Risk factors for death from invasive pneumococcal disease, Europe, 2010

Abstract

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were significantly associated with death. Non-pneumococcal conjugate vaccine (PCV) serotypes among children <5 years of age and 7-valent PCV serotypes among persons 5-64 years of age were associated with increased risk for death; among adults >65 years of age, risk did not differ by serotype. These findings highlight differences in case-fatality rates between serotypes and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs.

Figure 1

Flow of invasive pneumococcal disease cases through the study, Europe, 2010. *Sex was unknown for 1 patient. AST, antimicrobial susceptibility testing; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV; TESSy, The European Surveillance System.

Figure 2

Invasive pneumococcal disease study variables and PCV coverage of Streptococcus pneumoniae serotypes, Europe, 2010. A) Age group. B) Clinical presentation. C) Penicillin susceptible. D) Erythromycin susceptible. For all 4 variables, p<0.001. White bars, PCV7 serotypes; gray bars, PCV13 serotypes; black bars, non-PCV serotypes. PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV.