After the introduction of routine infant immunization with 7-valent pneumococcal conjugate vaccine (PCV-7), the United States has witnessed a 74% decline in the number of children <5 years of age diagnosed with invasive pneumococcal disease (IPD) and a 30% decline among all age groups. Likewise, rates of pneumonia- and otitis media-related medical visits among children, hospitalizations for pneumonia among children and young adults, and procedures for insertion of tympanostomy tubes also decreased. Because of increases in IPD owing to pneumococcal serotypes not included in the vaccine, 13-valent pneumococcal conjugate vaccine replaced PCV-7 10 years later.3,4  Although a major public health accomplishment, the current 4-dose 13-valent pneumococcal conjugate vaccine series administered at 2, 4, 6, and 12 to 15 months of age is now the most expensive vaccine series in the routinely recommended immunization schedule for persons 0 through 18 years of age.

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