Introduction: Widespread implementation of pneumococcal conjugate vaccines (PCVs)-namely the 7-valent PCV (PCV7), 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), and 13-valent PCV (PCV13)-in infant national immunization programs has reduced pneumococcal diseases in children, including invasive pneumococcal disease (IPD), acute otitis media (AOM), and community-acquired pneumonia (CAP). However, as the use of PCV impacts pneumococcal epidemiology, identifying the serotypes associated with remaining disease is crucial to guide future vaccination strategies for this population.

Methods: We systematically searched the literature for observational studies (2006-2020) on pneumococcal serotype distribution in IPD, AOM, and CAP among ≤5-year-old children post-PCV introduction. Serotype-specific pooled percentage averages were calculated by post-PCV period (post-PCV7 or pooled post-PHiD-CV/PCV13), or by PCV product (PHiD-CV or PCV13) to determine the contribution of each serotype to a certain clinical manifestation.

Results: Our analysis of 86 studies (47 on IPD, 30 on AOM, and 9 on CAP) shows continued reporting of several vaccine serotypes in all clinical manifestations post-PHiD-CV/PCV13, particularly serotypes 19A, 3, and 1. In PCV13 settings, serotype 19A reporting was reduced but still prevalent compared to PHiD-CV settings. Predominant non-PCV13 serotypes varied by clinical manifestation.

Conclusion: Post-PCV implementation, pneumococcal epidemiology in children is intricate. The persistence of some vaccine serotypes, variations across clinical manifestations, rising antimicrobial resistance, and other factors highlight the need for new vaccine technologies providing enhanced and broader protection to children.

Keywords: Streptococcus pneumoniae; acute otitis media; children; community-acquired pneumonia; invasive pneumococcal disease; pneumococcal conjugate vaccine; serotype distribution.

Copyright © 2025 Izurieta, AbdelGhany and Borys.

简介： 广泛实施肺炎球菌结合疫苗（PCV），包括7价PCV（PCV7）、10价非血清型流感嗜血杆菌蛋白D结合疫苗（PHiD-CV）和13价PCV（PCV13），在婴幼儿国家免疫计划中的应用，已经减少了儿童的肺炎球菌疾病，包括侵袭性肺炎球菌病（IPD）、急性中耳炎（AOM）和社区获得性肺炎（CAP）。然而，随着PCV使用对肺炎球菌流行病学的影响，确定与剩余疾病相关的血清型对于指导该人群未来的疫苗策略至关重要。

方法： 我们系统地检索了2006年至2020年关于IPD、AOM和CAP中≤5岁儿童肺炎球菌血清型分布的观察性研究文献。通过PCV引入后的时期（PCV7后或综合PHiD-CV/PCV13后），或根据不同的PCV产品（PHiD-CV或PCV13）计算了特定血清型的汇总百分比平均值，以确定每个血清型对某种临床表现的贡献。

结果： 我们分析了86项研究的结果（47项关于IPD、30项关于AOM和9项关于CAP），结果显示在引入PHiD-CV/PCV13后，所有临床表现中继续报告了几种疫苗血清型，特别是血清型19A、3和1。在PCV13环境中，与PHiD-CV环境相比，血清型19A的报告有所减少但仍然普遍存在。非PCV13的主要血清型因临床表现而异。

结论： 引入PCV后，儿童中的肺炎球菌流行病学变得复杂。一些疫苗血清型的持续存在、不同临床表现的变化趋势、抗菌药物耐药性的增加以及其他因素都强调了需要开发提供增强和更广泛保护的新疫苗技术。

关键词： 肺炎链球菌；急性中耳炎；儿童；社区获得性肺炎；侵袭性肺炎球菌病；肺炎球菌结合疫苗；血清型分布。