Community-Acquired Pneumonia Incidence in Adults Aged 18 Years and Older in Goto City, Japan

Abstract

BackgroundFew studies have measured the burden of community-acquired pneumonia (CAP) and pneumococcal vaccine-type CAP in Japan after the introduction of the 23-valent pneumococcal polysaccharide vaccine into the adult national immunization program (NIP) for individuals ≥ 65 years of age in 2014. In this study, we estimated the incidences of CAP and Streptococcus pneumoniae CAP among Japanese adults between 2015 and 2020.Research QuestionWhat are the incidences of CAP and S pneumoniae CAP among Japanese adults? What are the common pneumococcal serotypes detected in patients with S pneumoniae CAP?Study Design and MethodsThis prospective, population-based, multicenter, active surveillance study enrolled adults ≥ 18 years of age with clinically and radiologically confirmed CAP in Goto City, Japan. S pneumoniae was detected using standard-of-care blood and sputum cultures, BinaxNOW, and serotype-specific urinary antigen detection assays.ResultsA total of 2,103 patients with CAP were enrolled; 84% were ≥ 65 years of age and 6.7% died during the study. The annual CAP, S pneumoniae CAP, 13-valent pneumococcal conjugate vaccine (PCV13) serotype CAP, and 20-valent pneumococcal conjugate vaccine (PCV20) serotype CAP incidences per 100,000 population were 1,280, 227, 63, and 110, respectively. S pneumoniae was detected in 17.8% of all patients with CAP by any detection method, with 4.9%, 5.5%, and 8.6% of cases of CAP resulting from PCV13, 15-valent pneumococcal conjugate vaccine, and PCV20 serotypes, respectively. Applying Goto’s incidence and case fatality rate to the Japanese population, assuming PCV20 has the same vaccine efficacy and duration of protection as PCV13 and if licensed in Japan for the prevention of CAP, the inclusion of PCV20 in the NIP for adults ≥ 65 years of age could prevent 29,036 cases of CAP and 2,275 CAP-related deaths per year.InterpretationGiven the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Few studies have measured the burden of community-acquired pneumonia (CAP) and pneumococcal vaccine-type CAP in Japan after the introduction of the 23-valent pneumococcal polysaccharide vaccine into the adult national immunization program (NIP) for individuals ≥ 65 years of age in 2014. In this study, we estimated the incidences of CAP and Streptococcus pneumoniae CAP among Japanese adults between 2015 and 2020. What are the incidences of CAP and S pneumoniae CAP among Japanese adults? What are the common pneumococcal serotypes detected in patients with S pneumoniae CAP? This prospective, population-based, multicenter, active surveillance study enrolled adults ≥ 18 years of age with clinically and radiologically confirmed CAP in Goto City, Japan. S pneumoniae was detected using standard-of-care blood and sputum cultures, BinaxNOW, and serotype-specific urinary antigen detection assays. A total of 2,103 patients with CAP were enrolled; 84% were ≥ 65 years of age and 6.7% died during the study. The annual CAP, S pneumoniae CAP, 13-valent pneumococcal conjugate vaccine (PCV13) serotype CAP, and 20-valent pneumococcal conjugate vaccine (PCV20) serotype CAP incidences per 100,000 population were 1,280, 227, 63, and 110, respectively. S pneumoniae was detected in 17.8% of all patients with CAP by any detection method, with 4.9%, 5.5%, and 8.6% of cases of CAP resulting from PCV13, 15-valent pneumococcal conjugate vaccine, and PCV20 serotypes, respectively. Applying Goto’s incidence and case fatality rate to the Japanese population, assuming PCV20 has the same vaccine efficacy and duration of protection as PCV13 and if licensed in Japan for the prevention of CAP, the inclusion of PCV20 in the NIP for adults ≥ 65 years of age could prevent 29,036 cases of CAP and 2,275 CAP-related deaths per year. Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Take-home PointsStudy Question: What are the incidences of community-acquired pneumonia (CAP) and Streptococcus pneumoniae CAP among Japanese adults?Results: The annual incidences of CAP and S pneumoniae CAP were high in Goto City (1,280 and 227 cases per 100,000 population, respectively) and increased with age.Interpretation: Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Study Question: What are the incidences of community-acquired pneumonia (CAP) and Streptococcus pneumoniae CAP among Japanese adults? Results: The annual incidences of CAP and S pneumoniae CAP were high in Goto City (1,280 and 227 cases per 100,000 population, respectively) and increased with age. Interpretation: Given the substantial burden of preventable pneumococcal disease, introduction of pneumococcal conjugate vaccines in Japanese adults may be of merit. Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality. Age of 65 years of older and certain medical conditions are risk factors for CAP,1Torres A. Peetermans W.E. Viegi G. Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: a literature review.Thorax. 2013; 68: 1057-1065Crossref PubMed Scopus (406) Google Scholar and the incidence and mortality of CAP are highest among the elderly.2Ramirez J.A. Wiemken T.L. Peyrani P. et al.Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812Crossref PubMed Scopus (280) Google Scholar,3Theilacker C. Sprenger R. Leverkus F. et al.Population-based incidence and mortality of community-acquired pneumonia in Germany.PLoS One. 2021; 16e0253118Crossref Scopus (15) Google Scholar With 28.7% of the Japanese population being 65 years of age or older, pneumonia was ranked the fifth leading cause of death in 2019 (77.2 deaths per 100,000 population).4Dunne E.M. Cilloniz C. von Mollendorf C. et al.Pneumococcal vaccination in adults: what can we learn from observational studies that evaluated PCV13 and PPV23 effectiveness in the same population?.Archivos de Bronconeumología. 2023; Crossref Scopus (0) Google Scholar Because Japan has become the first super-aged society in the world,5D’Ambrogio E. Japan’s aging society. European Parliament website.https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/659419/EPRS_BRI(2020)659419_EN.pdfDate accessed: September 16, 2022Google Scholar the burden of pneumonia is expected only to increase. Streptococcus pneumoniae is a leading cause of bacterial CAP. However, the use of pneumococcal conjugate vaccine (PCV) has reduced the proportion of disease attributed to S pneumoniae in children and adults.6Moore M.R. Link-Gelles R. Schaffner W. et al.Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.Lancet Infect Dis. 2015; 15: 301-309Abstract Full Text Full Text PDF PubMed Scopus (551) Google Scholar,7Sherwin R.L. Gray S. Alexander R. et al.Distribution of 13-valent pneumococcal conjugate vaccine Streptococcus pneumoniae serotypes in US adults aged ≥50 years with community-acquired pneumonia.J Infect Dis. 2013; 208: 1813-1820Crossref PubMed Scopus (0) Google Scholar In June 2010, a 7-valent PCV was introduced into the national immunization program (NIP) for children in Japan, replaced by a 13-valent PCV (PCV13) in 2013.8Yanagihara K. Kosai K. Mikamo H. et al.Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan.Int J Infect Dis. 2021; 102: 260-268Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar PCV13 coverage in Japanese children is high (> 95%), and a substantial decline (45%) in the CAP hospitalization rate has been observed among children younger than 5 years.9Takeuchi N. Naito S. Ohkusu M. et al.Epidemiology of hospitalised paediatric community-acquired pneumonia and bacterial pneumonia following the introduction of 13-valent pneumococcal conjugate vaccine in the national immunisation programme in Japan.Epidemiol Infect. 2020; 148: e91Crossref PubMed Scopus (16) Google Scholar Currently, two pneumococcal vaccines are available in Japan for adults. The 23-valent pneumococcal polysaccharide vaccine (PPSV23) was introduced into the adult NIP in October 2014 for adults ≥ 65 years of age and for adults 60 to 64 years of age with certain medical conditions.8Yanagihara K. Kosai K. Mikamo H. et al.Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan.Int J Infect Dis. 2021; 102: 260-268Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar The cumulative vaccination rate of PPSV23 among adults ≥ 65 years of age was 74% at the end of 2018.10Naito T. Suzuki M. Fujibayashi K. et al.The estimated impact of the 5-year national vaccination program on the trend of 23-valent pneumococcal polysaccharide vaccine vaccination rates in the elderly in Japan, 2009-2018.J Infect Chemother. 2020; 26: 407-410Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar In 2014, PCV13 was approved in adults ≥ 65 years of age in Japan, and in 2020, this approval was extended to include individuals 6 to 64 years of age with underlying medical conditions. However, PCV13 is not included in the adult NIP in Japan.11Fukusumi M. Chang B. Tanabe Y. et al.Invasive pneumococcal disease among adults in Japan, April 2013 to March 2015: disease characteristics and serotype distribution.BMC Infect Dis. 2017; 17: 2Crossref PubMed Scopus (37) Google Scholar Recently, higher-valent PCVs—15-valent PCV (including PCV13 serotypes plus serotypes 22F and 33F; Merck & Co., Inc.) and 20-valent PCV (PCV20; including PCV13 serotypes and seven additional serotypes: 8, 10A, 11A, 12F, 15B, 22F, and 33F; Pfizer, Inc.)—have been licensed by the US Food and Drug Administration and European Medicines Agency for use in adults ≥ 18 years of age12Committee for Medicinal Products for Human Use, European Medicines AgencySummary of opinion (initial authorisation): Apexxnar. European Medicines Agency website.https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-apexxnar_en.pdfDate accessed: September 16, 2022Google Scholar, 13Committee for Medicinal Products for Human Use, European Medicines AgencySummary of opinion (initial authorisation): Vaxneuvance. European Medicines Agency website.https://www.ema.europa.eu/en/documents/smop-initial/chmp-summary-positive-opinion-vaxneuvance_en.pdfDate accessed: September 16, 2022Google Scholar, 14Kobayashi M. Farrar J.L. Gierke R. et al.Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 109-117Crossref PubMed Scopus (87) Google Scholar and are undergoing clinical evaluations in Japan. In an aging society like Japan, it is important to understand the burden of CAP in adults and the degree to which CAP may be prevented with the current and next-generation pneumococcal vaccines. However, while studies have been conducted measuring the burden of CAP and vaccine-type (VT) CAP in Japan, the most were between and K. Suzuki M. T. et al.The burden and of pneumonia in the aging Japanese a One. 2015; Scopus Google Scholar which was PPSV23 introduction into the NIP for older adults in 2014. we the from a population-based CAP incidence study among adults in Goto City, Japan, between 2015 and 2020. the population aging rate 65 in Goto City in was than that in Japan as a in of of Japan accessed: Scholar Goto City is to Japan as the in this study are to Japan. This was a prospective, multicenter, population-based incidence study. ≥ 18 years of age in Goto City, Japan, with CAP were at all and Goto City is in the of Japan, the are ≥ 18 years of T. K. et of in Japanese Infect Dis. 2021; Scopus Google Scholar Study were between 2015 and 2020. in Goto City, including and were include in the study. The study was approved by the and was in the the patients at the and and of pneumonia were for be to be ≥ 18 years of to be a of Goto to have a of pneumonia on the of two or of the and of ≥ or of or or of or of to a pneumonia associated with on or and to be and to a were were to a after been hospitalized for ≥ at pneumonia pneumonia ≥ after PPSV23 or PCV13 the vaccine may cause urinary antigen detection or been enrolled in the study the patients were for the study, medical pneumococcal vaccination the 5 pneumonia on and clinical were were for to after The pneumococcal vaccination was to 5 years PPSV23 was introduced into the adult NIP in 2014 and the study were between 2015 and 2020. only a proportion of pneumococcal vaccination to the 5 years have a coverage The risk of at and was on the of certain medical conditions on et of pneumococcal disease in adults with medical Infect Dis. PubMed Google Scholar and on the US Advisory Committee on Immunization Practices and from were as of standard-of-care and at Goto S pneumoniae were to the for for and using the were as a for S pneumoniae antigen and were at and The are on the serotype-specific S pneumoniae in the can S pneumoniae K. et and clinical of an for additional Streptococcus pneumoniae serotype-specific in Infect Dis. 2020; 71: K. et of an for detection of Streptococcus pneumoniae serotype-specific in PubMed Scopus (87) Google Scholar The all serotypes in PCV13 and and the additional serotypes 8, 12F, and The and and were high and from patients with K. et and clinical of an for additional Streptococcus pneumoniae serotype-specific in Infect Dis. 2020; 71: K. et of an for detection of Streptococcus pneumoniae serotype-specific in PubMed Scopus (87) Google Scholar However, the and for CAP have not been of a of a for this A was as CAP if the all the was as pneumococcal CAP if the CAP and for S pneumoniae (including or or and was as PCV13 CAP or PCV20 CAP if the pneumococcal CAP with of the PCV13 serotypes or PCV20 serotypes detected by (including or the assays. analysis was were as and and and a in two and were evaluated by the were as and and a in two and were evaluated by on the of CAP, pneumococcal CAP, PCV13 CAP, and PCV20 CAP were with the on the of cases and using population of Goto et al.Pneumococcal conjugate vaccine serotype pneumococcal pneumonia in adults: a and Scopus Google Scholar per 100,000 population was by age and ≥ and by study the of PCV20 into the adult NIP in Japan, we PCV20 vaccine efficacy to be the same as that of PCV13 which is for the prevention of first of vaccine-type CAP in adults ≥ 65 years of as in the M. et conjugate vaccine pneumococcal pneumonia in J 2015; PubMed Scopus Google Scholar This was PCV20 is on the by PCV13 and the to PCV20 in adults have been to B. C. K. et clinical of the and of 20-valent pneumococcal conjugate vaccine in adults aged Infect Dis. 2022; PubMed Scopus (0) Google Scholar CAP cases preventable by the PCV20 CAP annual incidence rate from Goto City was by Japan’s population to annual PCV20 CAP cases among adults ≥ 65 years of age. the annual PCV20 CAP cases were by PCV20 of to at the of cases per preventable by CAP-related deaths preventable by the annual CAP death rate from Goto City was by Japan’s population to annual CAP deaths among adults ≥ 65 years of age. the annual CAP deaths were by the proportion of CAP cases by PCV20 serotypes and PCV20 of to at CAP-related deaths per preventable by In Japan, the use of PCV13 in adults ≥ 65 years of age is and protection pneumonia by most cases of pneumococcal in adults with E.M. Cilloniz C. von Mollendorf C. et al.Pneumococcal vaccination in adults: what can we learn from observational studies that evaluated PCV13 and PPV23 effectiveness in the same population?.Archivos de Bronconeumología. 2023; Crossref Scopus (0) Google T. Suzuki M. Fujibayashi K. et al.The estimated impact of the 5-year national vaccination program on the trend of 23-valent pneumococcal polysaccharide vaccine vaccination rates in the elderly in Japan, 2009-2018.J Infect Chemother. 2020; 26: 407-410Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar we vaccination with PCV13 or PPSV23 to have or on the of the of PCV20 patients 2,103 patients were and included in the analysis population patients were not included in the analysis the were not with CAP. The age at was patients were ≥ 65 years of and were The pneumonia on was with and of patients or respectively. The was and of patients a of to vaccination the 5 years was for of 2,103 patients with in adults 18 to 64 years of age and in adults ≥ 65 years of age. In of all patients were the duration was during the study was 6.7% and mortality was patients were ≥ 65 years of age and were 18 to 64 years of age. patients ≥ 18 years of 18 to 64 years of and ≥ 65 years of and were at risk or high and of With 65 18 at vaccine vaccine 5 PPSV23 PCV13 with and were included in the duration ≥ with hospitalization and with study end after were in to patients with of ≥ by from hospitalization to death in after are as CAP community-acquired PCV13 13-valent pneumococcal conjugate PPSV23 23-valent pneumococcal polysaccharide with and were included in the with hospitalization and with study end after were in to patients with of ≥ in a of With 65 18 risk of with ≥ with ≥ risk of risk factors in the with are as CAP community-acquired in a are as CAP community-acquired PCV13 13-valent pneumococcal conjugate PPSV23 23-valent pneumococcal polysaccharide are as CAP community-acquired all the annual incidence of CAP was cases per 100,000 CAP incidence increased with and the incidence among adults ≥ years of age was the incidence among adults 18 to 64 years of age per 100,000 population per 100,000 and the incidence among 65 to years of age per 100,000 population per 100,000 A between incidence and age was observed for pneumococcal CAP, PCV13 CAP, and PCV20 CAP. In all adults 18 to 64 years of 65 to years of and ≥ years of annual incidences per 100,000 population were 227, and for pneumococcal 63, and for PCV13 and 110, and for PCV20 CAP. the CAP incidence and the case fatality rate to Japan’s population and assuming PCV20 has the same and duration of protection as M. et conjugate vaccine pneumococcal pneumonia in J 2015; PubMed Scopus Google Scholar if PCV20 immunization in Japanese adults ≥ 65 years of age could prevent 29,036 CAP cases and 2,275 CAP-related deaths per year. 2015 and 2020, CAP incidence and pneumococcal CAP incidence for 5 during which the incidences were with study years were not in of 2,103 patients S pneumoniae was detected by in 5 of patients from a was not patients S pneumoniae was detected in patients by BinaxNOW, or S pneumoniae was detected by in of patients patients with pneumococcal by in of patients and by in of patients of patients with CAP were detected by and BinaxNOW, of patients with CAP were detected by and and 18 of patients with CAP were detected by and A total of of patients with CAP were detected by all detection of S pneumoniae by of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at pneumoniae detection by are and are are plus are plus are are plus plus are are as or CAP community-acquired urinary antigen of patients included in the CAP population with available from at of patients included in the pneumococcal CAP population with available from at are in a are as or CAP community-acquired urinary antigen patients 18 to 64 years of age and ≥ 65 years of the of S pneumoniae by any detection was and respectively. S pneumoniae serotypes were by or in of patients PCV13, 15-valent and PPSV23 serotypes were detected in patients patients patients and patients respectively. PCV13 were detected in ≥ 65 years of this was observed for 15-valent PCV PCV20 and PPSV23 the most common vaccine serotypes were and and by were the most common vaccine serotypes among patients 18 to 64 years of age and among ≥ 65 years of age. the most common serotype was of by or 65 18 pneumoniae serotypes detected by or 6 serotypes in serotypes not in PCV20 serotypes not in PPSV23 serotypes not in serotypes are as after the in case are and 15-valent pneumococcal conjugate PCV13 13-valent pneumococcal conjugate PCV20 20-valent pneumococcal conjugate pneumococcal conjugate PPSV23 23-valent pneumococcal polysaccharide urinary antigen in a are as after the in case are and 15-valent pneumococcal conjugate PCV13 13-valent pneumococcal conjugate PCV20 20-valent pneumococcal conjugate pneumococcal conjugate PPSV23 23-valent pneumococcal polysaccharide urinary antigen ≥ 65 years of age for of hospitalized patients and of patients the PPSV23 vaccination rate was between hospitalized and patients with hospitalized patients were older years and a on hospitalized patients were to have certain risk conditions and to have a mortality after study than patients S pneumoniae detection rate was between the hospitalized and patients of With at ≥ ≥ PPSV23 use 5 to to to to to to to to to in the with to of S to from to to to to from to of 65 of ≥ 65 of to ≥ of to are as CAP community-acquired not PPSV23 23-valent pneumococcal polysaccharide urinary antigen in a are as CAP community-acquired not PPSV23 23-valent pneumococcal polysaccharide urinary antigen This prospective, active surveillance study was to CAP incidence in in Japan after the introduction of PPSV23 into the adult study serotype distribution of and pneumococcal CAP cases using the assays. The annual CAP incidence was high in Goto City (1,280 cases per 100,000 increased with and was associated with a high mortality. hospitalized with pneumonia have a mortality risk at and mortality only the of J.A. Wiemken T.L. Peyrani P. et al.Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812Crossref PubMed Scopus (280) Google Scholar S pneumoniae was detected in 17.8% of all patients with CAP, and of cases were attributed to PCV13 serotypes to J.A. Wiemken T.L. Peyrani P. et al.Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality.Clin Infect Dis. 2017; 65: 1806-1812Crossref PubMed Scopus (280) Google M.R. Y. M.R. for pneumonia after a of pneumococcal J 2013; PubMed Scopus Google S. et pneumonia hospitalization among U.S. J 2015; PubMed Scopus Google Scholar that older adults were at increased risk of CAP. the highest CAP incidence was in the ≥ years age and CAP incidence among adults ≥ years of age was than adults 18 to 64 years of age and than adults 65 to years of age. adults ≥ 65 years of age for most hospitalized patients and a high proportion of deaths of hospitalization Because the population in Japan is aging E. Japan’s aging society. European Parliament website.https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/659419/EPRS_BRI(2020)659419_EN.pdfDate accessed: September 16, 2022Google Scholar the substantial CAP burden in Japan and the of vaccination S pneumoniae for the prevention of CAP. study and in to the detection and to the of S a total of cases of CAP of all pneumococcal CAP were detected by the assays. However, the are and for CAP, the and for CAP of a of for this by PCV13 or effectiveness S pneumoniae with the assays. In the clinical et of 13-valent pneumococcal conjugate vaccine impact on adult disease from a clinical in the Scopus Google Scholar and a analysis of the US M. et of 13-valent pneumococcal conjugate vaccine in US adults hospitalized with Infect Dis. Google Scholar PCV13 prevented between and of CAP among adults ≥ 65 years of age. The proportion of CAP cases prevented by PCV13 in studies is than that estimated by the as of CAP cases resulting from PCV13 serotypes in a US CAP et al.Pneumococcal among adults hospitalized for community-acquired PubMed Scopus Google Scholar a of efficacy are not available for to PCV20 serotypes detected by the the serotypes detected by are an and only the of the proportion of CAP cases resulting from S the of the the of and in the and being in the at disease F. N. Blasi F. vaccination and J Dis. 2017; Scopus Google M. et al.The impact of 13-valent pneumococcal conjugate vaccination on community-acquired pneumonia in analysis of the Infect. Full Text Full Text PDF PubMed Scopus (0) Google Scholar may the between the of CAP preventable by PCV13 on and that measured in clinical PCV13 was introduced into the Japanese NIP in 2013.8Yanagihara K. Kosai K. Mikamo H. et al.Serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae associated with invasive pneumococcal disease among adults in Japan.Int J Infect Dis. 2021; 102: 260-268Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar However, from study a of PCV13 serotype CAP in that the protection by the PCV13 program a substantial burden of PCV13 serotype CAP in the adult of higher-valent the pneumococcal CAP burden CAP resulting from PCV20 serotypes, the two most serotypes, and are to the of for the of serotype CAP, this study has this study enrolled patients from only were ≥ 65 years of age and CAP at which was from studies in M. Farrar J.L. Gierke R. et al.Use of 15-valent pneumococcal conjugate vaccine and 20-valent pneumococcal conjugate vaccine among U.S. adults: updated recommendations of the Advisory Committee on Immunization Practices - United States, 2022.MMWR Morb Mortal Wkly Rep. 2022; 71: 109-117Crossref PubMed Scopus (87) Google Scholar during the of the study were et in the incidence of invasive disease to Streptococcus and during the in and in the a analysis of surveillance 2021; Full Text Full Text PDF PubMed Google S. et in pneumococcal disease in children during the disease 2019 in associated with of pneumococcal a Infect Dis. 2022; Scopus Google Scholar patients with CAP may have not been enrolled in the study. were at the medical In this prospective, multicenter, population-based study incidence rates of CAP, pneumococcal CAP, PCV13 CAP, and PCV20 CAP after PPSV23 introduction into the adult NIP and after PCV13 introduction into the NIP in Japan. that PPSV23 use in adults and a PCV13 a high burden of CAP, pneumococcal CAP, PCV13 CAP, and PCV20 CAP among Japanese among ≥ 65 years of age. that inclusion of in the adult higher-valent may be an to to CAP cases in Japan. surveillance studies are to serotype and to pneumococcal vaccination in the This study was by Pfizer,

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