Epidemiological and clinical impact of pneumococcal disease in Spain in 2023: A nationwide retrospective analysis

<i>Streptococcus pneumoniae</i> remains a significant cause of morbidity and mortality in Spain, particularly among older adults and individuals with comorbidities. This nationwide retrospective study analyzed hospitalizations in 2023 due to pneumococcal pneumonia, sepsis, and meningitis using data from the Spanish Minimum Basic Data Set at Hospitalization (MBDS-H), covering 98% of public hospitals. A total of 66,391 hospitalizations were recorded, with an overall rate of 140.94 per 100,000 population. Pneumonia was the most common presentation, followed by sepsis and meningitis. Hospitalization and mortality rates increased with age, peaking in individuals aged ≥90 years. Men consistently showed higher rates than women. The overall in-hospital mortality rate was 13.27 per 100,000, with sepsis showing the highest case fatality. Comorbidities such as cerebrovascular disease, malignancy, and chronic kidney disease were strongly associated with increased mortality risk. Despite the introduction of broader-spectrum vaccines like PCV15 and PCV20, adult vaccination coverage remains suboptimal. The emergence of non-PCV13 serotypes highlights the need for improved immunization strategies targeting high-risk adult populations. Pneumococcal disease continues to pose a major public health challenge in Spain. Strengthening adult vaccination programs and prioritizing vulnerable groups are essential to reduce hospitalizations and mortality.