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Changes in pathogens and pneumococcal serotypes causing community-acquired pneumonia in The Netherlands
Stefan M T Vestjens1, Gertjan H J Wagenvoort2, Jan C Grutters3
1Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
Vaccine
|July 3, 2017
Summary
Pneumococcal conjugate vaccines (PCV) in infants reduced pneumococcal community-acquired pneumonia (CAP) in adults. Herd effects were observed, decreasing PCV7 serotype disease significantly in both bacteremic and non-bacteremic patients.
Area of Science:
- Infectious Diseases
- Vaccinology
- Public Health
Background:
- The introduction of pneumococcal conjugate vaccines (PCV7 in 2006, PCV10 in 2011) in the Netherlands infant immunization program aimed to reduce pneumococcal disease burden.
- Limited data exist on the comprehensive impact of PCV on the overall microbial etiology of community-acquired pneumonia (CAP) in adults.
Purpose of the Study:
- To investigate the changes in the microbial etiology of adult CAP following the introduction of PCV7 and PCV10.
- To assess the impact of PCV on the overall pneumococcal burden, including non-bacteremic pneumococcal pneumonia, and serotype distribution in adult CAP patients.
Main Methods:
- A retrospective study of hospitalized adult CAP patients across three periods: pre-PCV7 (2004-2006), PCV7 (2007-2009), and PCV10 (2012-2016).
- Extensive microbiological testing was performed, and pneumococcal CAP was diagnosed based on serotype-specific antibody response.
- Proportions of causative pathogens and pneumococcal serotype distributions were analyzed and compared across the study periods.
Main Results:
- The proportion of pneumococcal CAP in adults decreased significantly from 37% in the pre-PCV7 period to 26% in the PCV10 period (p=0.01).
- No sustained shifts were observed in the relative contribution of other pathogens like Legionella spp., Mycoplasma pneumoniae, S. aureus, H. influenzae, and respiratory viruses.
- Within pneumococcal CAP cases, a decrease in PCV7 serotype disease was noted, alongside an increase in non-PCV10 serotype disease. PCV7 serotype disease declined in both bacteremic and non-bacteremic patients.
Conclusions:
- The introduction of PCV in infants has a demonstrable impact on the microbial etiology of adult CAP.
- The findings suggest that infant vaccination programs confer herd protection against pneumococcal CAP in the adult population.
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