Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013-2023) and the role of serotype 3.

Autor:	Lansbury L; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK louise.lansbury@nottingham.ac.uk.; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., McKeever TM; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Lawrence H; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Pick H; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.; Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK., Baskaran V; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Edwards-Pritchard R; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Matthews L; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Bailey H; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Ashton D; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Bendall L; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK., Rodrigo C; Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK., Daniel P; Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK., Litt D; Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK.; Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK., Eletu S; Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK., Parmar H; Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK., Sheppard C; Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK., Ladhani SN; Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK., Trotter C; Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK., Lim WS; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK.; Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2024 Dec 12. Date of Electronic Publication: 2024 Dec 12.
DOI:	10.1136/thorax-2024-221976
Abstrakt:	Background: With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined. Methods: We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression. Results: Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%-66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission. Interpretation: Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype. Competing Interests: Competing interests: WSL’s institution received unrestricted investigator-initiated research funding from Pfizer for the conduct of this study (please see funding statement). WSL reports research funding from NIHR for a multicentre clinical trial of aspirin in community-acquired pneumonia in which WSL is a co-applicant. WSL is Deputy Chair of the Joint Committee of Vaccination and Immunisation (JCVI) (unpaid) and unpaid Chair of the NIHR Respiratory-Translational Research Centre’s Acute Respiratory Infection National Strategy Research Group. CT participated in a CMV vaccine advisory board meeting in May 2022, unrelated to the topic of this paper. SE declares participation in a Virtual Advisory Board for a pneumococcal project organised by Sanofi Pasteur SA unrelated to the submitted work. The UK Health Security Agency (UKHSA) received monies from the University of Nottingham from an unrestricted grant from Pfizer for this work. The Vaccine Preventable Bacteria Section of UKHSA has received grants from GSK and Pfizer for investigator-led research unrelated to the current project. The UKHSA provides vaccine manufacturers (GlaxoSmithKline (GSK), MSD, Pfizer) with postmarketing surveillance reports on vaccine-preventable disease, including pneumococcal infections for which a cost recovery charge is made and which is unrelated to the submitted work. No other authors declare competing interests. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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