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Epidemiology of community-acquired pneumonia in the era of extended serotype-covering multivalent pneumococcal conjugate vaccines

Authors
Heo, Jung YeonSeo, Yu BinJeong, Hye WonChoi, Min JooMin, Kyung HoonChoi, Won SukLee, JacobNoh, Ji YunCheong, Hee JinKim, Woo JooSong, Joon Young
Issue Date
17-11월-2020
Publisher
ELSEVIER SCI LTD
Keywords
Community-acquired pneumonia; Epidemiology; Incidence; Mortality; Pneumococcus
Citation
VACCINE, v.38, no.49, pp.7747 - 7755
Indexed
SCIE
SCOPUS
Journal Title
VACCINE
Volume
38
Number
49
Start Page
7747
End Page
7755
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/138897
DOI
10.1016/j.vaccine.2020.10.046
ISSN
0264-410X
Abstract
Background: South Korea has been providing 10-valent pneumococcal conjugate vaccine/(PCV10)/13-valent pneumococcal conjugate vaccine (PCV13) to children and 23-valent pneumococcal polysaccharide vaccine (PPSV23) to older adults as part of a national immunization program. Methods: From September 2015 to August 2017, a prospective cohort study was conducted for adults aged >= 19 years with community-acquired pneumonia (CAP) at four university hospitals. All-cause and pneumococcal CAP incidence and mortality rates were evaluated on the basis of hospital catchment population. Serotype distribution of pneumococcal CAP was also evaluated. Results: Among 2669 patients with CAP, 252 cases (9.4%) were pneumococcal CAP cases. The annual incidences of all-cause and pneumococcal CAP were 194.3 cases and 18.3 cases respectively, per 100,000 persons. Serotyped Streptococcus pneumoniae was identified in 107 cases (42.5%) through culture or a serotype-specific urinary antigen detection assay. Pneumococcal CAP caused by the PCV13 and PPSV23 serotypes were 50 cases (46.7% of serotyped pneumococcal CAP and 19.8% of pneumococcal CAP), and 83 cases (77.6% of serotyped pneumococcal CAP and 32.9% of pneumococcal CAP), respectively. The most prevalent serotype was 3 (n = 21, 19.6% of serotyped pneumococcal CAP), followed by 19A (n = 10, 9.3% of serotyped pneumococcal CAP) and 11A (n = 10, 9.3% of serotyped pneumococcal CAP). Compared with non-pneumococcal CAP patients, pneumococcal CAP patients were more likely to have a higher CURB65 scores (P = 0.002). The overall 30-day mortality rate of pneumococcal CAP was higher than that of non-pneumococcal CAP (6.3% versus 5.6%; odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67-1.96), but this trend was reversed in patients aged 65-74 years (4.2% versus 8.6%; OR, 0.47; 95% CI, 0.14-1.54). Conclusions: The disease burden of PCV13-serotype pneumococcal CAP remains significantly high in Korean adults, particularly among elderly people, even after a high uptake of pediatric PCVs. (C) 2020 Elsevier Ltd. All rights reserved.
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