Multicountry Review of Streptococcus pneumoniae Serotype Distribution Among Adults With Community-Acquired Pneumonia

Abstract

Background Nonbacteremic community-acquired pneumonia (CAP) is a leading presentation of severe pneumococcal disease in adults. Serotype-specific urinary antigen detection (UAD) assay can detect serotypes causing pneumococcal CAP, including nonbacteremic cases, and guide recommendations for use of higher valency pneumococcal conjugate vaccines (PCVs). Methods Adult CAP serotype distribution studies that used both Pfizer UADs (UAD1, detects PCV13 serotypes; UAD2, detects PCV20 non-PCV13 serotypes plus 2, 9N, 17F, and 20) were identified by review of an internal study database and included if results were published. The percentages of all-cause radiologically confirmed CAP (RAD + CAP) due to individual or grouped (PCV13, PCV15, and PCV20) serotypes as detected from culture or UAD were reported. Results Six studies (n = 2, United States; n = 1 each, Germany, Sweden, Spain, and Greece) were included. The percentage of RAD + CAP among adults ≥18 years with PCV13 serotypes equaled 4.6% to 12.9%, with PCV15 serotypes 5.9% to 14.5%, and with PCV20 serotypes 7.8% to 23.8%. The percentage of RAD + CAP due to PCV15 and PCV20 serotypes was 1.1–1.3 and 1.3–1.8 times higher than PCV13 serotypes, respectively. Conclusions PCV13 serotypes remain a cause of RAD + CAP among adults even in settings with pediatric PCV use. Higher valency PCVs among adults could address an important proportion of RAD + CAP in this population.

Association between oral microbiome and five types of respiratory infections: a two-sample Mendelian randomization study in east Asian population

“…Pneumococcal pneumonia poses a significant challenge to global public health, especially in children and the elderly. Studies have shown that community-acquired pneumonia is the primary manifestation of severe pneumococcal disease in adults ( Grant et al, 2024 ), consistent with the findings of our study.…”

Strategies for pneumococcal vaccination in older adults in the coming era

“… 1 , 5 , 34–36 A recent multi-country review found that serotypes covered by PCV13 still account for 34–54% of adult pneumococcal pneumonia cases after the introduction of PCV13 in children. 35 This indicates the continued presence of PCV13 serotypes as causative agents in adult pneumonia. Furthermore, a study across 33 high-income countries revealed that PCV13 serotypes comprised 30.6% of adult IPD cases in pediatric PCV13-using countries.…”

“…Additionally, PCV15 and PCV20 offer expanded serotype coverage compared to PCV13. 5 , 35 , 37 A multi-country review estimated the serotype coverage rates for PCV15 and PCV20 to be between 43–60% and 63–72% in the adult population, respectively, after the introduction of childhood PCV13. 35 In the study evaluating high-income countries, it was found that in addition to the serotypes included in PCV13, PCV15 and PCV20 potentially cover an extra 10.6% and 34.6% of serotypes, respectively, in pediatric PCV13-using countries.…”

“… 5 , 35 , 37 A multi-country review estimated the serotype coverage rates for PCV15 and PCV20 to be between 43–60% and 63–72% in the adult population, respectively, after the introduction of childhood PCV13. 35 In the study evaluating high-income countries, it was found that in addition to the serotypes included in PCV13, PCV15 and PCV20 potentially cover an extra 10.6% and 34.6% of serotypes, respectively, in pediatric PCV13-using countries. 37 Similar trends were reported in studies on adult pneumococcal pneumonia in Japan, after the introduction of PCV13 in children, between 2018 and 2020.…”