Epidemiological differences among pneumococcal serotypes.

The bacterial species Streptococcus pneumoniae consists of 90 immunologically distinct serotypes, of which some possess distinct epidemiological properties. Certain serotypes are much more likely to be associated with nasopharyngeal colonisation than to cause invasive disease. Compared with transient or infrequent colonisers, serotypes carried at high rates by young children may rapidly elicit age-associated natural immunity to invasive disease. Other serotypes seem to be of disproportionate importance as causes of disease in very young infants, in older children, in immunocompromised individuals, or in elderly people. Some serotypes seem to be associated with particular disease syndromes, such as complicated pneumonias in children, or with higher rates of hospitalisation in children or mortality in adults, or are consistently responsible for outbreaks in certain populations. Since pneumococcal conjugate vaccines are directed at specific serotypes, national immunisation advisory committees may wish to consider these serotype-specific properties when considering which vaccine formulation to introduce into a national programme.