Abstract
BackgroundRecently, the 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for adults. We analyzed the epidemiology of invasive pneumococcal disease (IPD) in older adults in Spain before PCV13 introduction.Methodology/Principal FindingsIPD episodes, defined as clinical findings together with an invasive pneumococcal isolate, were prospectively collected from patients aged over 65 years in three hospitals in Spain from 2007 to 2009. A total of 335 IPD episodes were collected. Pneumonia was the main clinical syndrome, while chronic obstructive pulmonary disease, diabetes mellitus and cancer were the main underlying diseases. Pneumococcal isolates were serotyped and the molecular typing was performed by PFGE/MLST. PCV13 serotypes accounted for 59.3% of isolates, the most prevalent being serotypes 19A (15.1%), 3 (9.6%), 7F (7.5%), 14 (6.9%) and 1 (5.4%). The most frequent non-PCV13 serotypes were serotypes 16F (4.5%), 22F (3.6%), 24F (3.3%) and 6C (2.1%). The most common genotypes were CC230 (8.5%, serotypes 19A and 24F), CC156 (8.2%, serotypes 9V and 14), ST191 (7.9%, serotype 7F), CC260 (6.6%, serotype 3), ST306 (5.2%, serotype 1), CC30 (4.6%, serotype 16F) and ST433 (3.6%, serotype 22F). Comparing the 335 IPD isolates to 174 invasive pneumococci collected at the same hospitals in 1999–2000, PCV7 serotypes decreased (45.4% vs 18.4%,p<0.001), non-PCV7 serotypes included in PCV13 increased (26.4% vs 41.0%,p = 0.001) and two non-PCV13 serotypes increased (serotype 6C 0% vs 2.1%, p = 0.05; serotype 24F 0.6% vs 3.3%, p = 0.04,).ConclusionIn our older adult population two serotypes (19A and 3) included in PCV13 accounted for about a quarter of IPD episodes in people ≥65 years. Non-PCV13 emerging serotypes should be carefully monitored in future surveillance studies.
Highlights
Comparing the 335 invasive pneumococcal disease (IPD) isolates to 174 invasive pneumococci collected at the same hospitals in 1999–2000, PCV7 serotypes decreased (45.4% vs 18.4%,p,0.001), non-PCV7 serotypes included in PCV13 increased (26.4% vs 41.0%,p = 0.001) and two non-PCV13 serotypes increased
In our older adult population two serotypes (19A and 3) included in PCV13 accounted for about a quarter of IPD episodes in people $65 years
Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide, it being responsible for a wide variety of invasive diseases such as bacteremic pneumonia, septicemia and meningitis [1]
Summary
Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide, it being responsible for a wide variety of invasive diseases such as bacteremic pneumonia, septicemia and meningitis [1]. Children under 2 years of age and adults over 65 are the two most important groups with a higher risk of invasive pneumococcal disease (IPD). Since the late 1970s adult vaccination has been based on pneumococcal polysaccharide vaccines (PPV). PPV23 is recommended for people over 65 and adults at risk of IPD [2]. Since PPV23 has low effectiveness against children under (especially those under 18 months), conjugate pneumococcal vaccines have been developed, with the 7-valent pneumococcal conjugate vaccine (PCV7) being licensed in 2000 in the US, and since 2001 in most European countries. The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for adults. We analyzed the epidemiology of invasive pneumococcal disease (IPD) in older adults in Spain before PCV13 introduction
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