<i>Streptococcus pneumoniae</i>re-emerges as a cause of community-acquired pneumonia, including frequent co-infection with SARS-CoV-2, in Germany, 2021

Ankert, Juliane; Hagel, Stefan; Schwarz, Claudia; Pan, Kaijie; Wang, Liz; Eiff, Christof von; Gessner, Bradford D.; Theilacker, Christian; Pletz, Mathias W.

doi:10.1101/2022.12.15.22282988

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Vaccination can effectively reduce the risk of exacerbations, pneumonia and related hospitalisation. Respiratory pathogens can also occur as a mixed infection with a higher mortality [10,145]. Therefore, vaccination can help to prevent mixed infections even against pathogens not included in the vaccine [146].…”

Section: Discussionmentioning

confidence: 99%

The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus

Simon,

Joean,

Welte

et al. 2023

Eur Respir Rev

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Exacerbations of COPD are associated with worsening of the airflow obstruction, hospitalisation, reduced quality of life, disease progression and death. At least 70% of COPD exacerbations are infectious in origin, with respiratory viruses identified in approximately 30% of cases. Despite long-standing recommendations to vaccinate patients with COPD, vaccination rates remain suboptimal in this population.Streptococcus pneumoniaeis one of the leading morbidity and mortality causes of lower respiratory tract infections. The Food and Drug Administration recently approved pneumococcal conjugate vaccines that showed strong immunogenicity against all 20 included serotypes. Influenza is the second most common virus linked to severe acute exacerbations of COPD. The variable vaccine efficacy across virus subtypes and the impaired immune response are significant drawbacks in the influenza vaccination strategy. High-dose and adjuvant vaccines are new approaches to tackle these problems. Respiratory syncytial virus is another virus known to cause acute exacerbations of COPD. The vaccine candidate RSVPreF3 is the first authorised for the prevention of RSV in adults ≥60 years and might help to reduce acute exacerbations of COPD. The 2023 Global Initiative for Chronic Lung Disease report recommends zoster vaccination to protect against shingles for people with COPD over 50 years.

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Section: Discussionmentioning

confidence: 99%

The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus

Simon,

Joean,

Welte

et al. 2023

Eur Respir Rev

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“…For example, the prevalence of concomitant bacterial infection in COVID-19 may have changed with loosening non-pharmaceutical public health interventions. 48 The rapidly changing nature of COVID-19 may limit the generalisability of these findings to other infectious diseases, but the importance of antimicrobial stewardship considerations likely holds true regardless of the novelty of the disease. While important in principle, it is not yet clear if addressing antimicrobial stewardship and antimicrobial resistance as part of a guideline recommendation influences prescribing practice.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey

Langford,

Leung,

et al. 2023

eClinicalMedicine

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“…Currently, no RSV-related hospitalization estimates based on active surveillance and prospective testing are available for Germany. We used data from a prospective study of CAP incidence [22] to estimate RSV-related CAP and ARI hospitalization incidence, including adjustment for undiagnosed RSV infections due to use of NP/nasal swab testing only and non-CAP ARI events.…”

Section: Introductionmentioning

confidence: 99%

Estimated Incidence of Respiratory Syncytial Virus (RSV)-related Hospitalizations for Acute Respiratory Infections (ARIs), including Community Acquired Pneumonia (CAP), in Adults in Germany

Liang,

Begier,

Hagel

et al. 2024

Preprint

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BackgroundRSV is a leading cause of ARI, including CAP, in older adults, but available data often substantially underestimate incidence. We estimated RSV-related ARI hospitalization incidence from a prospective CAP study and adjusted for undiagnosed RSV infections due to use of nasopharyngeal/nasal swab testing only.MethodsWe conducted active, population-based surveillance of adult CAP hospitalizations in Thuringia (Germany) between 2021–2023. Participant nasopharyngeal/nasal swabs were RSV-tested by multiplex nucleic acid amplification testing. To estimate RSV-related CAP incidence, age-group specific proportions of RSV positivity among tested patients were applied to all-cause CAP incidence. To adjust for underdiagnosis due to nasopharyngeal/nasal swab sampling only and the percentage of ARI with pneumonia diagnoses, we used data from a large, prospective, multispecimen study assessing impact of collecting multiple specimens (nasopharyngeal/nasal swab, saliva, paired serology, and sputum) among 3,669 adults hospitalized for ARI.ResultsAmong 1,040 enrolled adults (≥18 years) with radiologically confirmed CAP, 38 tested RSV-positive via nasopharyngeal/nasal swab (3.7%). The percentage positive increased to 7.8% after adjusting for higher RSV detection with multiple specimens compared to nasopharyngeal/nasal swab only. Adjusted RSV-related CAP hospitalization rates were 4.7 (95%CI 1.5–11.2) and 109.1 (95%CI 89.6–131.6) per 100,000 adults aged 18–59 and ≥60 years, respectively. Adjusted incidences of RSV-related ARI were 18.4 (95%CI 11.0–28.9) and 377.6 (95%CI 340.5–417.7) per 100,000 adults aged 18–59 and ≥60 years, respectively. Among RSV-positive CAP hospitalizations, 12.1% of patients aged ≥65 years died within 30 days, with no deaths in those aged 18–64 years. Cardiovascular events occurred in 11.1% of patients aged 18–64 and 36.4% of those aged ≥65 years.ConclusionsOlder adults in Germany face a high burden of RSV-related ARI hospitalizations, including CAP, underscoring RSV vaccination’s potential utility for this population.KEY PUBLIC HEALTH MESSAGEWhat did you want to address in this study and why?Hospital administrative data significantly underestimate respiratory syncytial virus (RSV) incidence due to infrequent testing and lower sensitivity of single nasopharyngeal/nasal swab testing among adults. No prospective incidence studies are available for Germany and most other European countries. We aimed to estimate RSV-related acute respiratory infection (ARI) hospitalization incidence from a prospective community-acquired pneumonia (CAP) study and adjust for undiagnosed RSV infections due to limited testing and use of nasopharyngeal/nasal swab testing only. Detailed data on RSV disease burden are crucial for developing vaccination policies.What have we learnt from this study?Adjusted annual incidence of RSV-related ARI rates were 18.4 (95% CI 11.0–28.9) and 377.6 (95% CI 340.5–417.7) per 100,000 population for adults 18–59 and ≥60 years, respectively. Among RSV-positive CAP hospitalizations, 12.1% of patients aged ≥65 years died within 30 days, with no deaths in those aged 18–64 years. Cardiovascular events occurred in 11.1% of patients aged 18–64 and 36.4% of those aged ≥65 years.What are the implications of your findings for public health?Our findings are similar to recent time-series incidence results from Germany (236–363/100,000 for adults ≥60 years) and underscore the substantial burden of RSV among adults, particularly the high rate of cardiovascular events contributes to a probably underestimated burden of RSV disease.

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Streptococcus pneumoniaere-emerges as a cause of community-acquired pneumonia, including frequent co-infection with SARS-CoV-2, in Germany, 2021

Cited by 4 publications

References 13 publications

The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus

The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus

Antibiotic prescribing guideline recommendations in COVID-19: a systematic survey

Estimated Incidence of Respiratory Syncytial Virus (RSV)-related Hospitalizations for Acute Respiratory Infections (ARIs), including Community Acquired Pneumonia (CAP), in Adults in Germany

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