The incidence of invasive pneumococcal disease in children has drastically decreased since the introduction of the 7-valent pneumococcal conjugate vaccine in the United States in 2000. However, epidemiology studies are now finding that non-vaccine serotypes are emerging and are associated with multidrug resistance. Specifically, the incidence of the non-vaccine serotype 19A causing invasive pneumococcal disease has increased over the past few years. Several studies from various areas of the United States report changes in serotypes and antimicrobial resistance associated with Streptococcus pneumoniae causing invasive disease, such as meningitis, bacteremia, and pneumonia. Evidence regarding the 19A isolate emergence in otitis media and mastoiditis is now being identified and detailed. Practitioners must be aware of this evolving pneumococcal organism and the potential clinical impact in children.
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