Multicountry Review of Streptococcus pneumoniae Serotype Distribution Among Adults With Community-Acquired Pneumonia

• Published in: The Journal of infectious diseases 2024-01, Vol.229 (1), p.282-293
• Main Authors: Grant, Lindsay R, Begier, Elizabeth, Theilacker, Christian, Barry, Rachid, Hall-Murray, Cassandra, Yan, Qi, Pope, Veneta, Pride, Michael W, Jodar, Luis, Gessner, Bradford D
• Format: Article
• Language: English
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiad379

Abstract Background Nonbacteremic community-acquired pneumonia (CAP) is a leading presentation of severe pneumococcal disease in adults. Serotype-specific urinary antigen detection (UAD) assay can detect serotypes causing pneumococcal CAP, including nonbacteremic cases, and guide recommendations for use of higher valency pneumococcal conjugate vaccines (PCVs). Methods Adult CAP serotype distribution studies that used both Pfizer UADs (UAD1, detects PCV13 serotypes; UAD2, detects PCV20 non-PCV13 serotypes plus 2, 9N, 17F, and 20) were identified by review of an internal study database and included if results were published. The percentages of all-cause radiologically confirmed CAP (RAD + CAP) due to individual or grouped (PCV13, PCV15, and PCV20) serotypes as detected from culture or UAD were reported. Results Six studies (n = 2, United States; n = 1 each, Germany, Sweden, Spain, and Greece) were included. The percentage of RAD + CAP among adults ≥18 years with PCV13 serotypes equaled 4.6% to 12.9%, with PCV15 serotypes 5.9% to 14.5%, and with PCV20 serotypes 7.8% to 23.8%. The percentage of RAD + CAP due to PCV15 and PCV20 serotypes was 1.1–1.3 and 1.3–1.8 times higher than PCV13 serotypes, respectively. Conclusions PCV13 serotypes remain a cause of RAD + CAP among adults even in settings with pediatric PCV use. Higher valency PCVs among adults could address an important proportion of RAD + CAP in this population. Urinary antigen detection assays enhanced detection of S pneumoniae community-acquired pneumonia (CAP) and detected an important fraction of CAP due to serotypes covered by PCV13 and PCV20 among adults ≥18 years from the United States, Germany, Greece, Spain, and Sweden.