Abstract
BackgroundAn association between pneumococcal serotypes and mortality has been suggested. We aimed to investigate this among individuals aged ≥15 years with invasive pneumococcal disease (IPD) in South Africa.MethodsIPD cases were identified through national laboratory-based surveillance at 25 sites, pre-pneumococcal conjugate vaccine (PCV) introduction, from 2003–2008. We assessed the association between the 20 commonest serotypes and in-hospital mortality using logistic regression with serotype 4 (the third commonest serotype with intermediate case-fatality ratio (CFR)) as referent.ResultsAmong 3953 IPD cases, CFR was 55% (641/1166) for meningitis and 23% (576/2484) for bacteremia (p<0.001). Serotype 19F had the highest CFR (48%, 100/207), followed by serotype 23F (39%, 99/252) and serotype 1 (38%, 246/651). On multivariable analysis, factors independently associated with mortality included serotype 1 (OR 1.9, 95%CI 1.1–3.5) and 19F (OR 2.9, 95%CI 1.4–6.1) vs. serotype 4; increasing age (25–44 years, OR 1.8, 95%CI 1.0–3.0; 45–64 years, OR 3.6, 95%CI 2.0–6.4; ≥65 years, OR 5.2, 95%CI 1.9–14.1; vs. 15–24 years); meningitis (OR 4.1, 95%CI 3.0–5.6) vs. bacteremic pneumonia; and HIV infection (OR1.7, 95%CI 1.0–2.8). On stratified multivariate analysis, serotype 19F was associated with increased mortality amongst bacteremic pneumococcal pneumonia cases, while no serotype was associated with increased mortality in meningitis cases.ConclusionMortality was increased in HIV-infected individuals, which may be reduced by increased antiretroviral therapy availability. Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization.
Highlights
Streptococcus pneumoniae is a common cause of pneumonia, meningitis and septicemia and is associated with substantial morbidity and mortality worldwide[1, 2]
invasive pneumococcal disease (IPD) cases were identified through national laboratory-based surveillance at 25 sites, prepneumococcal conjugate vaccine (PCV) introduction, from 2003–2008
Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization
Summary
Streptococcus pneumoniae is a common cause of pneumonia, meningitis and septicemia and is associated with substantial morbidity and mortality worldwide[1, 2]. Since the introduction of pneumococcal conjugate vaccines (PCVs), a decline in the incidence of vaccine-serotype invasive pneumococcal disease (IPD) has been observed in vaccinated children and unvaccinated adults (through herd effect) in areas where the vaccine is widely used[3]. Previous studies have shown an association between pneumococcal serotypes and mortality in adults[11, 12]. These associations could differ in a middle-income country, such as South Africa, where there is a high HIV prevalence (19% in adults aged 15–49 years in 2012)[13, 14] and a greater diversity of serotypes associated with IPD[15]. We aimed to investigate this among individuals aged !15 years with invasive pneumococcal disease (IPD) in South Africa
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