disease (7), chronic kidney disease (6), and heart failure (6). 

In 1999, the year before the pediatric pneumococcal conjugate vaccine (Prevnar [PCV-7]) was licensed, the rate of IPD among children <5 years of age in the metropolitan area was 111.7 cases/100,000. Over the years 2000-2002 there was a major downward trend in incidence in this age group (Figure 6). Rates in each of the subsequent 8 years were level or somewhat higher. Based on the distribution of serotypes among isolates from these cases, this increase was limited to disease caused by non-vaccine serotypes (i.e., serotypes other than the 7 included in PCV-7) (Figure 6). 

In March 2010, the U.S. Food and Drug Administration approved a 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. This vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of IPD cases among children <5 years of age was caused by the 6 new serotypes included in PCV-13 (Figure 6). Since 2011, the majority of IPD cases among children <5 years of age has been caused by serotypes not included in PCV-13. In 2021, 13% of cases with isolates available for testing were caused by 7 of the PCV-13- included serotypes: 3 (13%), 19F (5%), 19A (2%), 4 (1%), 18C (<1%), and 6B (<1%). 

In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults ≥65 years receive 1 dose of PCV-13 followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine 6 to 12 months later. Among adults ≥65 years, 11% of cases in 2021 had PCV-13 serotypes.

• For up to date information see: Streptococcus pneumoniae (Pneumococcal Disease)

In 2020, 292 (5.2 per 100,000) cases of invasive pneumococcal disease (IPD) were reported. By age group, annual incidence rates per 100,000 were 3.1 cases among children aged ≤5 years, 1.1 cases among children and adults aged 5-39 years, 8.1 cases among adults 40-64 years, and 12.0 cases among adults aged ≥65 years. 

Pneumonia occurred most frequently (51% of infections), followed by bacteremia without another focus of infection (13%), septic shock (12%), and meningitis (7%). Thirty-three (11%) cases died. Health histories were available for 31 deaths; 28 had an underlying health condition. The conditions most frequently reported were current tobacco smoker (14), current alcohol abuse (11), diabetes (10), emphysema/chronic obstructive pulmonary disease (7), cirrhosis (7), solid organ malignancy (5), chronic kidney disease (5), and asthma (4). 

In 1999, the year before the pediatric pneumococcal conjugate vaccine (Prevnar [PCV-7]) was licensed; the rate of IPD among children <5 years of age in the metropolitan area was 111.7 cases/100,000. Over the years 2000-2002 there was a major downward trend in incidence in this age group (Figure 6). Rates in each of the subsequent 8 years were level or somewhat higher. Based on the distribution of serotypes among isolates from these cases, this increase was limited to disease caused by non-vaccine serotypes (i.e. serotypes other than the 7 included in PCV-7) (Figure 5). 

In March 2010, the U.S. Food and Drug Administration approved a 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. This vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of IPD cases among children <5 years of age was caused by the 6 new serotypes included in PCV-13 (Figure 6). Since 2011, the majority of IPD cases among children <5 years of age has been caused by serotypes not included in PCV-13. In 2020, 13% of cases with isolates available for testing were caused by 8 of the PCV-13-included serotypes: 3 (7%), 19F (2%), 19A (2%), 9V (<1%), 18C (<1%), 6B (<1%), and 4 (<1%).

In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults ≥65 years receive 1 dose of PCV-13 followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine 6 to 12 months later. Among adults ≥65 years, 5% of cases in 2020 had PCV-13 serotypes.

• For up to date information see: Streptococcus pneumoniae (Pneumococcal Disease)

In 2019, 531 (9.4 per 100,000) cases of invasive pneumococcal disease (IPD) were reported. By age group, annual incidence rates per 100,000 were 10.2 cases among children aged ≤5 years, 2.1 cases among children and adults aged 5-39 years, 10.8 cases among adults 40-64 years, and 27.2 cases among adults aged ≥65 years.

Pneumonia occurred most frequently (60% of infections), followed by bacteremia without another focus of infection (13%), septic shock (11%), and meningitis (5%). Forty-six (9%) cases died. Health histories were available for 43 deaths; all had an underlying health condition. The conditions most frequently reported were current tobacco smoker (18), heart disease (15), solid organ malignancy, (13), chronic kidney disease (11), emphysema/chronic obstructive pulmonary disease (10), diabetes (10), and obesity (6).

In 1999, the year before the pediatric pneumococcal conjugate vaccine (Prevnar [PCV-7]) was licensed; the rate of IPD among children <5 years of age in the metropolitan area was 111.7 cases/100,000. Over the years 2000-2002 there was a major downward trend in incidence in this age group (Figure 5). Rates in each of the subsequent 8 years were level or somewhat higher. Based on the distribution of serotypes among isolates from these cases, this increase was limited to disease caused by nonvaccine serotypes (i.e. serotypes other than the 7 included in PCV-7) (Figure 6).

In March 2010, the U.S. Food and Drug Administration approved a 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. This vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of IPD cases among children <5 years of age was caused by the 6 new serotypes included in PCV-13 (Figure 6). Since 2011, the majority of IPD cases among children <5 years of age has been caused by serotypes not included in PCV-13. In 2019, 20% of cases with isolates available for testing were caused by 6 of the PCV-13-included serotypes: 3 (14%), 19F (4%), 19A (2%), 9V (<1%), 18C (<1%), and 4 (<1%).

In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults ≥65 years receive 1 dose of PCV- 13 followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine 6 to 12 months later. Among adults ≥65 years, 18% of cases in 2019 had PCV-13 serotypes.

Of the 516 isolates submitted for 2019 cases, 100 (19%) isolates were resistant to penicillin using meningitis breakpoints. Using non-meningitis breakpoints, 2 (<1%) of 516 isolates were resistant to penicillin. (Note: CLSI penicillin breakpoints changed in 2008).

• Find up to date information at>> Streptococcus pneumoniae (Pneumococcal Disease)

In 2018, 478 (8.6 per 100,000) cases of invasive pneumococcal disease (IPD) were reported. By age group, annual incidence rates per 100,000 were 7.9 cases among children aged ≤5 years, 2.7 cases among children and adults aged 5-39 years, 9.0 cases among adults 40-64 years, and 25.6 cases among adults aged ≥65 years.

Pneumonia occurred most frequently (55% of infections), followed by bacteremia without another focus of infection (15%), septic shock (12%), and meningitis (6%). Forty-six (10%) cases died. Health histories were available for all 46 deaths; of these, 43 had an underlying health condition reported. The conditions most frequently reported were current tobacco smoker (12), emphysema/ chronic obstructive pulmonary disease (11), cardiac failure (10), chronic kidney disease (10), diabetes (8), current alcohol abuse (8), and obesity (8).

In 1999, the year before the pediatric pneumococcal conjugate vaccine (Prevnar [PCV-7]) was licensed; the rate of IPD among children <5 years of age in the metropolitan area was 111.7 cases/100,000. Over the years 2000-2002 there was a major downward trend in incidence in this age group (Figure 6). Rates in each of the subsequent 8 years were level or somewhat higher. Based on the distribution of serotypes among isolates from these cases, this increase was limited to disease caused by non- vaccine serotypes (i.e. serotypes other than the 7 included in PCV-7) (Figure 6).

In March 2010, the U.S. Food and Drug Administration approved a 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. This vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of IPD cases among children <5 years of age was caused by the 6 new serotypes included in PCV-13 (Figure 6). Since 2011, the majority of IPD cases among children <5 years of age has been caused by serotypes not included in PCV-13. In 2018, 18% of cases with isolates available for testing were caused by 6 of the PCV- 13-included serotypes: 3 (13%), 19A (2%), 19F (2%), 7F (<1%), 6A (<1%), and 4 (<1%).

In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended that all adults ≥65 years receive 1 dose of PCV- 13 followed by 1 dose of 23-valent pneumococcal polysaccharide vaccine 6 to 12 months later. Among adults ≥65 years, 14% of cases in 2018 had PCV-13 serotypes.

Of the 452 isolates submitted for 2018 cases, 72 (16%) isolates were resistant to penicillin using meningitis breakpoints. Using non-meningitis breakpoints, 4 (<1%) of 452 isolates were resistant to penicillin. (Note: CLSI penicillin breakpoints changed in 2008).

• For up to date information see>> Streptococcus pneumoniae (Pneumococcal Disease)

• Archive of Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health
  Archive of past summaries (years prior to 2023 are available as PDFs).