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Background A second generation 13-valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the childhood immunization schedule in Massachusetts (MA) beginning in April,2010 Methods Cases of invasive pneumococcal disease (IPD) in children &amp;lt;18 years of age were detected through an enhanced surveillance system in MA since 2001. All cases in children and Streptococcus pneumoniae (SP) isolates, when available, are submitted to Department of Public Health (MDPH) and parents/physicians are interviewed for confirmation of demographic and clinical data. All available isolates are confirmed as SP, serotyped by Quellung reaction Results Three-hundred-thirty-seven IPD cases have been identified in MA children between 4.January 4, 2010 and 03.31.2017(Figure). Thirty-five(10.4%) were in infants &amp;lt;6 months; 41(12.2%) in children between 6 and 12 months; 60 (17.8%) in toddlers 12 to 24 months; 100 (29.7%) in children between 2 and 5 years of age and 101 (29.9%) were in children &amp;gt;5 years old. Among children under 2; incidence of IPD declined to 6.8/105 children (95% CI 2.6–11.1) in 2015/16 period which represents a 72.1% decline compared with 2010/11; however in 2016/17 IPD incidence increased by 41.2% to 9.6/105 (95% CI 4.6–14.6) for the first time since the implementation of PCV13.Bacteremia was the most common clinical presentation (62.9%) followed by pneumonia(30.5%) and CNS disease(6.6%). Children with at least one comorbidity were an increasing proportion of cases reaching 37.9% in 2016 (p 0.004). The overall mortality rate was 4.3%. Isolates from 301 (90.1%) were available for serotyping; vaccine serotypes (VST) were identified in 101 (33.6%) cases [serotype 19A(49 cases), 7F(21 cases), 3(18 cases), 19F (7cases), 6A(3 cases), serotypes 14, 18C and 5(1 case each)]. The proportion of VST disease declined to 24.1% from 59.2% over 6 years after PCV13 (p &amp;lt; 0.001). Serotypes 15BC (13.5%), 33F (12.5%) and 22F (12.5%) were the most common nonvaccine serotypes (NVST). Conclusion In the post-PCV13-era, IPD is primarily due to NVSTs and disproportionately observed in children with comorbid conditions. In the most recent year (4.1.2016 through 3.31.2017) an increase in incidence was observed in MA children after six years of declining cases following implementation of PCV13. Disclosures S. I. Pelton, Pfizer: Board Member and Grant Investigator, Consulting fee, Research grant and Speaker honorarium; Merck vaccines: Board Member, Consulting fee and Speaker honorarium; GSK: Board Member, Consulting fee and Speaker honorarium; Sequiris: Board Member, Consulting fee and Speaker honorarium

Invasive Pneumococcal Disease in Massachusetts Children 6 Years Following Introduction of PCV13