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Streptococcus pneumoniae Serotype Distribution Among US Adults Hospitalized With Community-Acquired Pneumonia,
Julio A Ramirez1,2, Robin A Hubler3, Mohammad Ali3
1Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky, USA.
Open Forum Infectious Diseases
|January 6, 2025
Summary
Pneumococcal conjugate vaccines (PCVs) serotypes caused significant community-acquired pneumonia (CAP) in US adults, even during the COVID-19 pandemic. Urinary antigen detection assays help guide PCV recommendations for preventing pneumococcal disease.
Area of Science:
- Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Community-acquired pneumonia (CAP) remains a significant public health concern in adults.
- Streptococcus pneumoniae is a leading cause of CAP, with serotype distribution influencing vaccine recommendations.
- Urinary antigen detection (UAD) assays offer a method for serotype-specific diagnosis of pneumococcal CAP.
Purpose of the Study:
- To estimate the contribution of Streptococcus pneumoniae serotypes covered by current and emerging pneumococcal conjugate vaccines (PCVs) in hospitalized adults with CAP.
- To assess the impact of the COVID-19 pandemic on the prevalence of vaccine-preventable pneumococcal serotypes causing CAP.
- To provide data for informing updated PCV recommendations in the United States.
Main Methods:
- Prospective enrollment of adults hospitalized with radiographic evidence of CAP across four US cities from November 2019 to December 2020.
- Collection of clinical data through patient interviews and medical chart reviews.
- Detection of Streptococcus pneumoniae using standard respiratory samples and blood, alongside per-protocol urine testing with BinaxNOW and UAD assays to identify specific serotypes covered by PCV13, PCV15, and PCV20.
Main Results:
- Of 2105 adults with radiographically confirmed CAP, 10.2% tested positive for Streptococcus pneumoniae.
- Pneumococcal serotypes covered by PCV13, PCV15, and PCV20 were detected in 3.0%, 3.9%, and 5.7% of participants, respectively.
- The detection rates of Streptococcus pneumoniae and PCV serotypes were higher in the pre-pandemic period (November 2019-April 2020) compared to the pandemic period (May 2020-December 2020).
Conclusions:
- Despite the COVID-19 pandemic, Streptococcus pneumoniae serotypes covered by PCVs continue to be a significant cause of adult CAP in the US.
- The findings underscore the importance of serotype-specific data for guiding PCV recommendations.
- This study establishes an epidemiologic baseline to evaluate the future impact of PCV recommendations on pneumococcal disease burden.
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