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Original article
Pneumococcal serotypes in adult non-invasive and invasive pneumonia in relation to child contact and child vaccination status
  1. Chamira Rodrigo1,
  2. Thomas Bewick1,
  3. Carmen Sheppard2,
  4. Sonia Greenwood1,
  5. Vanessa MacGregor3,
  6. Caroline Trotter4,
  7. Mary Slack2,
  8. Robert George2,
  9. Wei Shen Lim1
  1. 1Department of Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Respiratory and Systemic Infection Laboratory, Public Health England, Microbiology Services Division, London, UK
  3. 3Public Health England East Midlands, Derbyshire and Nottinghamshire Health Protection Team, Institute of Population Health, Nottingham City Hospital, Nottingham, UK
  4. 4Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr C Rodrigo, Department of Respiratory Medicine, David Evans Building, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG51PB, UK; chamira{at}doctors.org.uk

Abstract

Background On a population level, pneumococcal conjugate vaccination in children has reduced the incidence of vaccine-type disease in all age groups, including older adults. Few individual level studies have been performed describing the pneumococcal serotypes associated with adult community acquired pneumonia (CAP) and quantifying associations with child contact and child vaccination status.

Methods Pneumococcal serotypes were determined using a validated multiplex immunoassay (Bio-Plex) in a large prospective cohort of adults hospitalised with CAP. Child (<16 years old) contact history and child pneumococcal vaccination status were obtained from patients and public health records, respectively.

Results Of 1130 participants, 329 (29.1%) reported child contact, and pneumococcal infection was identified in 410 (36.3%). Pneumococcal CAP was commoner in adults with child contact (148/329 (45.0%) vs 262/801 (32.7%); adjusted OR 1.63, CI 1.25 to 2.14; p<0.001). A serotype was determined in 263 of 410 (64.1%) adults with pneumococcal CAP; 112 (42.6%) reported child contact, 38 (33.9%) with a vaccinated child. Adults in contact with a vaccinated child were significantly less likely to have vaccine-type CAP compared with adults in contact with an unvaccinated child (6 of 38 (15.8%) vs 25 of 74 (33.8%), respectively; OR 0.37, 95% CI 0.14 to 0.99; p=0.044).

Conclusions Pneumococcal aetiology in adult CAP is independently associated with child contact and implicated serotypes are influenced by child vaccination status. This is the first study to demonstrate these associations at an individual rather than population level; it affirms that ‘herd protection’ from childhood vaccination extends beyond adult invasive disease to pneumococcal CAP.

  • Pneumonia
  • Respiratory Infection
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