Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013-18
Pick, Harry J. Rodrigo, Chamira Ashton, Deborah Lawrence, Hannah Baskaran, Vadsala Lim, Wei Shen
Pick, Harry J.
Rodrigo, Chamira
Ashton, Deborah
Lawrence, Hannah
Baskaran, Vadsala
Lim, Wei Shen
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. Copyright © Author(s) (or their employer(s)) 2020.
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2020
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Pick, H., Daniel, P., Rodrigo, C., Bewick, T., Ashton, D., Lawrence, H., Baskaran, V., Edwards-Pritchard, R., Sheppard, C., Eletu, S.D., Rose, S., Litt, D., Fry, N.K., Ladhani, S., Chand, M., Trotter, C., McKeever, T.M. and Lim, W.S. (2020) 'Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013-18', Thorax, 75(1), pp. 38–49. doi: 10.1136/thoraxjnl-2019-213725 https://doi.org/10.1136/thoraxjnl-2019-213725.
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Available to view on the publisher's website here: https://doi.org/10.1136/thoraxjnl-2019-213725.