Streptococcus pneumoniae in western Europe: serotype distribution and incidence in children less than 2 years old

We did a systematic search and synthesis of evidence on the incidence of invasive pneumococcal disease, symptomatic disease, and circulating Streptococcus pneumoniae serotypes in western Europe. Using data from studies published between 1992 and 2005 we calculated a weighted mean invasive pneumococcal disease and pneumococcal meningitis incidence rate per 100 000 children aged 2 years or younger within 95% confidence intervals, together with the prevalence of S pneumoniae serotypes and resistance to penicillin. Invasive pneumococcal disease incidence was 27·03 cases per 100 000 children under 2 years (95% CI 2·85-33·43). Heptavalent conjugate vaccine serotypes account for 43·18-75·32% of isolates among people aged under 18 years of age. 11% of isolates in individuals aged under 18 years were penicillin resistant. The incidence of invasive pneumococcal disease appeared consistently lower in western European countries compared with studies from the USA. Thus the use of studies of vaccine effectiveness based on the US population may lead to an overestimation of the benefits of its introduction in Europe. © 2006 Elsevier Ltd. All rights reserved.