Levy C, et al. - Given a sharp decrease in invasive pneumococcal disease (IPD) following pneumococcal conjugate vaccine (PCV) implementation due to the reduction in PCV serotypes, researchers sought to illustrate the shifts in the spectrum of IPD and its clinical presentations after 13-valent PCV (PCV13) implementation. In this prospective, hospital-based, active surveillance, 130 pediatric wards and microbiology departments throughout France were included. IPD cases for which a pneumococcal isolate was forwarded to the National Reference Center for Pneumococci for serotyping from 2011 to 2016 were analyzed. Assessment of 1,082 IPD cases was undertaken; among these, a 35.3% decrease and the median age shift from 38.3 months to 23.7 months were observed. Among the emerging non-PCV13 types (NVTs), more frequent isolation was observed of those known to have the highest disease potential (8, 12F, 24F, and 33F) in patients without underlying conditions; these isolates were able to produce all IPD clinical presentations including bacteremic pneumonia. Conversely, rare isolation of serotypes with lower disease potential (15A, 15BC, 16F, and 23B) was reported from bacteremic pneumonia cases; these isolates were especially involved in IPD in patients with underlying conditions (35.8%). Findings hereby suggest significant changes in the spectrum of the remaining IPD cases, with substantial disparities across NVTs involved in terms of clinical features and underlying conditions, in addition to the decrease in IPD after 7-valent, then 13-valent PCV implementation.