The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011–2018

Torres, Antoni; Menéndez, Rosário; España, Pedro Pablo; Fernández-Villar, José Alberto; Marimón, José María; Méndez, Raúl; Egurrola, Mikel; Botana-Rial, Maribel; Ercibengoa, María; Méndez, Cristina; Cifuentes, Isabel; Gessner, Bradford D.

doi:10.1093/cid/ciab307

Cited by 37 publications

(46 citation statements)

References 26 publications

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“…In our series, serotype 3 (included in PCV13 and PPV23) was the most frequent serotype among both BPP and non-BPP episodes. This is in agreement with recently published data showing that the burden of pneumonia due to PCV13 serotypes in Spain remains high, mainly due to serotype 3, which accounted for 66% of pneumonia episodes caused by vaccine types in the period 2017-2018 [16]. Similarly, serotype 3 was the leading cause of pneumococcal community-acquired pneumonia (CAP) in adults in the UK over the period 2016-2018 and the second most frequent serotype in adults that required hospitalization in the USA over 2013-2016 [17,18].…”

Section: Discussionsupporting

confidence: 93%

Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines

et al. 2021

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We studied changes in serotype distribution and antimicrobial susceptibility in adult pneumococcal pneumonia in Spain (2011–2019). Among 895 pneumococci collected (433 bacteremic [BPP] and 462 non-bacteremic [non-BPP]), serotypes 3 (17%), 19A (10%), 8 (6.7%) and 11A (6.7%) were the most frequent. Serotypes 16F, 19A and 24F were associated with old people (≥65) and serotypes 4, 7F, 8, 12F and 19F to young adults. Serotypes 12F, 24F and 1 were significantly more frequent in BPP and serotypes 11A, 23A and 19F in non-BPP. Amoxicillin resistance was higher in non-BPP (17% vs. 11%) while penicillin non-susceptibility (37% vs. 24%) and macrolide resistance (29% vs. 14%) were higher in older adults. In the period 2017–2019, the vaccine coverages were: 32% (PCV13), 39% (PCV15), 65% (PCV20) and 69% (PPV23). Differences were found in serotype composition and antimicrobial resistance by age and type of infection. The maintenance of serotype 3 as a leading cause of adult pneumococcal pneumonia and the increase in highly invasive (serotype 8) or antimicrobial-resistant (serotype 11A) serotypes is worrisome. Further studies will be required to analyse the impact of the upcoming broader conjugate vaccines.

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Section: Discussionsupporting

confidence: 93%

Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines

et al. 2021

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“…While studies in Europe have attributed 7%–14% of all community-acquired adult pneumonia cases to PCV13-serotype pneumococci using urinary antigen detection assays [ 39–41 ], US studies have obtained lower estimates, in the range of 4%–6% [ 42 , 43 ]. However, randomized and observational studies of PCV13 among older adults have consistently estimated VEs against all-cause LRTI or pneumonia end points in the range of 6%–12% [ 9 , 44–46 ], suggesting that urinary antigen detection assays may generate conservative estimates of the burden of disease attributable to PCV13-targeted serotypes.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Pneumococcal Conjugate Vaccination Against Virus-Associated Lower Respiratory Tract Infection Among Adults: A Case-Control Study

Lewnard

Bruxvoort

Hong

et al. 2022

The Journal of Infectious Diseases

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Background Interactions of Streptococcus pneumoniae with viruses feature in the pathogenesis of numerous respiratory illnesses. Methods We undertook a case-control study among adults at Kaiser Permanente Southern California between 2015-2019. Cases were diagnosed with lower respiratory tract infection (LRTI; including pneumonia or non-pneumonia LRTI diagnoses) with viral infections detected by multiplex polymerase chain reaction testing. Controls without LRTI diagnoses were matched to cases by demographic and clinical attributes. We measured vaccine effectiveness (VE) for PCV13 against virus-associated LRTI via the adjusted odds ratio of PCV13 receipt, comparing cases to controls. Results Primary analyses included 13,856 virus-associated LRTI cases and 227,887 matched controls. Receipt of PCV13 was associated with 24.9% (95% confidence interval: 18.4-30.9%) VE against virus-associated pneumonia and 21.5% (10.9-30.9%) VE against other (non-pneumonia) virus-associated LRTI. We estimated 26.8% (19.9-33.1%) and 18.6% (9.3-27.0%) VE against all virus-associated LRTI episodes diagnosed in inpatient and outpatient settings, respectively. We identified statistically-significant protection against LRTI episodes associated with influenza A and B viruses, endemic human coronaviruses, parainfluenza viruses, human metapneumovirus, and enteroviruses, but not respiratory syncytial virus or adenoviruses. Conclusions Among adults, PCV13 conferred moderate protection against virus-associated LRTI. Impacts of PCVs may be mediated, in part, by effects on polymicrobial interactions between pneumococci and respiratory viruses.

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“…Some additional factors need to be considered regarding these recommendations (Table 5) [62][63][64][65][66][67][68][69][70][71][72][73][74][75]. Environmental factors may affect the burden of pneumococcal disease and the immune response to vaccines [62].…”

Section: The Advisory Committee For Immunization Practices (Acip) Rec...mentioning

confidence: 99%

“…From references [62][63][64][65][66][67][68][69][70][71][72][73][74][75] • Burden of pneumococcal disease varies in different regions -Different rates of risk factors such as smoking, HIV, other comorbidities in the population or community…”

Section: Table 5 Additional Aspects That Need Consideration In the El...mentioning

confidence: 99%

The remarkable history of pneumococcal vaccination: an ongoing challenge

2022

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Although it varies with age and geographical distribution, the global burden of infection with Streptococcus pneumoniae (pneumococcus) remains considerable. The elderly, and younger adults with comorbid conditions, are at particularly high risk of pneumococcal infection, and this risk will increase as the population ages. Vaccination should be the backbone of our current strategies to deal with this infection.Main body: This manuscript reviews the history of the development of pneumococcal vaccines, and the impact of different vaccines and vaccination strategies over the past 111 years. It documents the early years of vaccine development in the gold mines of South Africa, when vaccination with killed pneumococci was shown to be effective, even before the recognition that different pneumococci were antigenically distinct. The development of type-specific vaccines, still with whole killed pneumococci, showed a high degree of efficacy. The identification of the importance of the pneumococcal capsule heralded the era of vaccination with capsular polysaccharides, although with the advent of penicillin, interest in pneumococcal vaccine development waned. The efforts of Austrian and his colleagues, who documented that despite penicillin therapy, patients still died from pneumococcal infection in the first 96 h, ultimately led to the licensing first of a 14-valent pneumococcal polysaccharide in 1977 followed by the 23-valent pneumococcal polysaccharide in 1983. The principal problem with these, as with other polysaccharide vaccines, was that that they failed to immunize infants and toddlers, who were at highest risk for pneumococcal disease. This was overcome by chemical linking or conjugation of the polysaccharide molecules to an immunogenic carrier protein. Thus began the era of pneumococcal conjugate vaccine (PCV), starting with PCV7, progressing to PCV10 and PCV13, and, most recently, PCV15 and PCV20. However, these vaccines remain serotype specific, posing the challenge of new serotypes replacing vaccine types. Current research addresses serotype-independent vaccines which, so far, has been a challenging and elusive endeavor.Conclusion: While there has been enormous progress in the development of pneumococcal vaccines during the past century, attempts to develop a vaccine that will retain its efficacy for most pneumococcal serotypes are ongoing.

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The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011–2018

Cited by 37 publications

References 26 publications

Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines

Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines

Effectiveness of Pneumococcal Conjugate Vaccination Against Virus-Associated Lower Respiratory Tract Infection Among Adults: A Case-Control Study

The remarkable history of pneumococcal vaccination: an ongoing challenge

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