Nationwide surveillance of invasive pneumococcal disease has been conducted in Germany since 1992. From 1992 to 2008, a total of 12,137 isolates from invasive pneumococcal disease were collected. Data on serotypes were available for 9,394 invasive isolates. The leading serotypes were serotypes 14 (16.5%), 3 (8.0%), 7F (7.6%), 1 (7.3%), and 23F (6.0%). Variations in serotype distribution over the years are particularly extensive, especially concerning serotype 14 (min 7.4%, max 33.5%) with the highest percentages among the isolates serotyped from around 1997 to 2006. Serotypes 1 and 7F increased over the last decade. No increase was observed concerning serotype 19A. Higher pneumococcal conjugate vaccine coverages were observed among children (7v, 57.3%; 10v, 72.8%; 13v, 83.5%) than among adults (7v, 39.9%; 10v, 55.5%; 13v, 73.5%). The temporal variations in serotype distribution have to be kept in mind when interpreting vaccine coverages reported in epidemiological studies. 1. Introduction Streptococcus pneumoniae is one of the most important pathogens in bacterial pneumonia, sepsis, and meningitis worldwide [1]. Significant temporal [2–4] and regional [5–7] variations among pneumococcal serotypes have been described. While the “epidemic” serogroups (serogroups 1-3 and 5) decreased considerably in the United States during the last century, the serogroups included in the seven-valent pneumococcal conjugate vaccine (PCV7) increased clearly [2]. A similar trend has been described in Spain, where the prevalence of PCV7 serotypes increased significantly (except serotype 4) since the start of the study in the early 1980s but then decreased considerably in the 2000s for all PCV7 serotypes except serotype 23F. Among the “epidemic” serotypes, a significant decrease of serotypes 1 and 5 has been observed in the 1980s followed by a significant increase in the late 1990s, while serotype 3 decreased continuously during the observational period. Furthermore, serotypes 6A, 7F, and 19A increased significantly since the late 1990s [4]. The widespread use of antibiotics and the increasing application of pneumococcal conjugate vaccines (a general recommendation of pneumococcal conjugate vaccination for children 2 years in Germany was issued at the end of July 2006) will have an impact on future changes in serotype distribution. The NRCS has conducted surveillance for invasive pneumococcal disease in Germany since 1992 [8]. Between 1992 and 1996 surveillance was based on a limited number of laboratories in Germany on a voluntary basis [9]. In 1996, nationwide
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