Skip to main content

Advertisement

SpringerLink
Log in

Changing Epidemiology of Pneumococcal Disease in the Era of Conjugate Vaccines

  • Infectious Disease Epidemiology (A Reingold, Section Editor)
  • Published:
Current Epidemiology Reports Aims and scope Submit manuscript

Abstract

Pneumococcal disease is a major cause of illness and death in the young, the elderly, and those with certain medical conditions. Pneumococcal conjugate vaccines are changing both the epidemiology of pneumococcal disease and disease burden. Conjugate vaccines were first licensed in 2000 for use in young children; second generation conjugates covering more serotypes became available in 2009 and are now part of the routine infant immunization programs of most countries around the world. When part of a routine program, conjugate vaccines not only prevent disease in the targeted age group but also in unvaccinated children and adults because of reduced pneumococcal transmission. Measurement of these direct and indirect benefits of immunization programs has illustrated how young children serve as the primary reservoir of pneumococci in the community. Clinical trials of pneumococcal conjugate vaccines have proven to be an effective method for eliciting the proportion of disease syndromes like pneumonia that is caused by pneumococci or pneumococcal and viral co-infections. While these highly successful vaccines are introduced into more places, surveillance programs are monitoring for signs of any increase in disease caused by serotypes the vaccines are not designed to prevent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Watson DA, Musher DM, Jacobson JW, Verhoef J. A brief history of the pneumococcus in biomedical research: a panoply of scientific discovery. Clin Infect Dis. 1993;17(5):913–24.

    Article  CAS  PubMed  Google Scholar 

  2. Shapiro ED, Berg AT, Austrian R, Schroeder D, Parcells V, Margolis A, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine [see comments]. N Engl J Med. 1991;325(21):1453–60.

    Article  CAS  PubMed  Google Scholar 

  3. Robinson KA, Baughman W, Rothrock G, Barrett NL, Pass M, Lexau C, et al. Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995–1998: opportunities for prevention in the conjugate vaccine era. JAMA. 2001;285(13):1729–35.

    Article  CAS  PubMed  Google Scholar 

  4. World Health Organization. Estimated Hib and pneumococcal deaths for children under 5 years of age, 2008 2013 [updated 1 December 2013; cited 2016 February 22]. Available from: http://www.who.int/immunization/monitoring_surveillance/burden/estimates/Pneumo_hib/en/.

  5. Adegbola RA, DeAntonio R, Hill PC, Roca A, Usuf E, Hoet B, et al. Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: a systematic review and meta-analysis. PLoS One. 2014;9(8), e103293.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Levine OS, O’Brien KL, Knoll M, Adegbola RA, Black S, Cherian T, et al. Pneumococcal vaccination in developing countries. Lancet. 2006;367(9526):1880–2.

    Article  PubMed  Google Scholar 

  7. Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000;49(No. RR-9):1–35.

    Google Scholar 

  8. Black SB, Shinefield HR, Ling S, Hansen J, Fireman B, Spring D, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr Infect Dis J. 2002;21:810–5.

    Article  PubMed  Google Scholar 

  9. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente Vaccine Study Center Group. Pediatr Infect Dis J. 2000;19:187–95.

    Article  CAS  PubMed  Google Scholar 

  10. Hansen J, Black S, Shinefield H, Cherian T, Benson J, Fireman B, et al. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Pediatr Infect Dis J. 2006;25(9):779–81.

    Article  PubMed  Google Scholar 

  11. Klugman KP, Madhi SA, Huebner RE, Kohberger R, Mbelle N, Pierce N. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med. 2003;349(14):1341–8.

    Article  CAS  PubMed  Google Scholar 

  12. O’Brien KL, Moulton LH, Reid R, Weatherholtz R, Oski J, Brown L, et al. Efficacy and safety of seven-valent conjugate pneumococcal vaccine in American Indian children: group randomised trial. Lancet. 2003;362:355–61.

    Article  PubMed  Google Scholar 

  13. Cutts FT, Zaman SM, Enwere G, Jaffar S, Levine OS, Okoko JB, et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet. 2005;365(9465):1139–46.

    Article  CAS  PubMed  Google Scholar 

  14. Lucero MG, Nohynek H, Williams G, Tallo V, Simões EA, Lupisan S, et al. Efficacy of an 11-valent pneumococcal conjugate vaccine against radiologically confirmed pneumonia among children less than 2 years of age in the Philippines: a randomized, double-blind, placebo-controlled trial. Pediatr Infect Dis J. 2009;28(6):455–62.

    Article  PubMed  Google Scholar 

  15. Palmu AA, Jokinen J, Borys D, Nieminen H, Ruokokoski E, Siira L, et al. Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial. Lancet. 2013;381(9862):214–22.

    Article  PubMed  Google Scholar 

  16. Tregnaghi MW, Sáez-Llorens X, López P, Abate H, Smith E, Pósleman A, et al. Efficacy of pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in young Latin American children: a double-blind randomized controlled trial. PLoS Med. 2014;11(6):1001657.

    Article  Google Scholar 

  17. French N, Gordon SB, Mwalukomo T, White SA, Mwafulirwa G, Longwe H, et al. A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults. N Engl J Med. 2010;362(9):812–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bonten MJ, Huijts SM, Bolkenbaas M, Webber C, Patterson S, Gault S, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med. 2015;372(12):1114–25.

    Article  CAS  PubMed  Google Scholar 

  19. Le Polain De Waroux O, Flasche S, Prieto-Merino D, Goldblatt D, Edmunds WJ. The efficacy and duration of protection of pneumococcal conjugate vaccines against nasopharyngeal carriage: a meta-regression model. Pediatr Infect Dis J. 2015;34(8):858–64.

    Article  Google Scholar 

  20. World Health Organization. Immunizations, Vaccines, and Biologicals: Data, statistics, and graphics: World Health Organization; 2016 [updated 11 February 2016; cited 2016 February 23]. Available from: http://www.who.int/immunization/monitoring_surveillance/data/en/.

  21. Wang SA, Mantel CF, Gacic-Dobo M, Dumolard L, Cherian T, Flannery B, et al. Progress in introduction of pneumococcal conjugate vaccine — worldwide, 2000–2012. MMWR Morb Mortal Wkly Rep. 2013;62(16):308–11.

    Google Scholar 

  22. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network, ABCs Resport Streptococcus pneumoniae,1999: U.S. Department of Health and Human Services; 2010 [updated February 2, 2010; cited 2016 January 30]. Available from: http://www.cdc.gov/abcs/reports-findings/surv-reports.html.

  23. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network. ABCs Report: Streptococcus pneumoniae, 2013: U.S. Department of Health and Human Services; 2015 [updated May 18, 2015; cited 2016 January 30]. Available from: http://www.cdc.gov/abcs/reports-findings/survreports/spneu13.html.

  24. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs): Emerging Infections Program Network. ABCs Report: Streptococcus pneumoniae, 2009: U.S. Department of Health and Human Services; 2010 [updated December 6, 2010; cited 2016 January 30]. Available from: http://www.cdc.gov/abcs/reports-findings/survreports/spneu09.html.

  25. Said MA, O’Brien KL, Nuorti JP, Singleton R, Whitney CG, Hennessy TW. The epidemiologic evidence underlying recommendations for use of pneumococcal polysaccharide vaccine among American Indian and Alaska Native populations. Vaccine. 2011;29(33):5355–62.

    Article  CAS  PubMed  Google Scholar 

  26. Wortham JM, Zell ER, Pondo T, Harrison LH, Schaffner W, Lynfield R, et al. Racial disparities in invasive Streptococcus pneumoniae infections, 1998–2009. Clin Infect Dis. 2014;58(9):1250–7.

    Article  PubMed  Google Scholar 

  27. Hausdorff WP. Invasive pneumococcal disease in children: geographic and temporal variations in incidence and serotype distribution. Eur J Pediatr. 2002;161 Suppl 2:S135–9.

    Article  PubMed  Google Scholar 

  28. Kyaw MH, Rose Jr CE, Fry AM, Singleton JA, Moore Z, Zell ER, et al. The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults. J Infect Dis. 2005;192(3):377–86.

    Article  PubMed  Google Scholar 

  29. Muhammad RD, Oza-Frank R, Zell E, Link-Gelles R, Narayan KM, Schaffner W, et al. Epidemiology of invasive pneumococcal disease among high-risk adults since the introduction of pneumococcal conjugate vaccine for children. Clin Infect Dis. 2013;56(5):e59–67.

    Article  CAS  PubMed  Google Scholar 

  30. Greene CM, Kyaw MH, Ray SM, Schaffner W, Lynfield R, Barrett NL, et al. Preventability of invasive pneumococcal disease and assessment of current polysaccharide vaccine recommendations for adults: United States, 2001–2003. Clin Infect Dis. 2006;43(2):141–50.

    Article  PubMed  Google Scholar 

  31. Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis. 2010;201(1):32–41.

    Article  PubMed  Google Scholar 

  32. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364(21):2016–25.

    Article  CAS  PubMed  Google Scholar 

  33. Simonsen L, Taylor RJ, Young-Xu Y, Haber M, May L, Klugman KP. Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States. MBio. 2011;2(1):e00309–10.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Griffin MR, Zhu Y, Moore MR, Whitney CG, Grijalva CG. U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination. N Engl J Med. 2013;369(2):155–63.

    Article  CAS  PubMed  Google Scholar 

  35. Link-Gelles R, Thomas A, Lynfield R, Petit S, Schaffner W, Harrison L, et al. Geographic and temporal trends in antimicrobial nonsusceptibility in Streptococcus pneumoniae in the post-vaccine era in the United States. J Infect Dis. 2013;208(8):1266–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Waight PA, Andrews NJ, Ladhani SN, Sheppard CL, Slack MP, Miller E. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis. 2015;15(5):535–43.

    Article  PubMed  Google Scholar 

  37. Lowbridge C, McIntyre PB, Gilmour R, Chiu C, Seale H, Ferson MJ, et al. Long term population impact of seven-valent pneumococcal conjugate vaccine with a “3+0” schedule-How do “2+1” and “3+1” schedules compare? Vaccine. 2015;33(28):3234–41.

    Article  PubMed  Google Scholar 

  38. Ben-Shimol S, Greenberg D, Givon-Lavi N, Schlesinger Y, Somekh E, Aviner S, et al. Early impact of sequential introduction of 7-valent and 13-valent pneumococcal conjugate vaccine on IPD in Israeli children <5 years: an active prospective nationwide surveillance. Vaccine. 2014;32(27):3452–9.

    Article  PubMed  Google Scholar 

  39. Moore MR, Whitney CG. Use of pneumococcal disease epidemiology to set policy and prevent disease during 20 years of the Emerging Infections Program. Emerg Infect Dis. 2015;21(9):1551–6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Miller E, Andrews NJ, Waight PA, Slack MP, George RC. Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study. Lancet Infect Dis. 2011;11(10):760–8.

    Article  CAS  PubMed  Google Scholar 

  41. von Gottberg A, de Gouveia L, Tempia S, Quan V, Meiring S, von Mollendorf C, et al. Effects of vaccination on invasive pneumococcal disease in South Africa. N Engl J Med. 2014;371(20):1889–99. This manuscript describes the impact of pneumococcal conjugate vaccine on disease in children and adults, with and without HIV infection. The reports come from the largest surveillance program in Africa.

    Article  Google Scholar 

  42. Simonsen L, Taylor RJ, Schuck-Paim C, Lustig R, Haber M, Klugman KP. Effect of 13-valent pneumococcal conjugate vaccine on admissions to hospital 2 years after its introduction in the USA: a time series analysis. Lancet Respir Med. 2014;2(5):387–94.

    Article  PubMed  Google Scholar 

  43. Greenberg D, Givon-Lavi N, Ben-Shimol S, Ziv JB, Dagan R. Impact of PCV7/PCV13 introduction on community-acquired alveolar pneumonia in children <5 years. Vaccine. 2015;33(36):4623–9. This report from Israel demonstrates how vaccination can reveal the proportion of childhood pneumonia caused by pneumococcus.

    Article  PubMed  Google Scholar 

  44. Ben-Shimol S, Givon-Lavi N, Leibovitz E, Raiz S, Greenberg D, Dagan R. Near-elimination of otitis media caused by 13-valent pneumococcal conjugate vaccine (PCV) serotypes in southern Israel shortly after sequential introduction of 7-valent/13-valent PCV. Clin Infect Dis. 2014;59(12):1724–32.

    Article  PubMed  Google Scholar 

  45. Afonso ET, Minamisava R, Bierrenbach AL, Escalante JJ, Alencar AP, Domingues CM, et al. Effect of 10-valent pneumococcal vaccine on pneumonia among children. Brazil Emerg Infect Dis. 2013;19(4):589–97.

    Article  PubMed  Google Scholar 

  46. KEMRI-Wellcome Trust. The Pneumoccocal Conjugate Vaccine Impact Study (PCVIS) 2016 [updated February 15, 2016; cited 2016 February 24, 2016]. Available from: http://www.kemri-wellcome.org/index.php/en/studies_inner/75.

  47. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med. 2003;348(18):1737–46.

    Article  PubMed  Google Scholar 

  48. Van Effelterre T, Moore MR, Fierens F, Whitney CG, White L, Pelton SI, et al. A dynamic model of pneumococcal infection in the United States: implications for prevention through vaccination. Vaccine. 2010;28(21):3650–60.

    Article  PubMed  Google Scholar 

  49. Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, et al. Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA. 2006;295(14):1668–74.

    Article  CAS  PubMed  Google Scholar 

  50. Moore MR, Link-Gelles R, Shaffner W, Lynfield R, Lexau C, Bennett NM, et al. Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015;15(3):301–9.

    Article  CAS  PubMed  Google Scholar 

  51. Ray GT, Whitney CG, Fireman BH, Ciuryla V, Black SB. Cost-effectiveness of pneumococcal conjugate vaccine: evidence from the first 5 years of use in the United States incorporating herd effects. Pediatr Infect Dis J. 2006;25(6):494–501.

    Article  PubMed  Google Scholar 

  52. Bruce MG, Singleton R, Bulkow L, Rudolph K, Zulz T, Gounder P, et al. Impact of the 13-valent pneumococcal conjugate vaccine (pcv13) on invasive pneumococcal disease and carriage in Alaska. Vaccine. 2015;33(38):4813–9.

    Article  CAS  PubMed  Google Scholar 

  53. Singleton RJ, Hennessy TW, Bulkow LR, Hammitt LL, Zulz T, Hurlburt DA, et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA. 2007;297(16):1784–92.

    Article  CAS  PubMed  Google Scholar 

  54. Pai R, Moore MR, Pilishvili T, Gertz RE, Whitney CG, Beall B. Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis. 2005;192(11):1988–95.

    Article  CAS  PubMed  Google Scholar 

  55. Feikin DR, Kagucia EW, Loo JD, Link-Gelles R, Puhan MA, Cherian T, et al. Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites. PLoS Med. 2013;10(9):e1001517. After pneumococcal conjugate vaccine was first used, reports of increasing disease caused by nonvaccine types were slowing vaccine uptake. This analysis pulled together all available disease surveillance information and showed that while such “replacement disease” was reported from most countries using pneumococcal conjugate vaccines, the vaccine-induced disease reductions were much larger than any increase in nonvaccine-serotype disease.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lees EA, Ho DK, Guiver M, Mankhambo LA, French N, Carrol ED. Comparison of Binax NOW urine antigen test and pneumococcal DNA assay using qPCR before and after nasopharyngeal swabbing in healthy Malawian children. New Microbes New Infect. 2015;8:4–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372(9):835–45. This recent publication looked at pneumococcal etiology among children in the U.S. years after implementation of pneumococcal conjugate vaccine; a companion paper looked at etiology among adults.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Madhi SA, Klugman KP, Vaccine Trialist Group. A role for Streptococcus pneumoniae in virus-associated pneumonia. Nat Med. 2004;10(8):811–3.

    Article  CAS  PubMed  Google Scholar 

  60. World Health Organization. Pneumococcal vaccines WHO position paper— 2012. Wkly Epidemiol Rec. 2012;87(14):129–44.

    Google Scholar 

  61. Flasche S, Van Hoek AJ, Goldblatt D, Edmunds WJ, O’Brien KL, Scott JA, et al. The potential for reducing the number of pneumococcal conjugate vaccine doses while sustaining herd immunity in high-income countries. PLoS Med. 2015;12(6), e1001839.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Conklin LM, Bigogo G, Jagero G, Hampton L, Junghae M, da Gloria CM, et al. High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction. BMC Infect Dis. 2016;16(1):18.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Centers for Disease Control and Prevention. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61:816–9.

    Google Scholar 

  64. Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;63(37):822–5.

    PubMed  Google Scholar 

  65. Leimkugel J, Adams Forgor A, Gagneux S, Pflüger V, Flierl C, Awine E, et al. An outbreak of serotype 1 Streptococcus pneumoniae meningitis in northern Ghana with features that are characteristic of Neisseria meningitidis meningitis epidemics. J Infect Dis. 2005;192(2):192–9.

    Article  PubMed  Google Scholar 

  66. Yaro S, Lourd M, Traoré Y, Njanpop-Lafourcade BM, Sawadogo A, Sangare L, et al. Epidemiological and molecular characteristics of a highly lethal pneumococcal meningitis epidemic in Burkina Faso. Clin Infect Dis. 2006;43(6):693–700.

    Article  PubMed  Google Scholar 

  67. Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococcal serotypes. Lancet Infect Dis. 2005;5(2):83–93.

    Article  PubMed  Google Scholar 

  68. Brueggemann AB, Griffiths DT, Meats E, Peto T, Crook DW, Spratt BG. Clonal relationships between invasive and carriage Streptococcus pneumoniae and serotype- and clone-specific differences in invasive disease potential. J Infect Dis. 2003;187(9):1424–32. Epub 2003 Apr 4.

    Article  CAS  PubMed  Google Scholar 

  69. Saha SK, Hossain B, Islam M, Hasanuzzaman M, Saha S, Hasan M, et al. Epidemiology of invasive pneumococcal disease in Bangladeshi children before introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2015.

  70. World Health Organization, United Nations Childrens Fund (UNICEF). Ending preventable child deaths from pneumonia and diarrhoea by 2025: the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). Geneva, Switzerland: World Health Organization; 2013:1–64. This report provides guidance from the leading global health agencies for policy makers around the world. The guidance spells out the main measures that should be implemented to reduce the most common causes of death in young children—pneumonia and diarrhea. As pneumococcus is the leading cause of death from childhood pneumonia, the measures described here are the most important tools for pneumococcal disease prevention.

Download references

Author information

Authors and Affiliations

  1. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE Mailstop C25, Atlanta, GA, 30329, USA

    Cynthia G. Whitney

Authors
  1. Cynthia G. Whitney
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cynthia G. Whitney.

Ethics declarations

Conflict of Interest

Cynthia Whitney declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Infectious Disease Epidemiology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Whitney, C.G. Changing Epidemiology of Pneumococcal Disease in the Era of Conjugate Vaccines. Curr Epidemiol Rep 3, 125–135 (2016). https://doi.org/10.1007/s40471-016-0077-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40471-016-0077-5

Keywords

Search

Navigation