@article {Pickthoraxjnl-2019-213725, author = {Harry Pick and Priya Daniel and Chamira Rodrigo and Thomas Bewick and Deborah Ashton and Hannah Lawrence and Vadsala Baskaran and Rochelle C Edwards-Pritchard and Carmen Sheppard and Seyi D Eletu and Samuel Rose and David Litt and Norman K Fry and Shamez Ladhani and Meera Chand and Caroline Trotter and Tricia M McKeever and Wei Shen Lim}, title = {Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013{\textendash}18}, elocation-id = {thoraxjnl-2019-213725}, year = {2019}, doi = {10.1136/thoraxjnl-2019-213725}, publisher = {BMJ Publishing Group Ltd}, abstract = {Background Changes over the last 5 years (2013{\textendash}18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown.Methods We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses.Findings Of 2934 adults hospitalised with CAP, 1075 (36.6\%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013{\textendash}18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95\% CI 1.04 to 1.21 and 1.19, 95\% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9\% serotype 3) and PPV23non13 (44.1\% serotype 8) serotypes were identified in 349 (32.5\%) and 431 (40.1\%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95\% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95\% CI 1.13 to 2.10).Interpretation The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.}, issn = {0040-6376}, URL = {https://thorax.bmj.com/content/early/2019/10/08/thoraxjnl-2019-213725}, eprint = {https://thorax.bmj.com/content/early/2019/10/08/thoraxjnl-2019-213725.full.pdf}, journal = {Thorax} }