Hospital Clinic, Barcelona, Spain.
Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain.
Clin Infect Dis. 2021 Sep 15;73(6):1075-1085. doi: 10.1093/cid/ciab307.
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.
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.
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.
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.
西班牙于 2015-2016 年在儿童国家免疫计划中引入了 13 价肺炎球菌结合疫苗（PCV13），2018 年覆盖率为 3 剂 94.8%。我们评估了西班牙 2011-2018 年所有肺炎球菌、PCV13 疫苗型（VT）和实验性 PCV20-VT（PCV13+血清型 8、10A、11A、12F、15B、22F、33F）住院社区获得性肺炎（CAP）在成年人中的演变。
对 2011 年 11 月至 2018 年 11 月期间在西班牙 4 家医院因胸部 X 射线证实的 CAP 而住院的免疫功能正常的成年人（≥18 岁）进行前瞻性观察性研究。微生物学确认采用辉瑞血清型特异性尿抗原检测试验（UAD1/UAD2）、BinaxNow 尿液检测试验和血液、胸腔积液和高质量痰液的常规培养。
3107 名因 CAP 住院的成年人中，1943 名年龄≥65 岁。87%（n=2704）的参与者存在潜在疾病。在所有患者中，895 名（28.8%）患有肺炎球菌性 CAP，439 名（14.1%）患有 PCV13-VT CAP，从 2011-2012 年的 17.9%（n=77）到 2017-2018 年的 13.2%（n=68）（P=0.049）。2016-2018 年纳入的患者中有 243 例（23.8%）发生 PCV20-VT CAP。最常见的血清型为 3 型和 8 型。血清型 3 占 CAP 病例的 6.9%（n=215），在研究期间保持稳定，与疾病严重程度相关。
PCV13-VT 在西班牙免疫功能正常的成年人中引起了相当一部分 CAP，这是在引入儿童 PCV13 免疫接种 8 年后发生的。提高目标成人人群的直接 PCV13 覆盖率可以进一步降低 PCV13-VT 负担，如果 PCV20 获得许可并实施，这种益处可以进一步增加。
