Abstract
The epidemiology of hospitalised pneumococcal disease in adults following the introduction of universal childhood pneumococcal immunisation in 2009 was assessed. Culture-confirmed Streptococcus pneumoniae (SP) from adults hospitalised between 2009 to 2017 were examined. The cases were categorised into invasive pneumococcal disease (IPD) and pneumonia (bacteraemic, non-bacteraemic, and that associated with other lung conditions). The isolates were serotyped and antimicrobial susceptibilities were determined by microbroth dilution. Patient characteristics, comorbidities, and outcomes were analysed. Seven hundred and seventy-four patients (mean age, 67.7 years, SD ± 15.6) were identified, and IPD was diagnosed in 110 (14.2%). The most prevalent serotype, 19F, was replaced by serotype 3 over time. Penicillin and cefotaxime non-susceptibilities were high at 54.1% and 39.5% (meningitis breakpoints), 19.9% and 25.5% (non-meningitis breakpoints), respectively. The overall 30-day mortality rate was 7.8% and 20.4% for IPD. Age ≥ 75 years (OR:4.6, CI:1.3–17.0, p < 0.02), presence of any complications (OR:4.1, CI:1.02–16.3, p < 0.05), pleural effusion (OR:6.7, CI:1.2–39.4, p < 0.03) and intensive care unit (ICU) admission (OR:9.0, CI:1.3–63.4, p < 0.03) were independent predictors of 30-day mortality. Pneumococcal disease by PCV 13 covered serotypes; in particular, 19F and 3 are still prominent in adults. Strengthening targeted adult vaccination may be necessary in order to reduce disease burden.
Highlights
Pneumonia accounted for 18.9% of all deaths in Hong Kong in 2019 and has remained the second most common cause of death after cancers since 2012 [1]
Adult patients in the age group 16 years to 99 years were reviewed from cases in which Streptococcus pneumoniae (SP) was isolated during admission to the Prince of Wales Hospital, Hong Kong (PWH) and fulfilled the definition for pneumococcal infection based on the diagnoses from the electronic medical records from January 2009–December 2017
The proportion of patients with chronic obstructive pulmonary disease (COPD), a history of tuberculosis, hypertension, ischaemic heart disease, congestive cardiac failure and dementia was higher in patients who were ≥75 years
Summary
Pneumonia accounted for 18.9% of all deaths in Hong Kong in 2019 and has remained the second most common cause of death after cancers since 2012 [1]. Despite the wide availability of pneumococcal vaccines, Streptococcus pneumoniae (SP) remains the commonest bacterial pathogen associated with pneumonia and represents 12% of all adult community-acquired pneumonia (CAP) with confirmed aetiologies [2]. The pneumococcal conjugate vaccine, PCV7, was included in Hong Kong’s universal childhood immunisation in 2009 and switched to PCV13 in December 2011. Prior to this time, the vaccine had been available in the private sector. The incidence of IPD has ranged from 1.7–2.9/100,000 population during this postintroduction period [3]. While the incidence among infants has decreased, serotype replacement has been noted, and serotype 3 disease still occurs despite this serotype being included in PCV13
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