Abstract
BackgroundThere is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).MethodsAdults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges.ResultsThere were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP.ConclusionsOnly a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.
Highlights
Pneumonia is a leading cause of morbidity and mortality globally
Of the 472 included individuals with a radiographic infiltrate, 280 had S. pneumoniae isolated from an airway sample and clinical and laboratory criteria compatible with bacterial pneumonia (NBP)
We show that the serotype distribution of nonbacteremic and bacteremic pneumococcal pneumonia differ substantially
Summary
Pneumonia is a leading cause of morbidity and mortality globally. Annual rates of hospitalization for community-acquired pneumonia (CAP) range from 2 to 4 per 1000 adult population in Europe [1,2]. Data from a predominantly HIV-infected population, indicated that PCV7 was highly efficacious in preventing adults from reinfection with S. pneumoniae but the study did not distinguish between bacteremic and non-bacteremic pneumonia [7]. There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP). Conclusions: Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent twothirds of adult bacteremic pneumococcal pneumonia
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