AUTHOR=Silva-Costa Catarina , Gomes-Silva Joana , Santos Andreia , Ramirez Mário , Melo-Cristino José ,  The Portuguese Group for the Study of Streptococcal Infections 

TITLE=Adult non-invasive pneumococcal pneumonia in Portugal is dominated by serotype 3 and non-PCV13 serotypes 3-years after near universal PCV13 use in children

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1279656

DOI=10.3389/fpubh.2023.1279656

ISSN=2296-2565

ABSTRACT=<sec><title>Introduction</title><p>Non-invasive pneumococcal pneumonia (NIPP) is possibly the most frequent infection by <italic>Streptococcus pneumoniae</italic> in adults. However, the herd effect of vaccinating children in adult NIPP (aNIPP) remains poorly characterized.</p></sec><sec><title>Methods</title><p>We determined the serotype distribution and antimicrobial susceptibility of isolates causing aNIPP (&gt;18 years) in 2016–2018 in Portugal; 3 years with near universal vaccination of children with the 13-valent conjugate vaccine (PCV13), following over a decade of significant PCV use in children in the private market.</p></sec><sec><title>Results and discussion</title><p>Among the 1,149 aNIPP isolates, the most frequent serotypes detected were: 3 (<italic>n</italic> = 168, 14.6%), 11A (<italic>n</italic> = 102, 8.9%), 19F (<italic>n</italic> = 70, 6.1%), 23A and 23B (<italic>n</italic> = 62, 5.4% each), 9N (<italic>n</italic> = 60, 5.2%), 8 and 29/35B (<italic>n</italic> = 43, 3.7% each); together accounting for 53% of all isolates. The serotype distribution causing aNIPP was stable in 2016–2018, with the serotypes included in PCV7 still being important causes of disease and serotype 3, a PCV13 serotype, remaining the leading cause of aNIPP. There was an increase in penicillin non-susceptibility from 17% in 2016 to 24% in 2018 (<italic>p</italic> = 0.018). Some PCV13 serotypes, such as 14, 19A and 19F were associated to resistance, which may have contributed to their persistence. The fact that close to 20% of aNIPP is caused by four non-vaccine serotypes (23A, 23B, 9N, and 29/35B) and that there were significant differences in serotype distribution relative to invasive disease, stress the importance of maintaining the surveillance of these infections. The lack of a continued herd effect from vaccinating children and the significant fraction of aNIPP potentially preventable by PCV13 (30%), PCV15 (34%), PCV20 (53%) and the 23-valent polysaccharide vaccine (61%) underscore the importance of considering the broader use of pneumococcal vaccines in adults.</p></sec>