Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013–18. Issue 1 (8th October 2019)

• Record Type: Journal Article
• Authors: Pick, Harry; Daniel, Priya; Rodrigo, Chamira; Bewick, Thomas; Ashton, Deborah; Lawrence, Hannah; Baskaran, Vadsala; Edwards-Pritchard, Rochelle C; Sheppard, Carmen; Eletu, Seyi D; Rose, Samuel; Litt, David; Fry, Norman K; Ladhani, Shamez; Chand, Meera; Trotter, Caroline; McKeever, Tricia M; Lim, Wei Shen
• Is Part Of: Thorax. Volume 75:Issue 1(2020)
• Page Start: 38
• Page End: 49
• Publication Date: 2019-10-08
• Subjects: community acquired pneumonia -- Streptococcus pneumoniae -- pneumococcal conjugate vaccine -- pneumococcal polysaccharide vaccine -- replacement serotypes -- risk groups -- pneumococcal pneumonia -- non-invasive pneumococcal disease; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2019-213725
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Changes over the last 5 years (2013–18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown. Methods: We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses. Findings: Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013–18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10). Interpretation: The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.