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 38
OP 49
DO 10.1136/thoraxjnl-2019-213725
VO 75
IS 1
A1 Pick, Harry
A1 Daniel, Priya
A1 Rodrigo, Chamira
A1 Bewick, Thomas
A1 Ashton, Deborah
A1 Lawrence, Hannah
A1 Baskaran, Vadsala
A1 Edwards-Pritchard, Rochelle C
A1 Sheppard, Carmen
A1 Eletu, Seyi D
A1 Rose, Samuel
A1 Litt, David
A1 Fry, Norman K
A1 Ladhani, Shamez
A1 Chand, Meera
A1 Trotter, Caroline
A1 McKeever, Tricia M
A1 Lim, Wei Shen
YR 2020
UL http://thorax.bmj.com/content/75/1/38.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.