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>
Pneumococcal epidemiology among us adults hospitalized for community-acquired pneumonia
Community; Pneumococcus; Pneumonia; Streptococcus
BACKGROUND: Few studies have measured the burden of adult pneumococcal disease after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the US infant vaccination schedule. Further, most data regarding pneumococcal serotypes are derived from invasive pneumococcal disease (IPD), which represents only a fraction of all adult pneumococcal disease burden. Understanding which pneumococcal serotypes cause pneumonia in adults is critical for informing current immunization policy. The objective of this study was to measure the proportion of radiographically-confirmed (CXR+) community-acquired pneumonia (CAP) caused by PCV13 serotypes in hospitalized US adults. METHODS: This observational, prospective surveillance study recruited hospitalized adults aged ≥18 years from 21 acute care hospitals across 10 geographically-dispersed cities in the United States between October 2013 and September 2016. Clinical and demographic data were collected during hospitalization. Vital status was ascertained 30 days after enrollment. Pneumococcal serotypes were detected via culture from the respiratory tract and normally-sterile sites (including blood and pleural fluid). Additionally, a novel, Luminex-based serotype-specific urinary antigen detection (UAD) assay was used to detect serotypes included in PCV13. RESULTS: Of 15,572 enrolled participants, 12,055 eligible patients with CXR+CAP were included in the final analysis population. Mean age was 64.1 years and 52.7% were aged ≥65 years. Common comorbidities included chronic obstructive pulmonary disease (43.0%) and diabetes mellitus (28.6%). PCV13 serotypes were detected in 552/12,055 (4.6%) of all patients and 265/6347 (4.2%) of those aged ≥65 years. Among patients aged 18-64 years PCV13 serotypes were detected in 3.8-5.3% of patients depending on their risk status. CONCLUSIONS: After implementation of a pneumococcal conjugate vaccination program in US children, and despite the herd protection observed in US adults, a persistent burden of PCV13-type CAP remains in this population.
Isturiz Raul E; Ramirez Julio; Self Wesley H; Grijalva Carlos G; Counselman Francis L; Volturo Gregory; Ostrosky-Zeichner Luis; Peyrani Paula; Wunderink Richard G; Sherwin Robert; Overcash J Scott; Oliva Senen Pena; File Thomas; Wiemken Timothy L; McLaughlin John M; Pride Michael W; Gray Sharon; Alexander Ronika; Ford Kimbal D; Jiang Qin; Jodar Luis
Vaccine
2019
2019-05
<a href="http://doi.org/10.1016/j.vaccine.2019.04.087" target="_blank" rel="noreferrer noopener">10.1016/j.vaccine.2019.04.087</a>