IntroductionInvasive pneumococcal disease (IPD) is of concern. We describe the epidemiology and assess the vaccination schedule adequacy of IPD episodes (2019–2021) in northern Madrid. MethodsClinical, laboratory and vaccination data were collected from clinical/epidemiological records. Antimicrobial susceptibility testing was performed according to EUCAST and serotyping by Pneumotest-agglutination/Quellung. ResultsIPD was identified in 103 patients (71 [IQR 23.5] year-old; 50.4% males), 85.4% associated with bacteremia and a high mortality rate (19.4%). Serotypes 8 (29.9%), 3 and 22F (8% each) were dominant (45.9%), all antibiotic-susceptible. β-Lactams increased MICs and macrolide resistance were mainly linked to serotypes 19A, 23F, 24F, 6C, and 15A. Only 10.5% of adults eligible for vaccination had an adequate vaccine regimen before IPD being 40% due to nonvaccine-preventable serotypes (13, 23B, 24F, 31). ConclusionIPD episodes were dominated by antibiotic-susceptible ST8 and frequently occurred in adults at risk. Despite recommendations, vaccination adherence rates were very low.