Expanded Analysis of 20 Pneumococcal Serotypes Associated With Radiographically Confirmed Community-Acquired Pneumonia in Hospitalized US Adults.
pneumonia; adult; 20-valent pneumococcal conjugate vaccine; serotypes; urinary antigen detection
Background: Streptococcus pneumoniae is a causative agent of community-acquired pneumonia (CAP). The 13-valent pneumococcal conjugate vaccine (PCV13) has significantly decreased the burden of PCV13-serotype pneumococcal disease; however, disease due to nonvaccine serotypes remains substantial. A recent study documented the persistence of PCV13 serotypes among US adults hospitalized with radiographically confirmed CAP. The current analysis used a recently developed urinary antigen detection (UAD) assay (UAD2) to extend these results to additional serotypes included in an investigational PCV20 vaccine.; Methods: This prospective study enrolled adults aged ≥18 years hospitalized with radiographically confirmed CAP between October 2013-September 2016. Presence of S pneumoniae was determined by blood and respiratory sample culture, BinaxNOW® urine testing, and UAD. In addition to Quellung on cultured isolates when available, serotypes were identified from urine specimens using UAD1 for PCV13 serotypes and UAD2 for 7 PCV20-unique serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F) and 4 additional serotypes (2, 9N, 17F, and 20).; Results: Among 12,055 subjects with radiographically confirmed CAP, 1482 were positive for S pneumoniae. PCV13 and PCV20-unique serotypes were associated with 37.7% (n=559) and 27.0% (n=400) of cases, respectively; 288 subjects were exclusively diagnosed as positive for S pneumoniae by UAD2. Demographic and clinical disease characteristics were similar between subjects with CAP caused by PCV13 and PCV20-unique serotypes.; Conclusions: The current analysis using UAD2 identified a sizeable proportion of hospitalized adult CAP associated with PCV20-unique serotypes. PCV20 may therefore address the burden of CAP caused by the additional serotypes present in the vaccine. (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.)
Isturiz R; Grant L; Gray S; Alexander-Parrish R; Jiang Qin; Jodar L; Peyrani P; Ford KD; Pride MW; Self Wesley H; Counselman F; Volturo G; Ostrosky-Zeichner L; Wunderink RG; Sherwin R; Overcash JS; File T; Ramirez J
Clinical Infectious Diseases
2021
2021-05-13
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journalArticle
<a href="http://doi.org/10.1093/cid/ciab375" target="_blank" rel="noreferrer noopener">10.1093/cid/ciab375</a>
Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged >= 50 Years With Community-Acquired Pneumonia
13-valent pneumococcal; care-associated pneumonia; cohort; community-acquired pneumonia; conjugate vaccine; disease; efficacy; epidemiology; healthcare-associated pneumonia; immunization; Immunology; Infectious Diseases; Microbiology; older-adults; pneumococcal serotypes; polysaccharide vaccine; population; serotype distribution; Streptococcus pneumoniae; united-states; urinary antigen detection assay
Background. Streptococcus pneumoniae causes a substantial proportion of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) in the United States. Limited data are available regarding the pneumococcal serotypes causing CAP and HCAP. Methods. Adults aged >= 50 years presenting to participating US hospitals with radiographically confirmed pneumonia between February 2010 and September 2011 were screened for inclusion. S. pneumoniae was identified using microbiological cultures, BinaxNOW (R) S. pneumoniae assay, or urine antigen detection (UAD) assay capable of detecting 13-valent pneumococcal conjugate vaccine (PCV13)-associated serotypes. Results. Among 710 subjects enrolled, the median age was 65.4 years; 54.2% of subjects were male, 22.4% of radiographically confirmed pneumonia cases were considered HCAP, and 96.6% of subjects were hospitalized. S. pneumoniae was detected in 98 subjects (13.8%) by any test, and PCV13-associated serotype(s) were identified by UAD in 78 (11.0%). Serotype 19A was most prevalent, followed by 7F/A, 3, and 5. Serotypes associated with 7-valent pneumococcal conjugate vaccine (PCV7) accounted for 25% of UAD-positive isolates. Conclusions. Pneumococcal serotypes causing noninvasive pneumonia in adults may differ significantly from those causing invasive disease, with PCV7-associated serotypes overrepresented. Serotype 5, rarely seen in contemporary surveillance of invasive disease in the United States, substantially contributed to the observed cases of S. pneumoniae-positive CAP or HCAP.
Sherwin R L; Gray S; Alexander R; McGovern P C; Graepel J; Pride M W; Purdy J; Paradiso P; File T M
Journal of Infectious Diseases
2013
2013-12
Journal Article
<a href="http://doi.org/10.1093/infdis/jit506" target="_blank" rel="noreferrer noopener">10.1093/infdis/jit506</a>