Pneumococcal Disease is Rebounding, Requiring Broader Vaccine Distribution

In a post-COVID-19 landscape, pneumococcal disease cases are rising, especially among children under 5 who are experiencing non-invasive pneumococcal disease (IPD), according to a study in Biomedical Journal.¹ Study researchers used their findings to suggest a broader adoption of disease serotype surveillance as well as higher-valency pneumococcal vaccines.

“Surveillance for IPD in persons aged ≥5 years is useful to monitor the impact of the herd effects of pediatric pneumococcal conjugate vaccine (PCV) use and replacement disease,” wrote the CDC.² “Following the introduction of new PCVs since 2021, monitoring disease trends in both children and adults is important to assess the impact of the updated vaccine recommendations.”

The resurgence observed in the Biomedical Journal study reflects a global trend where the incidence of culture-confirmed pneumococcal disease (CCPD) dropped significantly during the height of pandemic restrictions but rose again to 9.04 per 100,000 population by 2024. This rebound is particularly acute in children under 5, where CCPD incidence reached a staggering 66.4 per 100,000 in the same year.¹

These findings align with broader international data indicating that the incidence of IPD nearly doubled between 2012 and 2024, emphasizing that current vaccination strategies must adapt to a rapidly shifting epidemiological environment.³

READ MORE: Patient-Focused Strategies Are Most Effective for Boosting Pneumococcal Vaccination

For pharmacists, who serve as frontline immunization experts, this rebound necessitates a deep understanding of how non-vaccine serotypes (NVTs) are filling the void left by older vaccine formulations.^3,4

The phenomenon of serotype replacement has fundamentally altered the landscape of the disease, as non-PCV13 serotypes now contribute to approximately 75% of all CCPD cases. In Taiwan, the most prevalent lineages have shifted toward serotypes 23A and 15A, with the clonal complex CC166 emerging as a dominant force.¹

This shift is mirrored in other regions, such as Türkiye, where researchers found that although PCV13 serotype infections persist, the growing circulation of non-vaccine strains represents a significant pediatric health concern. As these NVTs expand, they often bring higher invasive potential and increased resistance to standard treatments.^3,5

Perhaps most concerning for clinical practice is the escalating antimicrobial resistance tied to these emerging serotypes. The Taiwan data show that penicillin non-susceptibility among non-PCV13 serotypes reached nearly 60% by 2024, actually surpassing the resistance levels of the serotypes originally targeted by PCV13.¹

Similar alarming trends were documented in pediatric populations in Türkiye, where susceptibility to first-line antibiotics like penicillin and ceftriaxone plummeted during the pandemic and post-pandemic periods. This rise in resistance is likely exacerbated by the widespread, and often unnecessary, use of broad-spectrum antibiotics for COVID-19-related respiratory infections, which has further pressured pneumococcal strains to evolve.⁵

Pharmacists are now tasked with navigating a complex symphony of factors when recommending the appropriate vaccine for a patient. The introduction of higher-valency vaccines like PCV15, PCV20, and the recently approved PCV21 offers a path forward, though the choice is no longer one-size-fits-all.^4,6

For instance, while PCV21 covers a vast majority of the serotypes currently causing disease in Taiwan, including over 90% of pediatric IPD, it lacks coverage for serotype 4. This is a critical distinction for pharmacists in the Western US, where serotype 4 remains prevalent, particularly among unhoused populations, making PCV20 the preferred choice in those specific geographic contexts.^1,4,6

To effectively manage this rebound, the health care community must prioritize continuous, high-quality surveillance to inform future vaccine policy. Surveillance allows for the detection of rare resistance patterns and helps characterize local trends that can guide empirical therapy.^1-3

Pharmacists can support these efforts by utilizing tools like the CDC’s PneumoRecs VaxAdvisor app to ensure patients remain up to date with the latest individualized recommendations based on their age, medical history, and specific risk factors.⁶

The post-pandemic era requires a proactive, tailored approach to immunization that combines broad vaccine distribution with vigilant monitoring of the evolving bacterial threats in our communities.^1,4

“Higher-valency vaccines, notably PCV21, substantially broaden serotype coverage, supporting their potential role in reducing residual disease,” concluded authors of the current study.¹ “Continuous surveillance, optimized antimicrobial stewardship in children, and integrated prevention of pneumococcus disease-associated respiratory viral infections are essential to mitigate the burden of pneumococcal disease.”

READ MORE: Pneumococcal Resource Center

REFERENCES

1. Chen CH, Li HC, Hsu MH, et al. Post-COVID-19 epidemiology of pneumococcal disease in Taiwan: escalating serotype replacement and antimicrobial resistance in all ages. Biomed J. May 28, 2026:100999. https://doi.org/10.1016/j.bj.2026.100999

2. Chapter 11: pneumococcal. CDC. January 17, 2025. Accessed June 4, 2026. https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-11-pneumococcal.html

3. Nowosielski B. Rise in IPD calls for development of more pneumococcal vaccines. Drug Topics. November 17, 2025. Accessed June 4, 2026. https://www.drugtopics.com/view/rise-in-ipd-calls-for-development-of-more-pneumococcal-vaccines

4. Nowosielski B, Garofoli GK. FAQ: how a variety of pneumococcal vaccines protect patient populations. Drug Topics. May 12, 2026. Accessed June 4, 2026. https://www.drugtopics.com/view/how-a-variety-of-pneumococcal-vaccines-protect-patient-populations

5. Tekgül EK, Cinel G, Kanık-Yüksek S, et al. Impact of COVID-19 on invasive pneumococcal disease: a comparative analysis of clinical features and antibiotic resistance across pandemic periods. Infect Chemother. 2025;57(4):531-540. https://doi.org/10.3947/ic.2025.0068

6. Summary of risk-based pneumococcal vaccination recommendations. CDC. May 8, 2026. Accessed June 4, 2026. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/risk-indications.html