Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018–20; a multicentre UK cohort study

Lansbury, Louise; Lawrence, Hannah; McKeever, Tricia M.; French, Neil; Aston, Stephen; Hill, Adam T.; Pick, Harry; Baskaran, Vadsala; Edwards-Pritchard, Rochelle C.; Bendall, Lesley; Ashton, Deborah; Butler, Jo; Daniel, Priya; Bewick, Thomas; Rodrigo, Chamira; Litt, David; Eletu, Seyi; Sheppard, Carmen L.; Fry, Norman K.; Ladhani, Shamez; Trotter, Caroline; Lim, Wei Shen

Abstract

Background: Higher-valency pneumococcal vaccines are anticipated. We aimed to describe serotype distribution and risk factors for vaccine-serotype community-acquired pneumonia (CAP) in the two years pre-SARS-CoV-2 pandemic. Methods: We conducted a prospective cohort study of adults hospitalised with CAP at three UK sites between 2018 and 2020. Pneumococcal serotypes were identified using a 24-valent urinary-antigen assay and blood cultures. Risk factors associated with vaccine-type pneumonia caused by serotypes in the 13-, 15- and 20-valent pneumococcal conjugate vaccines (PCV13, PCV15, PCV20) and 23-valent pneumococcal polysaccharide vaccine (PPV23) were determined from multivariable analysis. Findings: Of 1921 adults hospitalised with CAP, 781 (40.7%, 95% confidence intervals (CI) 38.5–42.9%) had pneumococcal pneumonia. A single PCV13-serotype was detected in 242 (31.0%, 95% CI 27.8–34.3%) pneumococcal CAP patients, mostly serotype 3 (171/242, 70.7%, 95% CI 64.5–76.0%). The additional two PCV15-serotypes were detected in 31 patients (4%, 95% CI 2.8–5.6%), and PCV20-non13-serotypes in 192 (24.6%), with serotype 8 most prevalent (123/192, 64.1%, 95% CI 57.1–70.5%). Compared to PCV13-serotype CAP, people with PCV20-non13 CAP were younger (median age 62 versus 72 years, p < 0.001) and less likely to be male (44% versus 61%, p = 0.01). PPV23-non13-serotypes were found in 252 (32.3%, 95% CI 29.1–35.6%) pneumococcal CAP patients. Interpretation: Despite mature infant pneumococcal programmes, the burden of PCV13-serotype pneumonia remains high in older adults, mainly due to serotype 3. PCV20-non13-serotype pneumonia is more likely in younger people with fewer pneumococcal risk factors. Funding: Unrestricted investigator-initiated research grant from Pfizer, United Kingdom; support from National Institute for Health Research (NIHR) Biomedical Research Centre, Nottingham.

Citation

Lansbury, L., Lawrence, H., McKeever, T. M., French, N., Aston, S., Hill, A. T., …Lim, W. S. (2024). Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018–20; a multicentre UK cohort study. Lancet Regional Health – Europe, 37, Article 100812. https://doi.org/10.1016/j.lanepe.2023.100812

• Journal Article Type: Article
• Acceptance Date: Nov 27, 2023
• Online Publication Date: Dec 11, 2023
• Publication Date: 2024-02
• Deposit Date: Nov 27, 2023
• Publicly Available Date: Dec 11, 2023
• Journal: Lancet Regional Health Europe
• Electronic ISSN: 2666-7762
• Peer Reviewed: Peer Reviewed
• Volume: 37
• Article Number: 100812
• DOI: https://doi.org/10.1016/j.lanepe.2023.100812
• Keywords: Pneumonia; Streptococcus pneumoniae; Serogroup; Pneumococcal vaccines; Risk factors
• Public URL: https://nottingham-repository.worktribe.com/output/27858502
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2666776223002314?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Pneumococcal serotypes and risk factors in adult community-acquired pneumonia 2018–20; a multicentre UK cohort study; Journal Title: The Lancet Regional Health - Europe; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.lanepe.2023.100812; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier Ltd.