Serotype Distribution, Antimicrobial Susceptibility, Multilocus Sequencing Type and Virulence of Invasive <i>Streptococcus pneumoniae</i> in China: A Six-Year Multicenter Study.

A declining trend in the prevalence of ST320 (from 26.5% in 2010 to 12% in 2015) and ST81 (from 14.7% in 2010 to 4% in 2015) was observed as can be seen in Supplementary Figure 3 , whilst an increasing trend is obvious for ST271 (from 8.8% in 2010 to 12% in 2015) and ST876 (from 2.9% in 2010 to 10.8% in 2014) ( Supplementary Figure 3 ).

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Noticeably, for both PCV13 and PPV23 vaccines, the vaccine serotype coverage among the isolates showed a decreasing trend from 2010 to 2015 (PCV13: 85.3 to 68%; PPV23: 91.2 to 72%), while the proportion of non-vaccine covered serotypes increased (non-PCV13: 14.7 to 32%; non-PPV23: 8.8 to 28%), though the difference was not statistically significant ( P = 0.2053 for PCV13 and P = 0.1114 for PPV23) ( Figures 1C,D ).

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