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. 2023 Nov 16;11(11):2781.
doi: 10.3390/microorganisms11112781.

Pneumococcal Serotypes Associated with Community-Acquired Pneumonia Hospitalizations in Adults in Spain, 2016-2020: The CAPA Study

Rosario Menéndez  1   2 , Antoni Torres  2   3 , Pedro Pablo España  4 , Jose Alberto Fernández-Villar  5 , José María Marimón  6 , Raúl Méndez  1   2 , Catia Cilloniz  3   7 , Mikel Egurrola  4 , Maribel Botana-Rial  5 , María Ercibengoa  6 , Cristina Méndez  8 , Isabel Cifuentes  8 , Bradford D Gessner  9 ; CAPA Study Group
Affiliations

Pneumococcal Serotypes Associated with Community-Acquired Pneumonia Hospitalizations in Adults in Spain, 2016-2020: The CAPA Study

Rosario Menéndez et al. Microorganisms. .

Abstract

Newer higher valency pneumococcal conjugate vaccines (PCVs) have the potential to reduce the adult community-acquired pneumonia (CAP) burden. We describe the evolution and distribution of adult community-acquired pneumonia (CAP) serotypes in Spain, focusing on serotypes contained in the 20-valent PCV (PCV20). This was a prospective, observational study of chest X-ray (CXR)-confirmed CAP in immunocompetent adults hospitalized in one of four Spanish hospitals between November 2016 and November 2020. Pneumococci were isolated from cultures and detected in urine using BinaxNow® and Pfizer serotype-specific urinary antigen tests UAD1 and UAD2. We included 1948 adults hospitalized with CXR-CAP. The median age was 69.0 years (IQR: 24 years). At least one comorbidity was present in 84.8% (n = 1653) of patients. At admission, 76.1% of patients had complicated pneumonia. Pneumococcus was identified in 34.9% (n = 680) of study participants. The PCV20 vaccine-type CAP occurred in 23.9% (n = 465) of all patients, 68.4% (n = 465) of patients with pneumococcal CAP, and 82.2% (83/101) of patients who had pneumococcus identified by culture. Serotypes 8 (n = 153; 7.9% of all CAP) and 3 (n = 152; 7.8% of all CAP) were the most frequently identified. Pneumococcus is a common cause of hospitalized CAP among Spanish adults and serotypes contained in PCV20 caused the majority of pneumococcal CAP.

Keywords: PCV20 serotypes; community-acquired pneumonia; pneumococcal conjugate vaccines; pneumococcal pneumonia.

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Conflict of interest statement

The institutions of R.M. (Rosario Menéndez), A.T., P.P.E, J.A.F.-V., J.M.M., R.M. (Raúl Méndez), C.C., M.E. (María Ercibengoa), M.B.-R. and M.E. (Mikel Egurrola) have received grants from Pfizer S.L.U., Madrid, Spain, for this study. C.M. and I.C. are employees of Pfizer S.L.U., Madrid, Spain. B.D.G. is an employee of Pfizer Vaccines, Collegeville, PA, USA.

Figures

Figure 1
Figure 1
Summary of national and regional pneumococcal immunization recommendations during the study period in the areas included. 1. Ministerio de Sanidad, Servicios Sociales e Igualdad. Vacunación frente a neumococo en grupos de riesgo. Available at https://www.sanidad.gob.es/en/profesionales/saludPublica/prevPromocion/vacunaciones/programasDeVacunacion/docs/Neumococo_Gruposriesgo.pdf (accessed on 2 May 2015). 2. Ministerio de Sanidad Servicios Sociales e Igualdad. Revisión del calendario de vacunación. Ponencia de Programa y Registro de Vacunaciones. Available at https://www.sanidad.gob.es/profesionales/saludPublica/prevPromocion/vacunaciones/calendario-y-coberturas/docs/Revision_CalendarioVacunacion.pdf (accessed on 18 June 2022). 3. Consellería de Sanidade. Xunta de Galicia. Vacunación antipneumocócica en adultos 2017. Available at https://www.sergas.es/Saude-publica/Documents/4536/Nota_informativa_vacinacion_antipneumococica_2017.pdf (accessed on 21 May 2022). 4. Consellería de Sanidade. Xunta de Galicia. Nota informativa sobre a vacinación antipneumocócica conxugada en pacientes en residencias da terceira idade setembro 2020. Available at https://www.sergas.es/Saude-publica/Documents/6572/PNEUMO_CONXUGADA_RESIDENCIAS.pdf (accessed on 21 May 2015). PCV13: 13-valent pneumococcal conjugate vaccine; PPSV23: 23-valent pneumococcal polysaccharide vaccine.
Figure 2
Figure 2
Distribution of serotypes in hospitalized adults with pneumococcal pneumonia in Spain between 2016–2020 aged 18–64 years (N = 289) (A) or ≥65 years (N = 391) (B).
Figure 3
Figure 3
Serotypes associated with severity on admission or during hospitalization in bivariate analysis Only serotypes with significant values are shown in the figure. For comparisons, no serotype identified is the reference parameter. ICU: intensive care unit; OR: odds ratio; PSI: pneumonia severity index.
See this image and copyright information in PMC

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