Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines

Thomas Benfield; Marlene Skovgaard; Henrik Carl Schønheyder; Inge Jenny Dahl Knudsen; Jette Bangsborg; Christian Østergaard Andersen; Hans-Christian Slotved; Helle Bossen Konradsen; Reimar Wernich Thomsen; Lotte Munch Lambertsen

doi:10.1371/journal.pone.0072743

Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines

Thomas Benfield, Marlene Skovgaard, Henrik Carl Schønheyder, Inge Jenny Dahl Knudsen, Jette Bangsborg, Christian Østergaard Andersen, Hans-Christian Slotved, Helle Bossen Konradsen, Reimar Wernich Thomsen, Lotte Munch Lambertsen

Department of Clinical Medicine

26 Citations (Scopus)

Abstract

Background:There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).Methods:Adults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges.Results:There were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP.Conclusions:Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.

Original language	English
Article number	e72743
Journal	P L o S One
Volume	8
Issue number	8
Pages (from-to)	1-8
Number of pages	8
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0072743
Publication status	Published - 23 Aug 2013

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10.1371/journal.pone.0072743

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Benfield, T., Skovgaard, M., Schønheyder, H. C., Knudsen, I. J. D., Bangsborg, J., Andersen, C. Ø., Slotved, H-C., Konradsen, H. B., Thomsen, R. W., & Lambertsen, L. M. (2013). Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines. P L o S One, 8(8), 1-8. [e72743]. https://doi.org/10.1371/journal.pone.0072743

Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia : Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines. / Benfield, Thomas; Skovgaard, Marlene; Schønheyder, Henrik Carl et al.

In: P L o S One, Vol. 8, No. 8, e72743, 23.08.2013, p. 1-8.

Research output: Contribution to journal › Journal article › Research › peer-review

Benfield, T, Skovgaard, M, Schønheyder, HC, Knudsen, IJD, Bangsborg, J, Andersen, CØ, Slotved, H-C, Konradsen, HB, Thomsen, RW & Lambertsen, LM 2013, 'Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines', P L o S One, vol. 8, no. 8, e72743, pp. 1-8. https://doi.org/10.1371/journal.pone.0072743

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title = "Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines",

abstract = "Background:There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).Methods:Adults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges.Results:There were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP.Conclusions:Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.",

author = "Thomas Benfield and Marlene Skovgaard and Sch{\o}nheyder, {Henrik Carl} and Knudsen, {Inge Jenny Dahl} and Jette Bangsborg and Andersen, {Christian {\O}stergaard} and Hans-Christian Slotved and Konradsen, {Helle Bossen} and Thomsen, {Reimar Wernich} and Lambertsen, {Lotte Munch}",

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T1 - Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia

T2 - Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines

AU - Benfield, Thomas

AU - Skovgaard, Marlene

AU - Schønheyder, Henrik Carl

AU - Knudsen, Inge Jenny Dahl

AU - Bangsborg, Jette

AU - Andersen, Christian Østergaard

AU - Slotved, Hans-Christian

AU - Konradsen, Helle Bossen

AU - Thomsen, Reimar Wernich

AU - Lambertsen, Lotte Munch

PY - 2013/8/23

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N2 - Background:There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).Methods:Adults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges.Results:There were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP.Conclusions:Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.

AB - Background:There is limited knowledge of serotypes that cause non-bacteremic pneumococcal pneumonia (NBP). Here we report serotypes, their associated disease potential and coverage of pneumococcal conjugate vaccines (PCV) in adults with NBP and compare these to bacteremic pneumonia (BP).Methods:Adults with pneumonia and Streptococcus pneumoniae isolated from the lower respiratory tract or blood were included 1 year in a population-based design in Denmark. Pneumonia was defined as a new infiltrate on chest radiograph in combination with clinical symptoms or elevated white blood count or plasma C-reactive protein. All isolates were serotyped using type-specific pneumococcal rabbit antisera. All values are medians with interquartile ranges.Results:There were 272 cases of NBP and 192 cases of BP. Ninety-nine percent were hospitalized. NBP and BP cases were of comparable age and sex but NBP cases had more respiratory symptoms and less severe disease compared to BP cases. In total, 46 different serotypes were identified. Among NBP cases, 5 serotypes accounted for nearly a third of isolates. PCV10 and -13 types covered 17% (95% confidence interval (CI): 11-23%) and 34% (95% CI: 25-43%) of NBP isolates, respectively. In contrast, the five most frequent serotypes accounted for two-thirds of BP isolates. PCV10 and -13 types covered 39% (95% CI: 30-48%) and 64% (95% CI: 48-79) of BP isolates, respectively. More severe NBP disease was associated with infection with invasive serotypes while there was an inverse relationship for BP.Conclusions:Only a third of cases of adult non-bacteremic pneumococcal pneumonia would potentially be preventable with the use of PCV13 and just one sixth of cases with the use of PCV10 indicating that PCVs with increased valency are needed to increase vaccine coverage for NBP in adults. PCV13 could potentially prevent two-thirds of adult bacteremic pneumococcal pneumonia.

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DO - 10.1371/journal.pone.0072743

M3 - Journal article

C2 - 24009703

SN - 1932-6203

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M1 - e72743

ER -

Serotype Distribution in Non-Bacteremic Pneumococcal Pneumonia: Association with Disease Severity and Implications for Pneumococcal Conjugate Vaccines

Abstract

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