Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
Division of Respiratory Medicine, University of Nottingham, Nottingham, UK.
Thorax. 2020 Jan;75(1):38-49. doi: 10.1136/thoraxjnl-2019-213725. Epub 2019 Oct 8.
Changes over the last 5 years (2013-18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown.
We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses.
Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013-18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10).
The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.
过去 5 年（2013-18 年），成人肺炎球菌性肺炎相关血清型以及与疫苗型疾病相关的患者群体发生了变化，这些变化在很大程度上尚不清楚。
我们对 2013 年 9 月至 2018 年 8 月期间在两家大型大学医院因社区获得性肺炎（CAP）住院的成年人进行了一项基于人群的前瞻性队列研究。使用新型 24 价尿单克隆抗体检测法和血培养来鉴定肺炎球菌血清型。通过比较国家侵袭性肺炎球菌病（IPD）数据来比较发病率趋势。通过多变量分析确定有患疫苗型肺炎（肺炎球菌结合疫苗（PCV）13 和肺炎球菌多糖疫苗（PPV）23）风险的人群。
2934 例因 CAP 住院的成年人中，有 1075 例（36.6%）患有肺炎球菌性肺炎。肺炎球菌性肺炎的年发病率从 32.2/100000 人增加到 48.2/100000 人（2013-18 年），主要是由于 PCV13 非 7 型血清型和非疫苗型（NVT）血清型肺炎的增加（发病率比 1.12，95%CI 1.04 至 1.21 和 1.19，95%CI 1.10 至 1.28）。发病趋势与 IPD 数据基本一致。349 例（32.5%）和 431 例（40.1%）肺炎球菌性肺炎患者分别检出 PCV13 非 7 型（56.9%血清型 3）和 PPV23 非 13 型（44.1%血清型 8）。PCV13 血清型肺炎（主要为血清型 3）更可能发生在英国肺炎球菌疫苗接种临床风险组的患者中（校正比值比（aOR）1.73，95%CI 1.31 至 2.28），而 PPV23 血清型肺炎更可能发生在临床风险组之外的患者中（aOR 1.54，95%CI 1.13 至 2.10）。
肺炎球菌 CAP 的发病率正在增加，主要是由于 NVT 血清型和血清型 3 引起的。PPV23 血清型肺炎更可能发生在目前未确定临床风险组之外的成年人中。
