After heptavalent pneumococcal conjugate vaccine (PCV7) was marketed in France, Spain, Belgium, and England and Wales (United Kingdom), invasive disease from non-PCV7 serotypes (NVT) increased. Adjusted serotype-specific incidences among children <15 years of age were compared between 1999-2002 (prevaccine) and 2005-2006 (postmarketing). Vaccine coverage increased to approximately 32%-48% in France, Spain, and Belgium but remained <1% in England and Wales. Serotype 1 incidence rose in all age groups and countries (incidence rate ratio [IRR] 1.3-4.2; p<0.004), independently of PCV7 use, but incidence of serotypes 7F and 19A increased most in France, Spain, and Belgium (IRR 1.9-16.9 in children <5 years; p<0.001), where PCV7 coverage was greater. Vaccine-induced replacement of PCV7 serotypes possibly contributed to NVT increases, as did secular trends. New vaccines targeting these serotypes are available, but serotype dynamics needs further exploration that accounts for underreporting and prevaccine trends. ; Molecular typing of isolates in Spain was made possible by a grant from the “Fondo de Investigaciones Sanitarias” of the Spanish Government. GlaxoSmithKline paid travel costs for D.T., A.F., R.G., and E.V. to a meeting for data exchange. J.V. is advisor for a study on invasive pneumococcal disease among adults in Belgium, which is sponsored by Wyeth. E.V. received travel grants from GlaxoSmithKline, Sanofi -Aventis, Wyeth, and honoraria from Sanofi -Aventis. R.G. received travel grants from GlaxoSmithKline and Wyeth ; Sí