Incidence Of Pneumococcal Community-acquired Pneumonia Research Articles

Decrease of Pneumococcal Community-Acquired Pneumonia Hospitalization and Associated Complications in Children after the Implementation of the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Taiwan.

The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on overall community-acquired pneumonia (CAP) and disease severity still needs thorough evaluation. In this study, we retrieve both pneumococcal CAP (P-CAP) and unspecific CAP (U-CAP) inpatient data from the Taiwan National Health Insurance Database (NHID) between 2005 and 2016. The interrupted time-series (ITS) analysis was performed to compare the incidence trend before and after the implementation of PCV13. After PCV13 implementation, there is a significant decreasing trend of P-CAP hospitalization, especially in children <1 year, 2–5 years, adults aged 19–65 years, 66 years, or older (all p value < 0.05). This corresponds to a 59% reduction in children <1 year, 47% in children aged 2–5 years, 39% in adult aged 19–65 years, and 41% in elderly aged 66 years or older. The intensive care rate (6.8% to 3.9%), severe pneumonia cases (21.7 to 14.5 episodes per 100,000 children–years), and the need for invasive procedures (4.3% to 2.0%) decreased in children aged 2–5 years (p value < 0.0001) with P-CAP. This PCV13 implementation program in Taiwan not only reduced the incidence of P-CAP, but also attenuated disease severity, especially in children aged 2–5 years.

Epidemiology of community-acquired pneumonia in the era of extended serotype-covering multivalent pneumococcal conjugate vaccines

BackgroundSouth Korea has been providing 10-valent pneumococcal conjugate vaccine/(PCV10)/13-valent pneumococcal conjugate vaccine (PCV13) to children and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to older adults as part of a national immunization program. MethodsFrom September 2015 to August 2017, a prospective cohort study was conducted for adults aged ≥19 years with community-acquired pneumonia (CAP) at four university hospitals. All-cause and pneumococcal CAP incidence and mortality rates were evaluated on the basis of hospital catchment population. Serotype distribution of pneumococcal CAP was also evaluated. ResultsAmong 2669 patients with CAP, 252 cases (9.4%) were pneumococcal CAP cases. The annual incidences of all-cause and pneumococcal CAP were 194.3 cases and 18.3 cases respectively, per 100,000 persons. Serotyped Streptococcus pneumoniae was identified in 107 cases (42.5%) through culture or a serotype-specific urinary antigen detection assay. Pneumococcal CAP caused by the PCV13 and PPSV23 serotypes were 50 cases (46.7% of serotyped pneumococcal CAP and 19.8% of pneumococcal CAP), and 83 cases (77.6% of serotyped pneumococcal CAP and 32.9% of pneumococcal CAP), respectively. The most prevalent serotype was 3 (n = 21, 19.6% of serotyped pneumococcal CAP), followed by 19A (n = 10, 9.3% of serotyped pneumococcal CAP) and 11A (n = 10, 9.3% of serotyped pneumococcal CAP). Compared with non-pneumococcal CAP patients, pneumococcal CAP patients were more likely to have a higher CURB-65 scores (P = 0.002). The overall 30-day mortality rate of pneumococcal CAP was higher than that of non-pneumococcal CAP (6.3% versus 5.6%; odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67–1.96), but this trend was reversed in patients aged 65–74 years (4.2% versus 8.6%; OR, 0.47; 95% CI, 0.14–1.54). ConclusionsThe disease burden of PCV13-serotype pneumococcal CAP remains significantly high in Korean adults, particularly among elderly people, even after a high uptake of pediatric PCVs.

Changing Epidemiology of Community-Acquired Pneumonia in the Era of Extended Serotype-Covering Multivalent Pneumococcal Conjugate Vaccines

Background: With high pneumococcal vaccine uptake rates in South Korea, the burden of community-acquired pneumonia (CAP) and serotype distribution of pneumococcal CAP may change. Methods: From September 2015 to August 2017, a prospective cohort study was conducted for Korean adults aged ≥ 19 years who were hospitalized with CAP at four university hospitals. All-cause and pneumococcal CAP incidence and mortality rates were evaluated based on the hospital catchment population. Pneumococcal CAP was identified by culture and BinaxNOW urinary antigen test. A newly developed 24 serotype-specific urinary antigen detection (UAD) assay was also used. Findings: Among 2,669 patients with medically attended CAP, 252 cases (9.4%) were pneumococcal CAP. Pneumococcal serotypes were determined in 107 cases. Annual incidence of all-cause and pneumococcal CAP were 194.3 cases and 18.3 cases per 100,000 persons, respectively. Pneumococcal CAP caused by PCV13 and PPSV23 serotypes comprised 46.7% and 77.6% of all serotypable S. pneumonia, respectively. The most prevalent serotype was 3 (19.6%), followed by 19A (9.3%) and 11A (9.3%). The overall 30-day mortality rate of pneumococcal CAP was higher than that of all-cause CAP (6.3% versus 5.7%), but the opposite was found in patients aged 65–74 years (4.2% versus 8.1%) Interpretation: Indirect herd effect from pediatric vaccination might be insufficient. To better control adult CAP, age- and risk-targeted individual PCV13 vaccination should be considered. PPSV23 might decrease the severity of pneumococcal pneumonia, thereby lowering the mortality rate in elderly patients aged 65–74 years. Funding Statement: This work was supported by a Korea University Guro Hospital grant (no. K1719481) that was underwritten by Pfizer. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was conducted after approval by Institutional Review Boards at each participating study hospital.

Serologically indicated pneumococcal pneumonia in children: a population-based study in primary care settings.

The aim of the study was to assess age-specific incidences of community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae and diagnosed serologically in a child population. The study was population-based, and prospective, and performed in primary health care settings. During a surveillance period of 12 months from 1981-1982, all pneumonia cases in a defined child population (57% urban residents) were registered prospectively. In total, 201 CAP cases were diagnosed (mean age 5.6 years; 57% boys; 58% urban residents). S. pneumoniae etiology was studied by antibody and immune complex (IC) assays to C-polysacchride (C-PS), type-specific capsular polysaccharides (CPS), and to pneumolysin (Ply), in acute and convalescent sera. Serologic evidence of S. pneumoniae etiology was indicated in 57(28%) cases, 35(61%) being mixed infections with other microbes. The distribution of pneumococcal cases was 44%, 30% and 26% in the three 5-year age groups, respectively. There were 33 (58%) males and 34 (60%) urban residents. In total, 26 cases were identified by antibody assays and 35 cases by IC assays, 26/35 being positive in acute sera. Responses to C-PS, CPS and Ply, when antibody and IC results are combined, were found equally often in 23-25 cases. The total annual incidence of pediatric S. pneumoniae CAP was 6.4/1000/year. S. pneumoniae etiology was found in 28% of the children and was similar at all ages. The incidence of pneumococcal CAP was assessed for the first time, being high (19/1000/year) in 0- to 4-year-old urban boys and rather stable (5-9/1000/year) in all other groups by age, sex and residence.