The results of enhanced national surveillance of pneumococcal disease in ch
ildren < 15 y of age in England and Wales are reported for the period 1996-
1998. Of the 1985 cases of laboratory confirmed invasive disease (annual in
cidence 6.6 per 100000 overall and 39.7 per 100000 in infants <1 y of age),
485 (24%) were meningitis (annual incidence of 1.6 per 100000 overall and
15.7 per 100000 in infants <1 y of age). Fifty-nine deaths in children with
invasive disease were identified-3% of the total reports. Thirty-one diffe
rent serogroups/types were identified, with organisms in the 7-valent conju
gate Vaccine responsible for 69% of the infections in children <5 y of age;
this rose to 77% and 82%, respectively, for the 9-and Ii-valent vaccines.
Resistance to penicillin varied from 2.3% to 6.2% in different years, but e
rythromycin resistance remained constant at 17%. The vast majority of resis
tant isolates were in Vaccine serotype/groups. Computerized hospital admiss
ion records for all children <15 y of age with a discharge diagnosis code i
ndicating probable pneumococcal disease were also analysed for 1997. The an
nual incidence for cases with a code specifically mentioning S. pneumoniae
was 9.9 per 100000 compared with 71.2 per 100000 for lobar pneumonia; the m
ean duration of stay for both was <1 wk. The incidence of admission for pne
umococcal meningitis (1.9 overall and 19.6 for infants <1y of age) was simi
lar to that derived from laboratory reports and resulted in an average dura
tion of stay of 2 wk.
Conclusion: This surveillance has confirmed the substantial burden of morbi
dity attributable to pneumococcal disease in British children and the poten
tial public health benefits that could be achieved by the use of pneumococc
al conjugate vaccines.