Regional differences in serotype distribution, pneumococcal vaccine coverage, and antimicrobial resistance of invasive pneumococcal disease among German federal states.

Continuous nationwide surveillance of invasive pneumococcal disease has been conducted in Germany for more than 15 years. In this study, 3724 isolates were included. A total of 2065 isolates were obtained from children under 16 years of age from 1997 to 2006, and 1659 isolates were obtained from adults aged 16 years and older between 2002 and 2006. Results were classified to federal states, and supra-regional trends were illustrated by classifying the federal states into the regions 'North-West', 'North-East' and 'South'. Among childhood isolates, the most common serotypes were 14 (26.4%), 6B (7.7%), 23F (7.4%), 19F (7.1%), 1 (7.0%), 18C (6.2%), and 7F (5.6%). Serotype coverage for the 7-valent conjugate vaccine was 62.3%. For the 10-valent and 13-valent vaccines (both in development) the coverage was 75.5% and 84.8%, respectively. The 23-valent polysaccharide vaccine had a coverage of 87.3%. The coverage varies considerably among the federal states. Penicillin G resistance was observed in 7.4% of meningitis cases. In the non-meningitis group, no intermediate resistant or resistant strains were detected. Among adults, the most common serotypes were 14 (16.9%), 3 (9.2%), 4 (7.8%), 7F (7.5%), 1 (6.8%), and 9V (6.1%). Serotype coverage for the 7-valent conjugate vaccine was 46.5%. For the pneumococcal conjugate vaccines in development, the coverage was 61.1% (10-valent) and 76.3% (13-valent). The 23-valent polysaccharide vaccine had a coverage of 88.7%. Penicillin G resistance was observed in 6.4% of meningitis cases. Among these, considerably higher rates of resistance were observed in the North-East region (13.0%) than in the North-West (7.1%) and South (1.8%) regions.