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Observational Study
. 2021 Sep 15;73(6):1075-1085.
doi: 10.1093/cid/ciab307.

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

Antoni Torres  1   2 , Rosario Menéndez  2   3 , Pedro Pablo España  4 , Jose Alberto Fernández-Villar  5 , José María Marimón  6 , Catia Cilloniz  1 , Raúl Méndez  3 , Mikel Egurrola  4 , Maribel Botana-Rial  5 , María Ercibengoa  6 , Cristina Méndez  7 , Isabel Cifuentes  7 , Bradford D Gessner  8 ; CAPA Study Group
Collaborators, Affiliations
Observational Study

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

Antoni Torres et al. Clin Infect Dis. .

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.

Keywords: PCV13 serotypes; community-acquired pneumonia; pneumococcal conjugate vaccines; pneumococcal pneumonia.

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Figures

Figure 1.
Figure 1.
Serotype distribution (%) according to underlying conditions at admission and study period in all-cause (A) and pneumococcal (B) CAP. Note: Differences related to study period 2017–2018. *P < .05; **P < .001. Abbreviations: CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; PCV, pneumococcal conjugate vaccine.
Figure 2.
Figure 2.
Serotype distribution (number of cases) in pneumococcal CAP by complications during hospitalization (≥5% in total cases). Abbreviations: CAP, community-acquired pneumonia; DPP, parapneumonic pleural effusion; ICU, intensive care unit; LoS, length of stay.
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