The Evolution and Distribution of Pneumococcal Serotypes in Adults Hospitalized With Community-Acquired Pneumonia in Spain Using a Serotype-Specific Urinary Antigen Detection Test: The CAPA Study, 2011–2018
Author:
Torres Antoni12, Menéndez Rosario23ORCID, España Pedro Pablo4, Fernández-Villar Jose Alberto5, Marimón José María6, Cilloniz Catia1, Méndez Raúl3, Egurrola Mikel4, Botana-Rial Maribel5, Ercibengoa María6, Méndez Cristina7, Cifuentes Isabel7, Gessner Bradford D8, Torres A, Cilloniz C, Ceccato A, San José A, Bueno L, Marco F, Menéndez R, Méndez R, Amara I, López Hontangas J L, Montull B, Gimeno A, Gil A, Piro A, González P, Zaldivar E, Feced L, Latorre A, España P P, Egurrola M, Uranga A, Martínez de la Fuente A P, Artaraz A, Pérez N, Fernández-Villar A, Botana-Rial M, Vasallo F, Priegue A, Marimón J M, Pérez-Trallero E, Ercibengoa M, Méndez C, Cifuentes I, Balseiro C, Del Amo M, García A, Sáez J, Perianes A, Díaz A, Garijo E, Fernández E, Martínez J, Casassas R, Samaniego M L,
Affiliation:
1. Hospital Clinic, Barcelona, Spain 2. Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain 3. Hospital Universitario y Politécnico la Fe, Valencia, Spain 4. Hospital Galdakao-Usansolo, Galdakao, Spain 5. Hospital Alvaro Cunqueiro, Vigo, Spain 6. Biodonostia, Hospital Universitario Donostia, San Sebastian, Spain 7. Pfizer S.L.U., Madrid, Spain 8. Pfizer Vaccines, Collegeville, Pennsylvania, USA
Abstract
Abstract
Background
Spain introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood National Immunization Program in 2015–2016 with coverage of 3 doses of 94.8% in 2018. We assessed the evolution of all pneumococcal, PCV13 vaccine type (VT), and experimental PCV20-VT (PCV13 + serotypes 8, 10A, 11A, 12F, 15B, 22F, 33F) hospitalized community-acquired pneumonia (CAP) in adults in Spain from 2011–2018.
Methods
A prospective observational study of immunocompetent adults (≥18 years) admitted to 4 Spanish hospitals with chest X-ray–confirmed CAP between November 2011 and November 2018. Microbiological confirmation was obtained using the Pfizer serotype-specific urinary antigen detection tests (UAD1/UAD2), BinaxNow test for urine, and conventional cultures of blood, pleural fluid, and high-quality sputum.
Results
Of 3107 adults hospitalized with CAP, 1943 were ≥65 years. Underlying conditions were present in 87% (n = 2704) of the participants. Among all patients, 895 (28.8%) had pneumococcal CAP and 439 (14.1%) had PCV13-VT CAP, decreasing from 17.9% (n = 77) to 13.2% (n = 68) from 2011–2012 to 2017–2018 (P = .049). PCV20-VT CAP occurred in 243 (23.8%) of those included in 2016–2018. The most identified serotypes were 3 and 8. Serotype 3 accounted for 6.9% (n = 215) of CAP cases, remaining stable during the study period, and was associated with disease severity.
Conclusions
PCV13-VT caused a substantial proportion of CAP in Spanish immunocompetent adults 8 years after introduction of childhood PCV13 immunization. Improving direct PCV13 coverage of targeted adult populations could further reduce PCV13-VT burden, a benefit that could be increased further if PCV20 is licensed and implemented.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
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