Risk factor profiles and clinical outcomes for children and adults with pneumococcal infections in Singapore: A need to expand vaccination policy?

Abstract

Invasive pneumococcal infection is a major cause of morbidity and mortality worldwide despite the availability of pneumococcal vaccines. The aim of this study was to re-evaluate the clinical syndromes, prognostic factors and outcomes for pneumococcal disease in adults and children in Singapore during the period before and after the introduction of the pneumococcal vaccine. We retrospectively analyzed a large cohort of patients admitted to the four main public hospitals in Singapore with S. pneumoniae infection between 1997 and 2013. A total of 889 (64% of all isolates identified in the clinical laboratories) cases were included in the analysis; 561 (63.1%) were adult (≥16 years) cases with a median age of 62 years and 328 (36.9%) were paediatric cases with a median age of 3 years. Bacteraemic pneumonia was the most common syndrome in both groups (69.3% vs. 44.2%), followed by primary bacteraemia without pneumonia (14.3% vs. 13.4%), meningitis (6.4% vs. 7.6%) and non-bacteraemic pneumonia (5.2% vs. 21%). The major serotypes in adults were 3, 4, 6B, 14, 19F and 23F whereas in children they were 14, 6B and 19F, accounting both for nearly half of pneumococcal disease cases. No particular serotype was associated with mortality or severity of the pneumococcal disease. Overall mortality rate was 18.5% in adults and 3% in children. Risk factors for mortality included acute cardiac events in adults, meningitis in children and critical illness and bilateral pulmonary infiltrates in both adults and children. Penicillin resistance was not associated with increased mortality. Our results agree with global reports that the course of pneumococcal disease and its clinical outcome were more severe in adults than in children. The main serotypes causing invasive disease were mostly covered by the vaccines in use. The high mortality rates reflect an urgent need to increase vaccination coverage in both adults and children to tackle this vaccine-preventable infection.

Missed Pneumococcal Vaccination Opportunities in Adults With Invasive Pneumococcal Disease in a Community Health System

“…The observed in-hospital mortality of 20.1% is similar to inpatient mortality rates reported in other studies [ 1 , 2 , 18 ]. Previous data support that mortality in IPD increases as the number of risk factors increases, which is known as risk stacking; patients with ≥2 risk factors appear to be at higher risk for disease and mortality [ 16 , 17 ].…”

“…Serotypes contained in pneumococcal 13-valent conjugate vaccine (PPV13): 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 19A, 19F, 23F. Serotypes contained in pneumococcal polysaccharide vaccine (PPSV23): 1, 2, 3, 4,5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F [ 18 ].…”

Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020

“…However, these networks mainly focus on AMR surveillance in adult populations, instead of addressing that in children. Additionally, the prevalence distributions and AMR patterns of bacteria isolated from children are quite unlike those from adults, because children are not just “little adults” in the AMR era ( 11 – 13 ). Taking Streptococcus pneumoniae as an example, the rate of S. pneumoniae carriage is high in children but low in adults (53% versus 4%), and S. pneumoniae serotype distribution and antibiotic resistance patterns are also very different between adults and children ( 14 , 15 ).…”

Heparin-based blood purification attenuates organ injury in baboons with Streptococcus pneumoniae pneumonia

“…Sepsis due to bacterial pneumonia is a leading cause of death in the United States and worldwide, particularly in adults over 65 yr of age (1-3). The most frequently identified pathogen in community-acquired bacterial pneumonia is Streptococcus pneumoniae, a virulent organism responsible for high rates of septic shock, bacteremia, respiratory failure, and $18% mortality rate among hospitalized patients (3)(4)(5)(6). Although sepsis mortality is improved by early initiation of antibiotics (7,8), antibiotic eradication of the infection is often insufficient for clinical recovery, and bactericidal antibiotics may even worsen inflammation temporarily by lysing bacterial cells, releasing pathogen-associated molecular patterns (PAMPs), and exaggerating the systemic inflammatory response syndrome (SIRS) (9)(10)(11)(12)(13)(14).…”