Pneumococcal conjugate serotype distribution and predominating role of serotype 3 in German adults with community-acquired pneumonia

Christina Forstner; Martin Kolditz; Miriam Kesselmeier; Santiago Ewig; Gernot Rohde; Grit Barten-Neiner; Jan Rupp; Martin Witzenrath; Tobias Welte; Mathias W Pletz; CAPNETZ study group

doi:10.1016/j.vaccine.2019.11.026

Pneumococcal conjugate serotype distribution and predominating role of serotype 3 in German adults with community-acquired pneumonia

Vaccine. 2020 Jan 29;38(5):1129-1136. doi: 10.1016/j.vaccine.2019.11.026. Epub 2019 Nov 21.

Authors

Affiliations

¹ Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria. Electronic address: christina.forstner@med.uni-jena.de.
² Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany; CAPNETZ STIFTUNG, Hannover, Germany.
³ Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
⁴ CAPNETZ STIFTUNG, Hannover, Germany; Thorax Center in the Ruhr Area, Department of Respiratory Medicine and Infectious Diseases, Evangelikal Protestant Hospital in Herne and Augusta Hospital in Bochum, Bochum, Germany.
⁵ CAPNETZ STIFTUNG, Hannover, Germany; Medical Department I, Department of Respiratory Medicine, Goethe University Hospital, Frankfurt/Main, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany.
⁶ CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany.
⁷ CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
⁸ CAPNETZ STIFTUNG, Hannover, Germany; Department of Infectious Diseases and Pulmonary Medicine, and Division of Pulmonary Inflammation, Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁹ CAPNETZ STIFTUNG, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Germany; Department of Pneumology, Hannover Medical School, Hannover, Germany.
¹⁰ Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; CAPNETZ STIFTUNG, Hannover, Germany.

PMID: 31761500
DOI: 10.1016/j.vaccine.2019.11.026

Abstract

Introduction: Implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in infant vaccination programs has substantially reduced the burden of PCV7 serotypes also in adult community-acquired pneumonia (CAP). Currently, it is unclear, if this extensive herd protection effect can be extrapolated to the additional 6 serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13), which replaced PCV7 in Germany in 2010.

Objectives: We investigated changing trends for PCV13 serotypes in adult CAP patients between three to seven years after implementation of PCV13 infant immunization in Germany.

Methods: Between December 2012 and January 2017, urine samples from German adult patients with radiologically confirmed CAP were prospectively collected by the multi-center cohort study CAPNETZ and analyzed by the serotype-specific multiplex urinary antigen detection assay (SSUAD) allowing for the detection of PCV13 serotypes.

Results: PCV13 serotypes were found in 59 of 796 (7.4%) patients with all-cause CAP, most prevalent was serotype 3 (30 of 59 patients, 50.8%). All patients with serotype 3-CAP were admitted to hospital and the majority required oxygen at admission (83.3% of patients with serotype 3-CAP versus 50.9% of patients with pneumococcal CAP by other serotypes, p = 0.005). Compared to SSUAD testing, conventional microbiological workup missed 27 of 30 (90.0%) serotype 3-CAP cases. We could not observe a time trend in the proportions of PCV13 serotypes and serotype 3 in all-cause CAP between 2013 and 2016 (OR trend per year 0.84, 95% CI 0.64-1.11 for PCV13 serotypes and OR trend per year 0.95, 95% CI 0.70-1.28 for serotype 3).

Conclusions: Conventional methods underestimate serotype 3-CAP that can cause severe disease. Changes in overall PCV13 coverage were not detected during the years 2013 to 2016, mostly driven by a high proportion of serotype 3.

Keywords: Conjugate vaccine; Herd immunity; Serotype 3; Serotype-specific urinary antigen detection assay; Streptococcus pneumoniae.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Community-Acquired Infections / microbiology
Female
Germany / epidemiology
Humans
Male
Middle Aged
Pneumococcal Vaccines
Pneumonia, Pneumococcal / epidemiology
Pneumonia, Pneumococcal / microbiology*
Serogroup*
Streptococcus pneumoniae / classification*
Urinalysis
Vaccines, Conjugate

Substances

Pneumococcal Vaccines
Vaccines, Conjugate