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Volume 32, Number 2—February 2026

Research Letter

Invasive Pneumococcal Disease among Childbearing-Age Women, United States, 2007–2023

Namrata PrasadComments to Author , Sopio Chochua, Bridget J. Anderson, Kathy M. Angeles, Meghan Barnes, Lee H. Harrison, Corinne Holtzman, Jessica R. Howard-Anderson, Shannon O’Brien, Susan Petit, Arthur Reingold, William Schaffner, Lesley McGee, Adam L. Cohen, and Miwako Kobayashi
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (N. Prasad, S. Chochua, L. McGee, A.L. Cohen, M. Kobayashi); New York State Department of Health, Albany, New York, USA (B.J. Anderson); New Mexico Department of Health, Santa Fe, New Mexico, USA (K.M. Angeles); Colorado Department of Public Health and the Environment, Denver, Colorado, USA (M. Barnes); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (L.H. Harrison); Minnesota Department of Health, St. Paul, Minnesota, USA (C. Holtzman); Emory University School of Medicine, Atlanta (J.R. Howard-Anderson); Oregon Health Authority, Portland, Oregon, USA (S. O'Brien); Connecticut Department of Public Health, Hartford, Connecticut, USA (S. Petit); California Emerging Infections Program, Oakland, California, USA (A. Reingold); University of California, Berkeley, California (A. Reingold); Vanderbilt University School of Medicine, Nashville, Tennessee, USA (W. Schaffner)

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Table

Characteristics of invasive pneumococcal disease cases among pregnant, postpartum, and nonpregnant childbearing-age women, United States, 2007–2023*

Characteristic Pregnant, n = 146
 Postpartum, n = 61
 Nonpregnant, n = 3,444
Value p value Value p value
Mean age, y (IQR)
 29 (25–34)
 <0.001
30 (25–34)
 <0.001
 35 (30–41)
Clinical manifestations, no. (%)†
Bacteremia 33 (22.6) 0.012 10 (16.4) 0.850 506 (14.7)
Meningitis 7 (4.8) 0.135 5 (8.2) 1.000 299 (8.7)
Pneumonia 93 (63.7) 0.142 38 (62.3) 0.263 2,403 (69.8)
Other
 25 (17.1)
 0.008
19 (31.1)
 0.626
 947 (27.5)
Patient outcome
  Admitted to ICU 28/89 (31.4) 0.056 15/47 (31.9) 0.205 1,000/2,369 (42.2)
  Death
 3/146 (2.1)
 0.014
0/61 (0.0)
 NA
 273/3,443 (7.9)
Fetal outcome in cases with available data
  Survived, no apparent illness or still pregnant 98/118 (83.1) 42/55 (76.4) NA
  Survived, clinical infection 1/118 (0.8) 3/55 (5.5) NA
  Miscarriage/stillbirth
 18/118 (15.3)
8/55 (14.5)
NA
Underlying conditions, no. (%)‡ 66 (45.2) <0.001 25 (41.0) <0.001 2,407 (69.9)
  Chronic conditions 53 (36.3) 0.463 20 (32.8) 0.336 1,367 (39.7)
  Immunocompromising conditions, cerebrospinal fluid leak, or cochlear implant 13 (8.9) <0.001 5 (8.2) <0.001 1,040 (30.2)
Healthy
 80 (54.8)
 <0.001
36 (59.0)
 <0.001
 1,037 (30.1)
Serotyped IPD cases during 2019–2023
PCV20-covered serotypes§ 16/23 (69.6) 0.598 8/12 (66.7) 1.000 460/743 (61.9)
PCV21-covered serotypes¶ 15/23 (65.2) 0.346 8/12 (66.7) 0.497 564/743 (76.0)
Covered by neither 1/23 (4.3) 1.000 2/12 (16.7) 0.265 61/743 (8.9)

*Values are no. positive/total no. (%) except as indicated. ICU, intensive care unit; IPD, invasive pneumococcal disease; IQR, interquartile range; NA, not applicable; PCV20, 20-valent pneumococcal conjugate vaccine; PCV21, 21-valent pneumococcal conjugate vaccine. †Sum of proportions could be >100% because case-patients could have had >1 clinical manifestation identified. ‡Conditions included chronic conditions (alcoholism; chronic heart, liver, or lung disease; chronic renal failure; cigarette smoking; diabetes mellitus) and immunocompromising conditions (congenital or acquired asplenia; generalized malignancy; HIV; Hodgkin disease; immunodeficiency; iatrogenic immunosuppression; leukemia, lymphoma, or multiple myeloma; nephrotic syndrome; solid organ transplant; or sickle cell disease or other hemoglobinopathies). Cerebrospinal fluid leak and cochlear implant were grouped together with immunocompromising conditions to align with 2023 vaccine recommendations (3). §PCV20 serotypes: 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F. ¶PCV21 serotypes: 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F, and 35B. PCV21 is approved for the prevention of invasive pneumococcal disease caused by serotype 15B based upon prespecified criteria for the proportion of participants with 4-fold or more rise in opsonophagocytic activity responses. Source: US Food and Drug Administration (https://www.fda.gov/media/179426/download?attachment).

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References
  1. Centers for Disease Control and Prevention. Pneumococcal disease: causes and how it spreads. [cited 2025 May 21]. https://www.cdc.gov/pneumococcal/causes
  2. Centers for Disease Control and Prevention. Pneumococcal vaccine recommendations. 2024 [cited 2025 May 21]. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations
  3. Kobayashi  M, Pilishvili  T, Farrar  JL, Leidner  AJ, Gierke  R, Prasad  N, et al. Pneumococcal vaccine for adults aged ≥19 years: recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep. 2023;72:1–39. DOIPubMedGoogle Scholar
  4. American College of Obstetricians and Gynecologists. Maternal immunization. 2022 [cited 2025 Jun 9]. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/10/maternal-immunization
  5. Centers for Disease Control and Prevention. Active Bacterial Core surveillance (ABCs). [cited 2025 Jun 9]. https://www.cdc.gov/abcs
  6. Centers for Disease Control and Prevention. Estimating the number of pregnant women in a geographic area—a reproductive health tool. 2024 [cited 2024 May 12]. https://www.cdc.gov/reproductive-health/media/pdfs/emergency/Pregnant-Population-Size-Estimator-508.pdf
  7. Amin-Chowdhury  Z, Bertran  M, Abdullahi  F, Sheppard  CL, Eletu  SD, Litt  DJ, et al. Risk of invasive pneumococcal disease during pregnancy and postpartum and association with adverse maternal and foetal outcomes: A prospective cohort study, England, 2014-19. J Infect. 2025;90:106363. DOIPubMedGoogle Scholar
  8. Deutscher  M, Lewis  M, Zell  ER, Taylor  TH Jr, Van Beneden  C, Schrag  S; Active Bacterial Core Surveillance Team. Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women. Clin Infect Dis. 2011;53:114–23. DOIPubMedGoogle Scholar

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Page created: January 22, 2026
Page updated: February 19, 2026
Page reviewed: February 19, 2026
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