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  • Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013–2023) and the role of serotype 3

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Respiratory infection
Original research
Pneumococcal pneumonia trends in adults hospitalised with community-acquired pneumonia over 10 years (2013–2023) and the role of serotype 3
  1. Louise Lansbury1,2,
  2. Tricia M McKeever1,2,
  3. Hannah Lawrence1,2,
  4. Harry Pick1,3,
  5. Vadsala Baskaran1,2,
  6. Rochelle Edwards-Pritchard1,2,
  7. Laura Matthews2,
  8. Helen Bailey2,
  9. Deborah Ashton2,
  10. Lesley Bendall2,
  11. Chamira Rodrigo3,
  12. Priya Daniel4,
  13. David Litt5,6,
  14. Seyi Eletu5,
  15. Hanshi Parmar5,
  16. Carmen Sheppard5,
  17. Shamez N Ladhani6,
  18. Caroline Trotter7,
  19. Wei Shen Lim2,3
  1. 1 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  2. 2 National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
  3. 3 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4 Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  5. 5 Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, UK
  6. 6 Immunisation and Vaccine Preventable Diseases, UK Health Security Agency, London, UK
  7. 7 Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Louise Lansbury; louise.lansbury{at}nottingham.ac.uk

Abstract

Background With higher valency pneumococcal vaccines on the horizon and new adult immunisation strategies under discussion, we aimed to evaluate the contribution of individual pneumococcal serotypes to the burden of pneumococcal community-acquired pneumonia (CAP). Over 10 years, trends in pneumococcal pneumonia epidemiology in adults hospitalised with CAP were assessed. The risk factors and severity associated with serotype 3 were examined.

Methods We conducted a prospective cohort study of adults hospitalised with CAP between September 2013 and May 2023. Pneumococcal serotypes were identified using a serotype-specific 24-valent urinary-antigen assay. Trends in the proportion of CAP due to pneumococcus and causative serotypes were compared prepandemic and postpandemic. Risk factors and severity of serotype 3 pneumonia were compared with other serotypes using logistic regression.

Results Of 5186 patients with CAP, 2193 (42.2%) had pneumococcal pneumonia. The proportion of CAP due to pneumococcus increased across all ages between 2013 and 2023 (36.4%–66.9%, p<0.001). The proportion due to serotype 3 increased significantly from 13.4% (2013) to 48.8% (2023). Serotype 3 pneumonia in adults was associated with older age (p<0.001), male sex (adjusted OR (aOR) 2.22, 95% CI 1.64 to 3.01) and chronic renal disease (aOR 1.81, 95% CI 1.09 to 3.02). Serotype 3 pneumonia was not observed to be associated with severity, critical care requirement, mortality or readmission.

Interpretation Serotype 3 is the predominant serotype in adult pneumococcal CAP and has been increasing despite a mature infant pneumococcal immunisation programme, consistent with a lack of herd protection for this serotype.

  • Pneumonia
  • Respiratory Infection
  • Bacterial Infection
  • Clinical Epidemiology

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/thorax-2024-221976

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors WSL and CS were responsible for study conception and design. HL, HPick, VB, RE-P, LM, HB, DA, LB, PD, CR, DL, SE, HParmar and SL were responsible for data acquisition and analysis. TM, LL and CT were responsible for the statistical analysis. LL and WSL drafted the initial version of the article. All authors contributed to data interpretation and read, commented on and approved the final version of the article. WSL is the guarantor.

    • Funding This study is independent research supported by the Nottingham National Institute for Health Research Biomedical Research Centre (NIHR BRC) from an unrestricted investigator-initiated research grant from Pfizer.

    • Disclaimer The study concept was developed and agreed by the authors with no input from the funding bodies; Pfizer had no part in the design or execution of the study, the analysis and interpretation of the results, the writing of this manuscript or the decision to submit for publication. The data are the sole responsibility of the authors and the sponsor for the study was Nottingham University Hospitals NHS Trust.

    • Competing interests WSL’s institution received unrestricted investigator-initiated research funding from Pfizer for the conduct of this study (please see funding statement). WSL reports research funding from NIHR for a multicentre clinical trial of aspirin in community-acquired pneumonia in which WSL is a co-applicant. WSL is Deputy Chair of the Joint Committee of Vaccination and Immunisation (JCVI) (unpaid) and unpaid Chair of the NIHR Respiratory-Translational Research Centre’s Acute Respiratory Infection National Strategy Research Group. CT participated in a CMV vaccine advisory board meeting in May 2022, unrelated to the topic of this paper. SE declares participation in a Virtual Advisory Board for a pneumococcal project organised by Sanofi Pasteur SA unrelated to the submitted work. The UK Health Security Agency (UKHSA) received monies from the University of Nottingham from an unrestricted grant from Pfizer for this work. The Vaccine Preventable Bacteria Section of UKHSA has received grants from GSK and Pfizer for investigator-led research unrelated to the current project. The UKHSA provides vaccine manufacturers (GlaxoSmithKline (GSK), MSD, Pfizer) with postmarketing surveillance reports on vaccine-preventable disease, including pneumococcal infections for which a cost recovery charge is made and which is unrelated to the submitted work. No other authors declare competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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