Serotype 15B/15C Pneumococcal Meningitis in a Vaccinated Toddler: Advocating PCV20 Boosters for Enhanced Pediatric Protection

Streptococcus pneumoniae remains a leading cause of bacterial pneumonia and meningitis in children globally, despite pneumococcal conjugate vaccine (PCV) implementation. We report a case of fatal pneumococcal meningitis in a fully vaccinated 2-year-old male. Despite prior PCV13 vaccination, the patient developed meningitis caused by S. pneumoniae serotype 15B in the cerebrospinal fluid and 15C in the blood. Genomic sequencing revealed nearly identical isolates differing by a capsular switch mutation. This case highlights the limitations of PCV13 against emerging serotypes like 15B and 15C. The recent approval of PCV20, which includes serotype 15B, represents a significant advancement. We propose a PCV20 booster dose for children under five previously vaccinated with PCV13 to enhance protection against the evolving landscape of pneumococcal serotypes and reduce invasive disease. Continued surveillance and adaptive vaccination strategies are crucial, as S. pneumoniae continues to pose a significant threat to young children worldwide.