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
Antoní Torres, Rosario Menéndez, Pedro Pablo España, José Alberto Fernández-Villar, José María Marimón, Catia Cillóniz, Raúl Méndez, Mikel Egurrola, Maribel Botana‐Rial, María Ercibengoa, Cristina Méndez, Isabel Cifuentes, Bradford D. Gessner, CAPA Study Group, Antoní Torres, Catia Cillóniz, Adrián Ceccato, Ashna Jose, Leticia Bueno, Francesc Marco, Rosario Menéndez, Raúl Méndez, Ibrahim Amara, J L López Hontangas, Beatriz Montull, Alejandra Gimeno, Alain Manuel Chaple Gil, Alba Piró, Pedro González, Enrique Zaldívar, L Feced, A. Latorre, Pedro Pablo España, Mikel Egurrola, Ane Uranga, Ana Patricia Martínez de la Fuente, Amaia Artaraz, N Pérez, Alberto Fernández‐Villar, Maribel Botana‐Rial, Francisco J. Vasallo, A Priegue, José María Marimón, Emilio Pérez‐Trallero, María Ercibengoa, Cristina Méndez, Isabel Cifuentes, César Balseiro, María del Amo, Ana García, Jaime Sáez, A Perianes, Álvaro Díaz, E. Garijo, Elvira Fernández, J Martínez, R Casassas, M L Samaniego
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.