Wieder-Finesod Anat, Yahav Dafna, Rubin Carmit, Hashkor Shirley, Southern Jo, Mircus Gabriel, Theilacker Christian, Dagan Ron, Regev-Yochay Gili
Infectious Diseases Unit, Sheba Medical Centre, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
Infectious Diseases Unit, Sheba Medical Centre, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel.
Clin Microbiol Infect. 2025 Feb;31(2):226-232. doi: 10.1016/j.cmi.2024.11.018. Epub 2024 Nov 15.
The 20-valent pneumococcal conjugate vaccine (PCV20) has been introduced in Israel. Its public health benefit depends on its effect on mortality caused by PCV20 serotypes not present in 13-valent pneumococcal conjugate vaccine (PCV13) (PCV20non13). We aimed to describe invasive pneumococcal disease (IPD) characteristics and case-fatality rate (CFR) among adults by serotypes.
We analysed data from the Israeli nationwide surveillance database of IPD in adults, 2009-2018. The primary outcome was in-hospital CFR within 30 days, focusing on specific serotypes. Adjusted ORs (aORs) for association between PCV20non13 serotypes and mortality were calculated using logistic regression.
Overall, 3864 IPD episodes were reported, 3733 (96.6%) with known serotype, 54% (1705/3123) were in men; 54% (1997/3733) were aged ≥65 years. PCV13-IPD cases constituted 40% of all IPD and decreased during the study years. PCV20non13 and nonPCV20 serotypes constituted 26% and 34% of cases, respectively, and increased over time. The most frequent non-PCV13 serotypes detected were PCV20non13 serotypes 8 (8%), 12F (7.2%), 22F (3%), and nonPCV20 serotype 16F (5%). In-hospital CFR was 22% (698/3140). CFR for PCV13 serotype was 21.1% (265/1255); for PCV20non13, it was 16.2% (124/766); and for nonPCV20, it was 28.5% (289/1014). Among PCV20non13 serotypes compared with PCV13 serotypes, 11A was associated with higher CFR (41%, aOR 3.1, 95% CI: 1.64-5.83), whereas serotype 8 was associated with lower CFR (8%, aOR: 0.5, 95% CI: 0.3-0.8).
PCV20non13 serotypes constituted 26% of all adult IPD in the post-PCV13 era. CFR from PCV20non13 serotype IPD was comparable with that from PCV13 serotypes. These data support the potential added benefit of PCV20 in reducing mortality from IPD, though mortality remains substantial from nonPCV20 serotypes. Future IPD-related mortality will depend on the evolution of serotype distribution over time.
20价肺炎球菌结合疫苗（PCV20）已在以色列投入使用。其公共卫生效益取决于对由13价肺炎球菌结合疫苗（PCV13）中不存在的PCV20血清型（PCV20non13）所致死亡率的影响。我们旨在按血清型描述成人侵袭性肺炎球菌疾病（IPD）的特征及病死率（CFR）。
我们分析了2009 - 2018年以色列全国成人IPD监测数据库的数据。主要结局是30天内的院内CFR，重点关注特定血清型。使用逻辑回归计算PCV20non13血清型与死亡率之间关联的调整比值比（aOR）。
总体而言，共报告了3864例IPD发作，3733例（96.6%）血清型已知，54%（1705/3123）为男性；54%（1997/3733）年龄≥65岁。PCV13-IPD病例占所有IPD的40%，且在研究期间有所下降。PCV20non13和非PCV20血清型分别占病例的26%和34%，且随时间增加。检测到的最常见非PCV13血清型为PCV20non13血清型8（8%）、12F（7.2%）、22F（3%）和非PCV20血清型16F（5%）。院内CFR为22%（698/3140）。PCV13血清型的CFR为21.1%（265/1255）；PCV20non13血清型的CFR为16.2%（124/766）；非PCV20血清型的CFR为28.5%（289/1014）。与PCV13血清型相比，PCV20non13血清型中，11A与较高的CFR相关（41%，aOR 3.1，95%CI：1.64 - 5.83），而血清型8与较低的CFR相关（8%，aOR：0.5，95%CI：0.3 - 0.8）。
在PCV13时代之后，PCV20non13血清型占所有成人IPD的26%。PCV20non13血清型IPD的CFR与PCV13血清型相当。这些数据支持PCV20在降低IPD死亡率方面的潜在附加益处，尽管非PCV20血清型的死亡率仍然很高。未来与IPD相关的死亡率将取决于血清型分布随时间的演变。
