Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013–18

Pick, Harry; Daniel, Priya; Rodrigo, Chamira; Bewick, Thomas; Ashton, Deborah; Lawrence, Hannah; Baskaran, Vadsala; Edwards-Pritchard, Rochelle C.; Sheppard, Carmen; Eletu, Seyi; Rose, Samuel; Litt, David; Fry, Norman K.; Ladhani, Shamez; Chand, Meera; Trotter, Caroline; McKeever, Tricia M.; Lim, Wei Shen

doi:10.1136/thoraxjnl-2019-213725

Cited by 76 publications

(104 citation statements)

References 30 publications

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“…This study is a secondary analysis of data collected from a prospective observational cohort study of consecutive adult patients with CAP admitted to 2 large university hospitals in Nottingham, UK, between September 2013 and August 2018. The primary study was designed to determine trends in pneumococcal serotypes in adults hospitalised with CAP over time; study details including epidemiological results arising over the first 10 years of study have been published previously [ 6 , 12 ]. Ethical approval for the primary study was provided by the Nottingham Research Ethics Committee (REC reference 08/H0403/80).…”

Section: Methodsmentioning

confidence: 99%

“…Study eligibility criteria, recruitment, and microbiological processes have been described in full previously [ 6 ]. Briefly, patients aged ≥16 years presenting with one or more acute lower respiratory tract symptoms, evidence of acute infiltrates consistent with respiratory infection on admission chest radiograph, and treated for a diagnosis of CAP were eligible.…”

Section: Methodsmentioning

confidence: 99%

“…Reductions in vaccine type IPD and non-invasive pneumococcal pneumonia (NIPP) in adults followed, largely due to herd protection effects [ 4 ]. However, with the emergence of replacement serotypes in the UK, recent studies have observed increases in the incidence rates of IPD and pneumococcal pneumonia due to non-PCV13 serotypes [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: A case-control test-negative design study

et al. 2020

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Background Vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is available in the United Kingdom to adults aged 65 years or older and those in defined clinical risk groups. We evaluated the vaccine effectiveness (VE) of PPV23 against vaccine-type pneumococcal pneumonia in a cohort of adults hospitalised with community-acquired pneumonia (CAP). Methods and findings Using a case-control test-negative design, a secondary analysis of data was conducted from a prospective cohort study of adults (aged ≥16 years) with CAP hospitalised at 2 university teaching hospitals in Nottingham, England, from September 2013 to August 2018. The exposure of interest was PPV23 vaccination at any time point prior to the index admission. A case was defined as PPV23 serotype-specific pneumococcal pneumonia and a control as non-PPV23 serotype pneumococcal pneumonia or nonpneumococcal pneumonia. Pneumococcal serotypes were identified from urine samples using a multiplex immunoassay or from positive blood cultures. Multivariable logistic regression was used to derive adjusted odds of case status between vaccinated and unvaccinated individuals; VE estimates were calculated as (1 − odds ratio) × 100%. Of 2,357 patients, there were 717 PPV23 cases (48% vaccinated) and 1,640 controls (54.5% vaccinated). The adjusted VE (aVE) estimate against PPV23 serotype disease was 24% (95% CI 5%–40%, p = 0.02). Estimates were similar in analyses restricted to vaccine-eligible patients ( n = 1,768, aVE 23%, 95% CI 1%–40%) and patients aged ≥65 years ( n = 1,407, aVE 20%, 95% CI −5% to 40%), but not in patients aged ≥75 years ( n = 905, aVE 5%, 95% CI −37% to 35%). The aVE estimate in relation to PPV23/non-13-valent pneumococcal conjugate vaccine (PCV13) serotype pneumonia ( n = 417 cases, 43.7% vaccinated) was 29% (95% CI 6%–46%). Key limitations of this study are that, due to high vaccination rates, there was a lack of power to reject the null hypothesis of no vaccine effect, and that the study was not large enough to allow robust subgroup analysis in the older age groups. Conclusions In the setting of an established national childhood PCV13 vaccination programme, PPV23 vaccination of clinical at-risk patient groups and adults aged ≥65 years provided moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. These findings suggest that PPV23 vaccination may continue to have an important role in adult pneumococcal vaccine policy, including the possibility of revaccination of older adults.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: A case-control test-negative design study

et al. 2020

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“…Entgegen des anfänglichen Trends nach Einführung der Impfung mit dem 13valenten Pneumokokken-Konjugatimpfstoff (PCV13) zeigen neuere Daten aus Großbritannien in den letzten Jahren eine erneute Zunahme an Pneumokokkenpneumonien. Hierbei fanden sich vermehrte Pneumokokken der nichtvakzinierten Serotypen, aber auch des Serotyps 3, der in dem Impfstoff PCV13 enthalten ist [22].…”

Section: Einteilung Respiratorischer Infektionenunclassified

Das neue Verständnis pulmonaler Infektionen

Hörster

Rupp

2019

Pneumologe

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“…One of the last major reviews of the state of antipneumococcal prevention of pneumonia in the UK and an editorial comment to it [1,2] again show the author's concern about the lack of effectiveness of the ongoing vaccination program, which does not have time to protect against the emergence of new etiological trends in the group of patients with acute inflammation in the lungs. In this regard, it is very significant that the authors determined the pneumococcal etiology of pneumonia only in 36.6% of patients, but they see prospects for improving the results of prevention in the further expansion of the spectrum of action of the antipneumococcal vaccine.…”

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confidence: 99%