AI Article Synopsis
- In South Korea, the population at risk for pneumococcal diseases is highly vaccinated, but the distribution of pneumococcal serotypes is changing, complicating vaccine administration.
- A cohort study analyzed 5,009 patients with community-acquired pneumonia (CAP), revealing serotype 3 as the most prevalent, even among fully vaccinated individuals, with advanced age and other health factors increasing the risk of 30-day mortality.
- The findings indicate that while vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) can lower mortality rates, serotypes 3 and 19A remain common causes of pneumococcal infections, challenging the effectiveness of current vaccination strategies.
Article Abstract
Background: Targeted risk population has been highly vaccinated against pneumococcal diseases in South Korea. Despite this, the pneumococcal serotype distribution is evolving, which impedes efficient roll-out of vaccines.
Methods: This prospective cohort study included patients aged ≥ 19 years with community-acquired pneumonia (CAP) from five university hospitals in South Korea between September 2018 and July 2021. The outcomes of interest were the demographic and clinical characteristics of patients with CAP, pneumococcal serotype distribution, and risk factors of 30-day mortality in patients with pneumococcal CAP (pCAP). Considering the high seroprevalence, we analyzed the clinical characteristics of serotype 3 pCAP.
Results: A total of 5,009 patients hospitalized with CAP was included (mean age ± standard deviation, 70.3 ± 16.0 years; 3,159 [63.1%] men). was the leading causative agent of CAP (11.8% overall, 17.7% in individuals aged < 65 years with chronic medical conditions). Among the 280 serotyped , serotype 3 was the most common (10.0%), followed by serotypes 19A (8.9%), 34 (8.9%), and 35B (8.9%). Non-vaccine serotypes (serotype 35B [13.9%] and 34 [12.0%]) were the most prevalent in 108 individuals vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23). Serotype 3 was prevalent, irrespective of PPSV23 vaccination status, and more common in individuals with chronic lung disease ( = 0.008). Advanced age (adjusted odds ratio [aOR], 1.040; 95% confidence interval [CI], 1.011-1.071), long-term care facility residence (aOR, 2.161; 95% CI, 1.071-4.357), and bacteremia (aOR, 4.193; 95% CI, 1.604-10.962) were independent risk factors for 30-day mortality in patients with pCAP. PPSV23 vaccination reduced the risk of mortality (aOR, 0.507; 95% CI, 0.267-0.961).
Conclusion: Serotype 3 and 19A were still the most common serotypes of pCAP in South Korea despite the national immunization program of 13-valent pneumococcal conjugated vaccine in children and PPSV23 in old adults. PPSV23 vaccination might reduce the risk of mortality in patients with pCAP.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615641 | PMC |
| http://dx.doi.org/10.3346/jkms.2023.38.e330 | DOI Listing |
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