Pneumococcal serotype distribution: A snapshot of recent data in pediatric and adult populations around the world

Figures & data

Table 1. Strains of S. pneumoniae among children under the age of 7 years.

			n (%) - [most prevalent serotype]
Source	Country (year)	Study population (N)	PCV7a	PCV10-specific [1, 5, 7F]	PCV13-specific [3, 6A, 19A]	PPV23-specific serotypesb	NV serotypes
IPD in Africa Eastern Mediterranean Region
Ben-Shimol et al. 2014^7	Israel (2012–13)	Children <5 y with IPD (155)	12 (7.7)–[NS]	37 (23.9) - [NS]c		—	106 (68.4) - [NS]d
Ben-Shimol et al. 2015^8	Israel (2012–13)	Children <5 y with IPD (NS)	7.0% [6B, 14]	11.1% [5]	14.4% [19A]	12F: 26.2% • 15B/C: 8% • 33F: 5.3% 10A: 2.1%	15A: 2.7% • 10B: 2.1% • other: 21.1%
von Gottberg et al. 2014^9	South Africa (2012)	IPD children < 2 y (373)	77 (20.6)–[19F]	34 (9.1)–[5]	57 (15.3) -[19A]	8: 9.7% • 15B: 6.4% • 12F: 3.8% 9N: 2.4%	7C: 2.1% • 13: 0.8% • 34: 1.6% -other: 28.2%
Ba et al. 2014^10	Senegal (2007–08)	NP carriage and IPD among children <2 y (132)	49 (37.1)–[6B, 19F]	4 (3.0)–[1]	18 (13.6)–[6A]	11A: 5.3% • 15B: 3.8% • 10A; 20: 3.0%	23B: 1.5% • 9A; 9L; 18B; 18F; 19B; 23A: 0.8% • NT: 20.5%
						8; 12F; 22F: 0.8% • Other: 2.3%
Ndlangisa et al. 2014^11	South Africa (2007)	Children < 5 y with IPD (1084)	637 (58.8)–[14]	58 (5.4)–[1]	233 (21.5)–[6A]	—	157 (14.5)–[NS]d
IPD in Asia Pacific Region
Wei et al. 2015^12	Taiwan (2013)	Children ≤ 5 y old with IPD (134)	27 (20.1)–[14]	0 (0)–[NA]	73 (54.5)–[19A]	—	34 (25.4)–[NS]d
Chiba et al. 2014^13	Japan (2012)	Children <4 y old with IPD (144)	18 (12.5)–[NS]	—	—	—	126 (87.5) – [NS]e
Cho et al. 2014^14	South Korea (2006–10)	Children <5 y old with IPD (110)	47 (42.7)–[NS]	1 (0.9)–[NS]	37 (33.6)–[NS]	—	25 (22.7)–[NS]d
IPD in Europe
Skoczynska et al. 2014^6	Poland (2011–13)	Children 0–4 y old with IPD (145)	81 (55.9)–[14]	7 (4.8)–[1]	27 (18.6)–[19A]	15B/C: 6.9% • 10A; 11A: 2.8% 22F: 1.4% • 8: 0.7%	10 (6.9)–[NS]
Lepoutre et al. 2015^15	France (2012)	Children < 2 y old with IPD (201)	13 (6.5)–[19F]	14 (7.0)–[7F]	16 (8.0)–[19A]	12F: 9.5% • 15B: 7.0% • 22F: 5.0%	24F: 19.9% • 15A: 6.5% • 15C: 2.0%
							6C: 0.5% • other: 28.4%
Aguiar et al. 2014^16	Portugal (2008–12)	Children <5 y old with IPD (283)	75 (26.5)–[14]	58 (20.5)–[7F]	78 (27.6)–[19A]	—	72 (25.4)–[NS]
Del Amo et al. 2014^17	Spain (2007–11)	Children ≤ 6 y old hospitalized with IPD (159)	22 (13.8)–[19F]	89 (56.0)–[1]	46 (28.9)–[19A]	22F: 1.9% • 10A: 1.3% • 8; 15B: 0.6%	23B: 3.1% • 15A; 15C; 16F; 24F: 1.3%
							6C; 24B; 28; 38: 0.6%
Navarro-Torne et al. 2015^18	Europe (26 countries −2010)	Children < 5 y old with IPD (570)	107 (18.8)–[NS]	329 (57.7)–[NS]c		—	134 (23.5)–[NS]d
Navarro-Torne et al. 2014^19	Europe (21 countries −2010)	Children < 5 y old with IPD (NS)	19.2%–[NS]	26.9%–[NS]	27.0%–[NS]	—	26.9% -[NS]d
del Amo et al. 2014^20	Spain (2007–9)	Children ≤ 5 y old hospitalized with IPD (141)	18 (12.8)–[14]	62 (44.0)–[1]	53 (37.6)–[19A]	10A; 15B/C; 22F: 0.7%	23B: 1.4% • 15A/F; 24B; other: 0.7%
IPD in Latin America
Echániz-Avilés et al. 2015^21	Mexico (2012)	Children ≤ 5 y old hospitalized with IPD (105)	22 (21.0)–[19F]	5 (4.8)–[1]	47 (44.8)–[19A]	—	31 (29.5)–[NS]c
Abate et al. 2014^22	Argentina (1993–2011)	Children 0–11 months old hospitalized with IPD (96)	45 (46.9)–[14]	27 (28.1)–[5]	12 (12.5)–[19A]	8: 3.1%	10F; 28A: 2.1%
						Others (totaling 5.2%): 2, 7C, 11, 12, 15B, 16A, 18A, 18B, 20, 35F, 42
Parra et al. 2014^23	Colombia (2009–10)	Children <2 y old with IPD (950)	252 (26.5)–[14]	100 (10.5)–[1]	100 (10.5)–[3]	12F: 1.6% • 8: 1.1% • 9N: 0.9%	16F: 1.2% • 6C; 23A: 0.7%
						11A; 22F: 0.7% • 17F: 0.6% • 10A: 0.5%	13; 15A; 18A; 34: 0.6% • 15C; 23B; 25A; 28A; 35B: 0.4% • other: 38.8%
						15B: 0.3% • 33F: .02% • 20: 0.1%
IPD in USA/Canada
Moore et al. 2015^24	United States (2012–13)	Children <5 y old with IPD (177)	14 (7.9)–[19F]	4 (2.3)–[7F]	23 (13.0)–[19A]	22F: 11.3% • 33F: 9.6%	38: 9.0% • 35B: 7.9% • 15C: 6.8%
						15B: 7.3% • 12F: 4.0%	23B: 5.1% • 6C: 1.7% • other: 18.1%
De Wals et al. 2014^25	Canada (2011)	Children <5 y old with IPD (87)	0 (0)–[NA]	8 (9.2)–[7F]	32 (36.8)–[19A]	—	48 (55.2)–[NS]c
Sader et al. 2014^26	USA (2011–12)	Children <2 y old with IPD (3199)	205 (6.4)–[19F]	0 (0)–[NA]	680 (21.3)–[19A]	15B/C: 11.8% • 33F: 2.7%	23A: 10.6% • 6C: 7.2% • 35B: 6.3%
						9N; 22F: 2.0% • 17F: 1.8%	23B: 5.6% • 21: 4.1% • 15A/F: 1.3%
						other: 10.2%	other: 6.7%
non-IPD in Africa Eastern Mediterranean Region
Ben-Shimol et al. 2014^27	Israel (2012–13)	Children <2 y old with OM (80)	7 (8.8)–[NS]e	12 (15.0)–[NS]c	—	61 (76.3)–[NS]d
Dagan et al. 2015^28	Israel (2012–13)	Healthy infants ≤ 2 y old (5049)	1074 (21.3)–[6B]	35 (0.7)–[7F]	794 (15.7)–[19A]	15B/C: 8.4% • 11A: 4.1% • 17F: 2.0%	35B: 4.6% • 16F: 4.3% • 15A: 3.6%
						10A: 1.8% • 33F: 1.1% • 22F: 1.0%	23A: 3.1% • 34: 2.9% • 21: 2.2%
						9N; 12F; 20: 0.5% • 8: 0.4%	6C; 23B; 38: 2.1% • 10B: 2.0%
							31: 1.9% • 13: 1.2% • 19B: 1.1%
							other: 8.6%
Nzenze et al. 2015^29	South Africa (2012–13)	NPC among children ≤ 4 y old born of HIV positive and negative mothers (1283)	128 (10.0)–[19F]	4 (0.3)–[1]	57 (2.5)–[19A]	15B: 4.4% • 11A: 3.8%e	16F: 3.6% • 15A: 3.4% • 34: 2.7%
							35B: 2.3% • Other NS: 65.1%e
Hammitt et al. 2014^30	Kenya (2012)	NPC among children <5 y old (129)	21 (16.3) [NS]g		—	—	108 (83.7) [NS]h
Daana et al. 2015^31	West Bank Palestine/East Jerusalem (2011)	NPC among children ≤ 5 y old (916)	354 (38.6)–[19F]	0 (0)–[NA]	146 (15.9)–[6A]	15B/C: 7.4% • 11A; 17F: 4.2%	35B: 5.1% • 15A: 3.3% • 6C: 1.9%
							19B; 33: 1.8% • 23A: 1.4% • 23B: 0.9%
							Other NS: 13.9%d
Nunes et al. 2015^32	South Africa (2009)	NPC among children <4 y old (201)	31 (15.4)–[NS]	26 (12.9)–[19A]c		—	61 (30.3)–[NS]d
non-IPD in Asia Pacific Region
Geng et al. 2014^33	China (2012–13)	NPC among children <5 y old admitted with respiratory infection (178)	128 (71.9)–[19F]	0 (0)–[NA]	32 (18.0)–[19A]	15B/C: 6.2%	15A; 34; NT: 1.1% • 23A: 0.6%
Hoskins et al. 2014^34	Australia (2011–13)	NPC among sick Aboriginal children <5 y old (197)	27 (13.7)–[19F]	2 (1.1)–[1]	23 (11.7)–[19A]	11A: 7.5% • 15B: 5.9% • 9N; 10A:	16F: 8.6% • 6C: 7.5% • 21: 5.4%
						2.2% 17F; 22F; 33F: 1.1% • 8: 0.5%	15C: 4.8% • 23B: 4.3% • 35B: 3.9%
							7B: 3.2% • 23A; 29: 2.7% • 38: 1.8%
							15A: 1.6% • 18A; 34; 35F: 1.1% • 7C; 10F; 22A; 31: 0.5%
Ho et al. 2015^35	Hong Kong (2010–13)	NPC among hospitalized children <5 y old (156)	45 (28.8)–[19F]	1 (0.6)–[5]	22 (14.1)–[6A]	15B: 10.3% • 11A; 17F; 22F; 33F: 0.6%	15C: 9.6% • 6C: 7.1% • 15A: 5.1%
							23A: 3.2% • 34; 35B: 2.6% • 11D: 1.3% 28A; 35F: 1.3% • 15F; 13; 18A; 21; 29: 0.6% • Other NS/NT: 6.4%
Kandasamy et al. 2015^36	Nepal (2012)	NPC among healthy children between 6 weeks and 2 y old (304)	63 (20.7)–[14]	1 (0.3)–[5]	29 (9.5)–[6A]	15B: 3.9% • 10A: 2.3% • 17F: 2.0%	11D; 35A: 2.3% • 34; 35B; 35F: 2.0%
						8; 9N; 20; 22F: 1.0%	6C; 13; 35C; 23A; 33B: 1.6%
						11A; 12F; 33F: 0.3%
							7C; 16F; 39: 1.3% • 7B; 15A; 15C; 21; 45 1.0% • 25 serotypes: <1%
							Other NS/NT: 19.4%
Khoshdel et al. 2014^37	Iran (2010–11)	NPC among healthy children <5 y old (107)	38 (35.5)–[23F]	—	—	—	—
Farida et al. 2014^38	Indonesia (2010)	NPC among healthy children between 6 and 60 months of age (111)	40 (36.0)–[6A/B]c	0 (0)–[NA]	0 (0)–[NA]	11A; 15B/C: 9.9%	23A: 4.5% • 15A: 1.8%
							Others/NT: 37.8%
Hanieh et al. 2014^39	Nepal (2009)	NPC among healthy children between 1.5 and 24 months of age (1100)	187 (17.0)–[6A/B]c	7 (0.6)–[1, 5]	17 (1.5)–[19A]	15B/C: 3.6% • 9N/L: 1.3% • 33F: 1.0% 17F: 20: 0.8% • 22F: 0.7%	34: 2.4% • 11: 2.3% • 35B: 1.4% • 23A: 1.1% • 15A/F: 1.0% • 17 serotypes: <1% Other NS/NT: 8.8%
						8; 10A: 0.5% • 2: 0.2%
non-IPD in Europe
Luminos et al. 2014^40	Romania (2011–13)	NPC among healthy children ≤ 5 y old (453)	199 (43.9)–[19F]	2 (0.4)–[NS]	89 (19.6)–[6A]	—	163 (36.0)–[NS]e
Mayanskiy et al. 2014^41	Russia (2009–13)	Noninvasive SP isolates from children at hospital, median age 3.5 y (835)	486 (58.2)–[19F]	13 (1.6)–[7F]	152 (18.2)–[3]	15B: 3.5% • 11A: 3.1% • 9N: 1.4%	23A: 2.0% • 15C: 1.6% • 37: 1.3%
						10A: 1.1% • 17F: 0.7% • 8: 0.5%	35F: 0.8% • 34: 0.7% • 16F; 35C: 0.6%
						22F; 33F: 0.4% • 12F: 0.2% • 20: 0.1%	15A; 23B: 0.4% • 5 serotypes: 0.2%
							9 serotypes: 0.1%
Dunais et al. 2015^42	France (2012)	NPC among healthy children between 3 and 40 months of age (168)	0 (0)–[NA]	0 (0)–[NA]	11 (6.5)–[19A]	15B/C: 22.6% • 11A: 7.1% • 17F: 6.5%	23A/B: 11.3% • 35B: 10.7% • 15A: 9.5%
							6C: 5.4% • Other NS/NT: 20.2%
Mameli et al. 2015^43	Italy (2011)	NPC among healthy children aged between 3 months 5 y (124)	2 (1.6)–[14]	0 (0)–[NA]	6 (4.8)–[3, 6A, 19A]	11A: 11.3% • 10A: 8.1% • 22F: 3.2%	15A: 23.4% • 6C; 35F: 7.3% • 23A: 5.6%
						12F: 1.6% • 8; 17F: 0.8%	21; 24F; 29: 3.2% • 16A; 23B; 28F: 2.4%
							33: 1.6% • 5 serotypes: <1%
							Other NS/NT: 1.6%
van der Linden et al. 2015^44	Germany (2010–11)	NPC among children with AOM aged between 2 months and 5 y (107)	11 (10.3)–[19F]	2 (1.9)–[7F]	53 (49.5)–[3]	22F: 4.7%	23B; 35B 3.6% • 6C: 1.8%
							Other NS/NT: 24.3%
Grivea et al. 2014^45	Greece (2010–11)	NPC among healthy children aged between 2 and 5 y (341)	6 (1.8)–[19F]	10 (2.9)–[7F]	64 (18.8)–[19A]	15B/C: 10.6% • 11A: 7.6% • 10A: 4.4%	23B: 12.6% • 21; 16F: 7.6% • 15A: 7.0%
						22F: 2.6% • 33F: 0.9% • 20: 0.3%	6C: 6.7% • 23A: 2.3% • 24F; 31: 1.2%
							7C; 33A; 35F: 0.9% • 4 serotypes: 0.3%
Pasinato et al. 2014^46	Italy (2010–11)	NPC among children aged between 6 and 59 months (1728)	436 (25.2)–[19F]	272 (15.7)–[5]	157 (9.1)–[19A]	33F: 1.0% • 22F: 0.8% • 20: 0.2%	23B: 1.9% • 21: 1.2% • 23A: 1.0%
						8: 0.1%	16F; 35B; 29: <1%
							Other NS/NT: 5.6%
Gladstone et al. 2015^47	UK (2010–11)	NPC among ≤ 4 y old (99)	1 (1.0)–[6B]	2 (2.0)–[1, 7F]	8 (8.1)–[19A]	33F: 8.1% • 11A; 15B: 7.1%	21: 12.1% • 6C: 9.1% • 35F: 9.1%
							23B: 8.1% • 15A: 6.1% • 16F: 4.0%
							23A: 4.0% • 35B: 3.0%
Del Amo et al. 2014^17	Spain (2007–11)	SP carriage among healthy children ≤ 6 y old (209)	30 (14.4)–[19F]	2 (1.0)–[1]	39 (18.7)–[19A]	10A: 4.8% • 11A; 15B: 4.3% • 22F:	6C: 9.1% • 23B: 8.1% • 23A: 4.3%
						3.8% 17F: 2.4% • 33F: 1.0% • 9N;	34; 15A: 2.9% • 16F; 21; 35B: 2.4%
						12F: 0.5%	15C; 31: 1.9% • 29: 1.4% • 35F: 1.0%
							7 serotypes: 0.5%
Alfayate-Miguélez et al. 2014^48	Spain (2009–10)	NPC among children aged between 1 and 4 y (343)	46 (13.4)–[14, 23F]	0 (0)–[NA]	81 (23.6)–[6A]	11A: 6.1% • 15B: 4.7% • 22F: 2.3%	15A; 23B: 7.3% • NT: 5.0% • 6C: 4.7%
						33F: 2.0% • 17F: 1.2%	23A; 35B: 4.1% • 15C: 2.6% • 35F: 1.7%
						9N: 0.6% • 8; 12F: 0.3%	24F: 1.2% • 9 serotypes: <1%
							Other NS: 2.3%
del Amo et al. 2014^20	Spain (2007–9)	NPC among healthy children ≤ 5 y old (224)	56 (25.0)–[6A/B]b	19 (8.5)–[5]	35 (15.6)–[19A]	15B/C: 4.0% • 10A; 22F: 2.2% • 20: 1.8%	23A: 4.5% • 6C: 4.0% • 23B: 3.6%
						11A/D; 17F: 1.3% • 33F: 0.9% • 2: 0.4%	35B: 2.2% • 15A/F; 21: 1.8%
							13; 34: 1.3% • 16F; 31: 0.9%
							Other NS: 14.2%
non-IPD in Latin America
Grijalva et al. 2014^49	Peru (2009–11)	NPC among Andean children <3 y old with ARI (681)	147 (21.6)–[19F]	5 (0.7)–[1, 7F]	40 (5.9)–[19A]	11A: 4.7% • 10A: 4.0% • 15B: 1.6%	6C: 4.3% • 23B: 3.1% • 13: 2.6%
						22F: 1.0% • 17F; 20: 33F: 0.7%	11A/D: 2.5% • 15A: 2.1% • 15C: 1.9%
						8: 0.3% • 9N; 12F: 0.1%	35B: 1.8% • 15A/F: 1.5% • 7C; 35F: 1.3%
							34: 1.2% • 21; 23A: 1.0% • 17 serotypes: <1% • Other NS/NT: 25.2%
non-IPD in North America
Martin et al. 2014^50	US (2012–13)	NPC among children with AOM aged between 6 and 23 months (113)	2 (1.8)–[19F, 23F]	0 (0)–[NA]	14 (12.4)–[19A]	15B: 10.6% • 11A: 8.0% • 10A: 2.7%	35B: 8.8% • 15C: 7.1% • 15A: 4.4%
						17F: 2.7% • 2 serotypes: <1%	40: 3.5% • 16F; 22; 33; 35F: 2.7%
							19B; 25A; 34; 37; 44: 0.9%
							Other NS: 21.3%
Ricketson et al. 2014^51	Canada (2011–12)	NPC among healthy children < 5 y of age (183)	5 (2.7)–[19F]	0 (0)–[NA]	13 (7.1)–[19A]	11A: 13.1% • 22F: 9.3% • 15B: 7.7%	35F: 11.5% • 23B: 7.7% • 15C; 23A: 6.0%
						33F: 2.2% • 9N; 10A: 1.6% • 8: 0.5%	15A; 35B: 5.5% • 6C: 4.9% • 21: 2.7%
							7C: 1.1% • 6 serotypes: 0.5%
Gounder et al. 2014^52	US (2011–12)	NPC among Alaskan children < 5 y of age (938)	10 (1.1)–[19F]	1 (0.1)–[7F]	83 (8.9)–[19A]	11A: 8.2% • 15B: 6.6% • 33F: 5.7%	16F: 8.3% • 35B: 8.2% • 6C: 7.7%
						22F: 2.9% • 10A: 2.7%	23B: 6.7% • 21: 5.3% • 15A: 4.3%
						9N; 17F: 1.5% • 8: 1.2%	35F: 3.4% • 23A: 2.7% • 31: 2.0%
							7C: 1.8% • 34: 1.3% • 37: 1.1%
							NT: 6.4%
Loughlin et al. 2014^53	US (2010–11)	NPC among children < 5 y of age (1080)	64 (6.1)–[NS]	89 (8.5)–[NS]c		—	927 (88.3)–[NS]d
Keck et al. 2014^54	US (2008–09)	NPC among Alaskan children < 5 y of age (798)	13 (1.6)–[19F]	43 (5.4)–[7F]	178 (22.3)–[19A]	22F: 7.4% • 15B: 5.1% • 11A: 3.6%	6C: 8.1% • 23B: 7.9% • 15A: 5.9%
						10A: 2.7% • 33F: 2.8% • 9N: 1.0%	16F: 4.8% • 23A: 3.6% • 35F: 3.5%
						17F: 0.8% • 8; 12F: 0.1%	35B: 1.9% • 15C: 1.6% • 22A: 1.1%
							3 serotypes: <1% • Other NS: 5.9%

AOM: acute otitis media; ARI: acute respiratory infection; HIV: human immunodeficiency virus; IPD: invasive pneumococcal disease; OM: otitis media; NA: not applicable; NPC: nasopharyngeal carriage; NS: not specified; NT: non-typeable; NV: non-vaccine; SP: S. pneumoniae.

^a PCV7 serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F;

^b PPV23-specific serotypes: 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, 33F;

^c PCV13 serotypes not found in PCV7;

^d non-PCV13 serotypes;

^e non-PCV7 serotypes;

^f includes serotype 6A;

^g PCV10 serotypes;

^h non-PCV10 serotypes

Table 2. Strains of S. pneumoniae among adults aged 65 y and older.

			n (%)–[most prevalent serotype]
Source	Country (year)	Study population (N)	PCV7a	PCV10-specific[1, 5, 7F]	PCV13-specific[3, 6A, 19A]	PPV23-specificb	PPV23 serotypes	NV serotypes
IPD in Europe
Harboe et al. 2014^55	Denmark (2011–13)	Adults with IPD aged ≥ 65 y (1439)	97 (6.7)–[4]	265 (18.4)–[1]	224 (15.6)–[3]	549 (38.2)	[NS]	304 (21.1)–[NS]
Skoczynska et al. 2014^6	Poland (2011–13)	Adults with IPD aged ≥ 65 y (373)	116 (31.3)–[14]	21 (5.7)–[1]	110 (29.6)–[3]	57 (15.3)	9N: 3.8% • 22F: 3.0% • 11A: 2.1% 10A: 1.9% • 12F: 1.9% • 8:1.6% 15B/C: 1.1%	67 (18.1)–[NS]
Guevara et al. 2014^56	Spain (2010–13)	Adults with IPD aged ≥ 65 y (114)	12 (10.5)–[NS]	47 (41.2)–[NS]c		—	—	55 (48.2)–[NS]c
Verhaegen et al. 2014^57	Belgium (2009–11)	Adults with IPD aged ≥ 65 y (742)	59 (8.0)–[NS]	146 (19.7)–[7F]	210 (28.3)–[19A]	214 (28.9)	12F: 5.9% • 22F: 5.8% • 8: 3.8%	141 (19.0)–[NS]
							Other NS: 9.6%
Navarro-Torne et al. 2015^18	Europe (26 countries–2010)	Adults with IPD aged ≥ 65 y (1108)	191 (17.2)–[NS]	385 (34.7)–[NS]c		—	—	532 (48.0)–[NS]d
Ochoa-Gondar et al. 2015^58	Spain (2006–09)	Adults with IPD aged ≥ 65 y (96)	14 (14.6)–[14]	17 (17.7)–[7F]	29 (30.2)–[19A]	13 (13.5)	9N: 4.2% • 8; 12F: 2.1% • 10A; 15A; 17F; 22F; 33F: 1.0%	38: 5.2% • 16/16F; 23B; 31: 3.1%
								11/11F; 23A; 24F: 2.1%
								10B; 15A; 35F; 37: 1.0%
IPD in Latin America
Garcia Gabarrot et al. 2014^5	Uruguay (2011–12)	Adults with IPD aged ≥ 60 y (150)	14 (9.3)–[NS]	52 (34.7)–[NS]c	—	84 (56)d	[NS]	—
IPD in North America
Moore et al. 2015^24	US (2011–13)	IPD cases among adults aged ≥ 65 y (3618)	45 (1.2)–[19F]	95 (2.6)–[7F]	423 (11.7)–[3]	–	22F: 4.6% • 11A: 1.6%e	6C: 2.7% • 23A: 2.0%
								35B: 1.8% •16F: 1.6%e
Wortham et al. 2014^59	US (2009)	Adults with IPD aged ≥ 65 y (1233)	510 (41.4)–[NS]f			—	—	723 (58.6)–[NS]f
non-IPD in Asia, North America, and Europe
Kim et al. 2014^60	South Korea (2013)	Adults with IPD or pneumococcal pneumonia aged ≥ 65 y (114)	14 (12.3)–[19F]	1 (0.9)–[7F]	34 (29.8)–[3]	32 (28.1)	11A/D/F: 14.0% • 20; 22F: 3.5%	34: 6.1% • 15A/F; 35B: 4.4% • 6D; 13: 2.6% • 6C; 7B/7C; 11E; 16F; 23A; 23B: 0.9% • Other NS: 3.5%
							15B: 2.6% • 10A; 33F: 1.8% • 8: 0.9%
Richter et al. 2014^61	US (2012–13)	Adults with IPD or non-IPD aged ≥ 65 y (346)	—	—	≥ 73 (21.1)–[3]f	—	11A; 22F: 6.0%g	6C: 6.0% • 15A; 23A: 5.0%f
Domenech et al. 2014^62	Spain (2009–12)	SP strains causing acute exacerbations among COPD patients aged 70.2 ± 8.7 y (197)	23 (11.7)–[19F]	5 (2.5)–[7F]	30 (15.2)–[3]	48 (24.2)	11A: 6.1% • 10A: 4.0%	15A: 9.6% • 6C: 5.6%
							17F; 22F; 33F: 3.0%	23A; 23B: 4.5%
							9N; 12F: 1.5% • 15B: 1.0%	16F; 35B: 3.5% • 31; 24F: 2.5%
								21; NT: 2.0% • 35F: 1.5%
								34; 20; 15C: 1.0%
								37; 10F; 13F; 35C: 0.5%

COPD: chronic obstructive pulmonary disease; IPD: invasive pneumococcal disease; NA: not applicable; NPC: nasopharyngeal carriage; NS: not specified; NV: non-vaccine; SP: S. pneumoniae

^a PCV7 serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F;

^b PPV23-specific serotypes: 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, 33F;

^c PCV13 serotypes not found in PCV7;

^d non-PCV13 serotypes;

^e PCV13-serotypes and the 5 most common among non-PCV serotypes reported;

^f PCV13-serotypes;

^g serotype-specific data for the 8 most common serotypes by age group were reported.

Table 3. Strains of S. pneumoniae among adults aged between 50 and 64 years.

			n (%)–[most prevalent serotype]
Source	Country (year)	Study population (N)	PCV7a	PCV10-specific[1, 5, 7F]	PCV13-specific[3, 6A, 19A]	PPV23-specificb	PPV23 serotypes	NV serotypes
IPD in Europe and North America
Skoczynska et al. 2014^6	Poland (2011–13)	Adults with IPD aged between 55 and 64 y (249)	78 (31.3)–[4]	19 (7.6)–[1]	74 (29.7)–[3]	43 (17.3)	8; 9N: 4.4% • 11A: 2.8%	32 (12.9)–[NS]
							12F; 15B/C: 2.0% •22F: 1.6%
Moore et al. 2015^24	US (2011–13)	Adults with IPD aged between 50 and 64 y (2994)	24 (0.8)–[19F]	73 (2.4)–[7F]	201 (6.7)–[3]	258	22F: 3.7% • 9N; 12F: 1.7%	6C: 1.5% • 16F: 1.3%c
						(8.6)c	33F: 1.5%c
Verhaegen et al. 2014^57	Belgium (2009–11)	Adults with IPD aged between 50 and 64 y (370)	22 (5.9)–[NS]	114 (30.8)–[7F]	73 (19.7)–[19A]	100 (27)	12F: 10.3% • 8; 22F: 3.5%d	48 (13.0)–[NS]d
Wortham et al. 2014^59	US (2009)	Adults with IPD aged between 50 and 64 y (1067)	523 (49.0)–[NS]e			—	—	544 (51.0)–[NS]f

IPD: invasive pneumococcal disease; NA: not applicable; NS: not specified; NV: non-vaccine; SP: S. pneumoniae

^a PCV7 serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F;

^b PPV23-specific serotypes: 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, 33F;

^c PCV serotypes and the 5 most common non-PCV serotypes were reported;

^d only the serotypes accounting for at least 4% of isolates overall were reported;

^e PCV13-serotypes;

^f non-PCV13-serotypes.

Table 4. Strains of S. pneumoniae among adults aged between 15 and 59 years.

			n (%)–[most prevalent serotype]
Source	Country (year)	Study population (N)	PCV7a	PCV10-specific[1, 5, 7F]	PCV13-specific[3, 6A, 19A]	PPV23-specificb	PPV23 serotypes	NV serotypes
IPD
Moore et al. 2015^24	US (2011–13)	Adults with IPD aged between 18 and 49 y (1990)	23 (1.2)–[4]	62 (3.1)–[7F]	102 (5.1)–[3]	125 (6.3)	22F: 4.1% • 12F: 1.9% • 8: 1.7%	6C: 1.0% • Other NS: 79.2%c
							11A: 1.4% • 9N: 1.3%c
Skoczynska et al. 2014^6	Poland (2011–13)	Adults with IPD aged between 15 and 54 y (315)	119 (37.8)–[4, 14]	26 (8.3)–[1]	71 (22.5)–[3]	62 (19.7)	8: 3.8% • 9N; 12F: 3.5%	32 (10.2)–[NS]
							10A; 15B/C: 2.5% • 11A; 22F: 1.9%
von Gottberg et al. 2014^9	South Africa (2012)	Adults with IPD aged between 25 and 44 y (1260)	256 (20.3)–[4]	199 (15.8)–[1]	251 (19.9)–[19A]	320 (25.4)	12F: 9.2% • 8: 4.7% • 9N: 3.1%	16F: 3.1% • 13: 2.5% • 7C: 1.9%
							22F: 2.4% • 10A; 15B: 2.1% • 17F: 1.8%	34: 1.3% • Other: 9.7%
Garcia Gabarrot et al. 2014^5	Uruguay (2011–12)	Adults with IPD aged between 15 and 59 y (126)	10 (7.9)–[NS]	47 (37.3)–[NS]d		—	—	69 (54.8)–[NS]e
Verhaegen et al. 2014^57	Belgium (2009–11)	Adults with IPD aged between 18 and 49 y (220)	13 (5.9)–[NS]	102 (46.4)–[1]	22 (10.0)–[19A]	—	12F: 7.3% • 8: 4.5% • 22F: 2.3%f	≥ 26 (11.8)–[NS]f
Van Mens et al. 2014^64	Netherlands (2008–10)	Adults with IPD aged between 20 and 45 y (148)	34 (23.0)–[NS]	—	—	—	—	114 (77.0)–[NS]
Wortham et al. 2014^59	US (2009)	Adults with IPD aged between 18 and 49 y (978)	536 (54.8)–[NS]g			—	—	442 (45.2)–[NS]e
non-IPD
Hammitt et al. 2014^30	Kenya (2012)	NPC among adults aged 18–49 y (116)	10 (8.6)–[NS]h			—	—	106 (91.4)–[NS]i

IPD: invasive pneumococcal disease; NA: not applicable; NS: not specified; NV: non-vaccine; SP: S. pneumoniae

^a PCV7 serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F;

^b PPV23-specific serotypes: 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20, 22F, 33F;

^c PCV serotypes and the 5 most common non-PCV serotypes were reported;

^d PCV13 serotypes not found in PCV7;

^e Non-PCV serotypes;

^f Only the serotypes accounting for at least 4% of isolates overall were reported;

^g PCV13-serotypes;

^h PCV10 serotypes;

ⁱ Non-PCV10 serotypes.

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