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Volume 3, Issue 12

Pneumococcal serotypes causing non-invasive pneumonia in adults from a South Indian tertiary care hospital and the impact of the newer conjugate vaccines Open Access

Abstract

is the leading cause of community-acquired pneumonia (CAP) in adults. Ageing, chronic conditions and comorbidities are important risk factors for pneumococcal pneumonia.

There is lack of data on the pneumococcal serotypes causing non-invasive pneumonia in India. This study aims to determine the prevalent pneumococcal serotypes causing non-invasive pneumonia, the associated comorbidities, and the coverage of both the available pneumococcal vaccines in India and conjugate vaccines that are currently undergoing clinical trials.

A total of 280 subjects (aged >16 years) who had clinical symptoms correlating with radiological findings for non-invasive bacteremic pneumonia and microbiological evidence of between 2018 and 2020 were included. The clinical, demographic, radiological and microbiological findings were retrieved from the Hospital Information System (HIS).

The common serotypes in order of prevalence were 19F, 9V, 23F, 6B, 11A, 13, 34, 10A, 19A and 6A. The predominant non-vaccine serotypes were 13, 34, 35B, 31 and 16F. The associated radiological findings were pneumonic consolidation and multi-lobar involvement. Other coinfected bacterial pathogens included , and .

The pneumococcal vaccines: PCV10/GSK, PCV10/SII, PCV13, PCV15, PCV20 and PPSV23 provide an overall serotype coverage of 36, 41, 47, 48, 61 and 69 %, respectively of causing non-invasive pneumonia in South India. Increasing catch-up vaccination using PCV10(SII) in pre-school children could have a more significant impact on reducing pneumococcal pneumonia in adults (>50 years) in terms of increased herd immunity at an affordable cost.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): adults , India , non-invasive pneumonia , PCV , PPSV and S. pneumoniae
© 2021 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial License.
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2021-12-07
2024-04-26
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References

  1. Troeger C. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis 2017; 17:1133–1161 [View Article] [PubMed]
     [Google Scholar]
  2. Ramasubramanian V. Pneumococcal disease in older adults-an overview. J Assoc Physicians India 2015; 63:12
     [Google Scholar]
  3. Morton JB, Morrill HJ, LaPlante KL, Caffrey AR. Risk stacking of pneumococcal vaccination indications increases mortality in unvaccinated adults with Streptococcus pneumoniae infections. Vaccine 2017; 35:1692–1697 [View Article] [PubMed]
     [Google Scholar]
  4. Koul PA, Chaudhari S, Chokhani R, Christopher D, Dhar R et al. Pneumococcal Disease Burden from an Indian Perspective: Need for its Prevention in Pulmonology Practice Lung India: Official Organ of Indian Chest Society; 2019 p 216
     [Google Scholar]
  5. van Werkhoven CH. Herd effects of child vaccination with pneumococcal conjugate vaccine against pneumococcal non-invasive community-acquired pneumonia: What is the evidence?. Hum Vaccines Immunother 2017; 13:1177–1181
     [Google Scholar]
  6. Weinberger DM, Pitzer VE, Regev-Yochay G, Givon-Lavi N, Dagan R. Association between the decline in pneumococcal disease in unimmunized adults and vaccine-derived protection against colonization in toddlers and preschool-aged children. Am J Epidemiol 2019; 188:160–168 [View Article] [PubMed]
     [Google Scholar]
  7. Varghese R, Veeraraghavan B, Jeyaraman Y, Kumar G, Arora NK et al. Pneumococcal conjugate vaccine rollout in India: Expectations and challenges. Indian J Med Microbiol 2019; 37:141
     [Google Scholar]
  8. Greenberg RN, Gurtman A, Frenck RW, Strout C, Jansen KU et al. Sequential administration of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine in pneumococcal vaccine–naïve adults 60–64 years of age. Vaccine 2014; 32:2364–2374 [View Article] [PubMed]
     [Google Scholar]
  9. Patterson S, Webber C, Patton M, Drews W, Huijts SM et al. CAPiTA Study Group. A post hoc assessment of duration of protection in CAPiTA (Community Acquired Pneumonia immunization Trial in Adults). Trials in Vaccinology 2016; 5:92–96
     [Google Scholar]
  10. Charlson ME, Pompei P, Ales KL. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383 [View Article] [PubMed]
     [Google Scholar]
  11. Kalin M, Lindberg AA, Tunevall G. Etiological diagnosis of bacterial pneumonia by gram stain and quantitative culture of expectorates: leukocytes or alveolar macrophages as indicators of sample representativity. Scand J Infect Dis 1983; 15:153–160 [View Article] [PubMed]
     [Google Scholar]
  12. Veeraraghavan B, Jayaraman R, John J, Varghese R, Neeravi A et al. Customized sequential multiplex PCR for accurate and early determination of invasive pneumococcal serotypes found in India. J Microbiol Methods 2016; 130:133–135 [View Article] [PubMed]
     [Google Scholar]
  13. Brueggemann AB, Griffiths DT, Meats E, Peto T, Crook DW et al. Clonal relationships between invasive and carriage Streptococcus pneumoniae and serotype-and clone-specific differences in invasive disease potential. J Infect Dis 2003; 187:1424–1432 [View Article] [PubMed]
     [Google Scholar]
  14. Jayaraman R, Varghese R, Kumar JL, Neeravi A, Shanmugasundaram D et al. Invasive pneumococcal disease in Indian adults: 11 years’ experience. J Microbiol Immunol Infect 2019; 52:736–742 [View Article]
     [Google Scholar]
  15. Sicras-Mainar A, Ibáñez-Nolla J, Cifuentes I, Guijarro P, Navarro-Artieda R et al. Retrospective epidemiological study for the characterization of community-acquired pneumonia and pneumococcal pneumonia in adults in a well-defined area of Badalona (Barcelona, Spain. BMC Infect Dis 2012; 12:283 [View Article] [PubMed]
     [Google Scholar]
  16. Bewick T, Sheppard C, Greenwood S, Slack M, Trotter C et al. Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia. Thorax 2012; 67:540–545 [View Article] [PubMed]
     [Google Scholar]
  17. Kanungo R, Rajalakshmi B. Serotype distribution & antimicrobial resistance in Streptococcus pneumoniae causing invasive & other infections in south India. J Med Res 2001; 114:127
     [Google Scholar]
  18. Thomas K, Kesavan LM, Veeraraghavan B, Jasmine S, Jude J et al. Invasive pneumococcal disease associated with high case fatality in India. J Clin Epidemiol 2013; 66:36–43 [View Article] [PubMed]
     [Google Scholar]
  19. Tsaban G, Ben-Shimol S. Indirect (herd) protection, following pneumococcal conjugated vaccines introduction: a systematic review of the literature. Vaccine 2017; 35:2882–2891 [View Article] [PubMed]
     [Google Scholar]
  20. Ahmed SS, Pondo T, Xing W, McGee L, Farley M et al. Early impact of 13-valent pneumococcal conjugate vaccine use on invasive pneumococcal disease among adults with and without underlying medical conditions—United States. Clin Infect Dis 2020; 70:2484–2492 [View Article] [PubMed]
     [Google Scholar]
  21. Shenoy AT, Beno SM, Brissac T, Bell JW, Novak L et al. Severity and properties of cardiac damage caused by Streptococcus pneumoniae are strain dependent. PLoS One 2018; 13:e0204032 [View Article] [PubMed]
     [Google Scholar]
  22. Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, Gomez-Bertomeu F, Figuerola-Massana E et al. Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged≥ 60 years: 3 years of follow-up in the CAPAMIS study. Clin Infect Dis 2014; 58:909–917 [View Article] [PubMed]
     [Google Scholar]
  23. Weinberger DM, Pitzer VE, Regev-Yochay G, Givon-Lavi N, Dagan R. Decline in pneumococcal disease in unimmunized adults is associated with vaccine-associated protection against colonization in toddlers and preschool-aged children. BioRxiv 2018; 1:293266
     [Google Scholar]
  24. Eshwara VK, Mukhopadhyay C, Rello J. Community-acquired bacterial pneumonia in adults: An update. Indian Journal of Medical Research 2020; 151:287 [View Article]
     [Google Scholar]
  25. Ghia CJ, Dhar R, Koul PA, Rambhad G, Fletcher MA. Streptococcus pneumoniae as a cause of community-acquired pneumonia in Indian adolescents and adults: a systematic review and meta-analysis. Clin Med Insights Circ Respir Pulm Med 2019131179548419862790 [View Article] [PubMed]
     [Google Scholar]
  26. Bansal S, Kashyap S, Pal LS, Goel A. Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci 2004; 46:17–22 [PubMed]
     [Google Scholar]
  27. Para RA, Fomda BA, Jan RA, Shah S, Koul PA. Microbial Etiology in Hospitalized North Indian Adults with Community-acquired Pneumonia Lung India: Official Organ of Indian Chest Society; 2018 p 108
     [Google Scholar]
  28. Peto L, Nadjm B, Horby P, Ngan TT, van Doorn R et al. The bacterial aetiology of adult community-acquired pneumonia in Asia: a systematic review. Trans R Soc Trop Med Hyg 2014; 108:326–337 [View Article] [PubMed]
     [Google Scholar]
  29. Bartlett JG, Mundy LM. Community-acquired pneumonia. N Engl J Med 1995; 333:1618–1624 [View Article]
     [Google Scholar]
  30. File Jr TM. Community-acquired pneumonia. The Lancet 2003; 362:1991–2001
     [Google Scholar]
  31. Eurich DT, Marrie TJ, Minhas-Sandhu JK, Majumdar SR. Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up. BMJ 2017; 356:j413 [View Article] [PubMed]
     [Google Scholar]
  32. Klugman KP, Feldman C. Serotype specific cardiac involvement in pneumococcal pneumonia. Clin Infect Dis 2020 [View Article] [PubMed]
     [Google Scholar]
  33. Africano HF, Serrano-Mayorga CC, Ramirez-Valbuena PC, Bustos IG, Bastidas A et al. Major adverse cardiovascular events during invasive pneumococcal disease are serotype dependent. Clinical Infectious Diseases 2020
     [Google Scholar]
  34. Chaguza C, Yang M, Cornick JE, du Plessis M, Gladstone RA et al. Bacterial genome-wide association study of hyper-virulent pneumococcal serotype 1 identifies genetic variation associated with neurotropism. Communications Biology 2020; 3:1–2 [View Article]
     [Google Scholar]
  35. Choe YJ, Blatt DB, Lee HJ, Choi EH. Associations between geographic region and immune response variations to pneumococcal conjugate vaccines in clinical trials: A systematic review and meta-analysis. Int J Infect Dis 2020; 92:261–268 [View Article] [PubMed]
     [Google Scholar]
  36. Nayar S, Hasan A, Waghray P, Ramananthan S, Ahdal J et al. Management of community-acquired bacterial pneumonia in adults: Limitations of current antibiotics and future therapies. Lung India 2019; 36:525 [View Article] [PubMed]
     [Google Scholar]
  37. Kyaw MH, Clarke S, Jones IG, Campbell H. Non-invasive pneumococcal disease and antimicrobial resistance: Vaccine implications. Epidemiol Infect 2002; 128:21–27 [View Article]
     [Google Scholar]
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Pneumococcal serotypes causing non-invasive pneumonia in adults from a South Indian tertiary care hospital and the impact of the newer conjugate vaccines
Access Microbiology 3, 000258 (2021); https://doi.org/10.1099/acmi.0.000258
/content/journal/acmi/10.1099/acmi.0.000258
/content/journal/acmi/10.1099/acmi.0.000258
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