RT Journal Article
SR Electronic
T1 Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013–18
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP thoraxjnl-2019-213725
DO 10.1136/thoraxjnl-2019-213725
A1 Harry Pick
A1 Priya Daniel
A1 Chamira Rodrigo
A1 Thomas Bewick
A1 Deborah Ashton
A1 Hannah Lawrence
A1 Vadsala Baskaran
A1 Rochelle C Edwards-Pritchard
A1 Carmen Sheppard
A1 Seyi D Eletu
A1 Samuel Rose
A1 David Litt
A1 Norman K Fry
A1 Shamez Ladhani
A1 Meera Chand
A1 Caroline Trotter
A1 Tricia M McKeever
A1 Wei Shen Lim
YR 2019
UL http://thorax.bmj.com/content/early/2019/10/08/thoraxjnl-2019-213725.abstract
AB Background Changes over the last 5 years (2013–18) 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 (2013–18), 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.