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Pneumococcal epidemiology among us adults hospitalized for community-acquired pneumonia
Raul E Isturiz1, Julio Ramirez2, Wesley H Self3
1Pfizer, Inc. Collegeville, PA, USA.
Insights
Despite childhood vaccination, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes still cause significant community-acquired pneumonia (CAP) in hospitalized US adults. This persistent burden highlights the need for ongoing immunization strategies.
Area of Science:
- Infectious Diseases
- Vaccinology
- Public Health
Background:
- The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on adult pneumococcal disease burden in the US remains understudied.
- Existing data on pneumococcal serotypes primarily focus on invasive pneumococcal disease (IPD), underrepresenting the overall disease burden.
- Identifying serotypes causing adult pneumonia is crucial for refining immunization policies.
Purpose of the Study:
- To determine the proportion of community-acquired pneumonia (CAP) caused by PCV13 serotypes in hospitalized adults in the United States.
- To assess the ongoing burden of PCV13-type pneumonia in the adult population post-infant vaccination introduction.
Main Methods:
- An observational, prospective surveillance study was conducted in 21 US hospitals from October 2013 to September 2016.
- Hospitalized adults (≥18 years) with radiographically confirmed CAP (CXR+) were enrolled, with data collected on demographics and comorbidities.
- Pneumococcal serotypes were identified using respiratory culture and a Luminex-based urinary antigen detection (UAD) assay for PCV13 serotypes.
Main Results:
- The final analysis included 12,055 patients with CXR+ CAP; the mean age was 64.1 years, with 52.7% aged 65 years or older.
- PCV13 serotypes were detected in 4.6% of all patients and 4.2% of those aged ≥65 years.
- Among younger adults (18-64 years), PCV13 serotype detection rates varied from 3.8% to 5.3% based on risk status.
Conclusions:
- A notable proportion of community-acquired pneumonia in hospitalized US adults is still attributed to PCV13 serotypes.
- Despite herd protection from infant vaccination, a persistent burden of PCV13-type pneumonia exists in the adult population.
- These findings underscore the importance of continued surveillance and potential updates to adult immunization recommendations.
Background:
Few studies have measured the burden of adult pneumococcal disease after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the US infant vaccination schedule. Further, most data regarding pneumococcal serotypes are derived from invasive pneumococcal disease (IPD), which represents only a fraction of all adult pneumococcal disease burden. Understanding which pneumococcal serotypes cause pneumonia in adults is critical for informing current immunization policy. The objective of this study was to measure the proportion of radiographically-confirmed (CXR+) community-acquired pneumonia (CAP) caused by PCV13 serotypes in hospitalized US adults.
Methods:
This observational, prospective surveillance study recruited hospitalized adults aged ≥18 years from 21 acute care hospitals across 10 geographically-dispersed cities in the United States between October 2013 and September 2016. Clinical and demographic data were collected during hospitalization. Vital status was ascertained 30 days after enrollment. Pneumococcal serotypes were detected via culture from the respiratory tract and normally-sterile sites (including blood and pleural fluid). Additionally, a novel, Luminex-based serotype-specific urinary antigen detection (UAD) assay was used to detect serotypes included in PCV13.
Results:
Of 15,572 enrolled participants, 12,055 eligible patients with CXR+CAP were included in the final analysis population. Mean age was 64.1 years and 52.7% were aged ≥65 years. Common comorbidities included chronic obstructive pulmonary disease (43.0%) and diabetes mellitus (28.6%). PCV13 serotypes were detected in 552/12,055 (4.6%) of all patients and 265/6347 (4.2%) of those aged ≥65 years. Among patients aged 18-64 years PCV13 serotypes were detected in 3.8-5.3% of patients depending on their risk status.
Conclusions:
After implementation of a pneumococcal conjugate vaccination program in US children, and despite the herd protection observed in US adults, a persistent burden of PCV13-type CAP remains in this population.
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