Clinical features of adults with seven-valent-conjugated-vaccine-serotype pneumococcal pneumonia
Author(s)
Rodrigo, Chamira
Bewick, Thomas
Sheppard, Carmen
Greenwood, Sonia
Trotter, Caroline
Slack, Mary
George, Robert
Lim, Wei Shen
Griffith University Author(s)
Year published
2014
Metadata
Show full item recordAbstract
Background: Despite the reduction in adult invasive pneumococcal disease through ‘herd protection’
consequentto the introduction of childhood pneumococcal conjugate vaccination (PCV), a significant proportion
of adults continue to develop pneumococcal pneumonia caused by one of the seven serotypes
included in the seven-valent conjugated pneumococcal vaccine (PCV7). The clinical features and outcomes
of these adults have not been previously reported.
Methods: Adults recruited over a three year period to a large prospective cohort study of community
acquired pneumonia (CAP) were investigated for pneumococcal serotypes using a ...
View more >Background: Despite the reduction in adult invasive pneumococcal disease through ‘herd protection’ consequentto the introduction of childhood pneumococcal conjugate vaccination (PCV), a significant proportion of adults continue to develop pneumococcal pneumonia caused by one of the seven serotypes included in the seven-valent conjugated pneumococcal vaccine (PCV7). The clinical features and outcomes of these adults have not been previously reported. Methods: Adults recruited over a three year period to a large prospective cohort study of community acquired pneumonia (CAP) were investigated for pneumococcal serotypes using a validated multiplex immunoassay (Bio-plex). The baseline characteristics and outcomes of adults with PCV7-serotype CAP in comparison to those with non-PCV7-serotype CAP were established. Results: Pneumococcal aetiology was identified in 415 of 1166 (35.6%) individuals, and a serotype determined in 287 (69.2%). Following exclusion of three individuals with both a PCV7 and non-PCV7 serotype, 77 of the remaining 284 (27.1%) adults had CAP due to PCV7 serotypes. Adults with PCV7-serotype CAP were older (median years (inter-quartile range) 73.3 (60.8–84.4) versus 65.0 (46.1–78.0); p = 0.001) and were more likely to have a World Health Organisation performance status ≥1 (odds ratio (OR) 2.05, 95% confidence interval (CI) 1.21–3.50).The presence of stroke (adjusted OR 2.84, 95% CI 1.36–5.95) and dementia (adjusted OR 3.55, 95% CI 1.26–9.94) as underlying co-morbid illnesses were independently associated with PCV7-serotype CAP; 30-day mortality was significantly greater in adults with PCV7-serotype CAP (adjusted OR 4.38, 95% CI 1.85–10.34). Conclusion: A significant proportion of adults continue to develop PCV7-serotype CAP in the era of childhood pneumococcal conjugate vaccination. These adults are more likely to have stroke and dementia as underlying co-morbid illnesses, and have a higher 30-day mortality. A combination of pneumococcal transmission factors, host factors and pneumococcal serotype specific characteristics are likely to explain these findings.
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View more >Background: Despite the reduction in adult invasive pneumococcal disease through ‘herd protection’ consequentto the introduction of childhood pneumococcal conjugate vaccination (PCV), a significant proportion of adults continue to develop pneumococcal pneumonia caused by one of the seven serotypes included in the seven-valent conjugated pneumococcal vaccine (PCV7). The clinical features and outcomes of these adults have not been previously reported. Methods: Adults recruited over a three year period to a large prospective cohort study of community acquired pneumonia (CAP) were investigated for pneumococcal serotypes using a validated multiplex immunoassay (Bio-plex). The baseline characteristics and outcomes of adults with PCV7-serotype CAP in comparison to those with non-PCV7-serotype CAP were established. Results: Pneumococcal aetiology was identified in 415 of 1166 (35.6%) individuals, and a serotype determined in 287 (69.2%). Following exclusion of three individuals with both a PCV7 and non-PCV7 serotype, 77 of the remaining 284 (27.1%) adults had CAP due to PCV7 serotypes. Adults with PCV7-serotype CAP were older (median years (inter-quartile range) 73.3 (60.8–84.4) versus 65.0 (46.1–78.0); p = 0.001) and were more likely to have a World Health Organisation performance status ≥1 (odds ratio (OR) 2.05, 95% confidence interval (CI) 1.21–3.50).The presence of stroke (adjusted OR 2.84, 95% CI 1.36–5.95) and dementia (adjusted OR 3.55, 95% CI 1.26–9.94) as underlying co-morbid illnesses were independently associated with PCV7-serotype CAP; 30-day mortality was significantly greater in adults with PCV7-serotype CAP (adjusted OR 4.38, 95% CI 1.85–10.34). Conclusion: A significant proportion of adults continue to develop PCV7-serotype CAP in the era of childhood pneumococcal conjugate vaccination. These adults are more likely to have stroke and dementia as underlying co-morbid illnesses, and have a higher 30-day mortality. A combination of pneumococcal transmission factors, host factors and pneumococcal serotype specific characteristics are likely to explain these findings.
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Journal Title
Vaccine
Volume
32
Issue
13
Subject
Biological sciences
Agricultural, veterinary and food sciences
Biomedical and clinical sciences