Differences in serious clinical outcomes of infection caused by specific pneumococcal serotypes among adults
Section snippets
Methods
To identify published articles describing differences in serious clinical outcomes related to individual pneumococcal serotypes among adults, we searched the entire PubMed database through February 2014, regardless of language. The search terms were [(Streptococcus pneumoniae OR pneumococcal infections) AND (epidemiology OR pathogenicity OR mortality OR immunology OR risk factors) AND (serotyping OR bacterial typing techniques) AND adult)]. We also considered relevant articles identified from
Results
The literature review yielded studies of important clinical outcomes involving empyema (or parapneumonic effusion), necrotizing pneumonia, septic shock, meningitis (each summarized in Table 1), and lethality (as measured by case-fatality rates), summarized in Table 2. One study assessed effect on quality-adjusted life years (QALYs), as a means of aggregating clinical consequences into a single quantitative parameter (Table 1) [16].
Specific clinical outcomes
Among four adult studies evaluating empyema or parapneumonic effusion [7], [26], [27], [28], the serotypes associated with elevated risk were 1, 3, 5, 7F, 8, and 19A (Table 1). Across the four studies, serotype 1 was the serotype associated with increased risk for empyema. In one adult study evaluating necrotizing pneumonia [29], serotype 3 was associated with elevated risk. Among three adult studies evaluating sepsis or septic shock [8], [30], [31], one study found no elevations, whereas the
Risk in relation to vaccine formulations
Most pneumococcal serotypes associated with a statistically significant elevation in risk for serious clinical outcomes are included in both the PPSV23 and PCV13 formulations (Table 3). Three studies (two meningitis studies and one mortality study) found elevated risk from serotype 6A (a component of PCV13). In 14 studies, elevated risk from serotypes included only in PPSV23 was found, repeatedly 10A and 15B with meningitis and 11A and 9N with mortality. In seven study analyses, elevated risk
Discussion
This review shows that multiple pneumococcal serotypes associated with increased risk for serious clinical outcomes are included in both PPSV23 and PCV13, notably serotypes 1, 3, 6B, 19F, 19A, and 23F. However, the extent of serotype coverage offered by each vaccine for adults is not the same [5]. Three studies found elevated risk from serotype 6A, unique to PCV13. Fourteen studies found elevated risk from nine of the 11 serotypes unique to PPSV23, notably 9N, 10A, 11A, and 15B. This divergence
Conflict of interest
JDG and LKM are employees of Merck & Co., Whitehouse Station, NJ, manufacturer of 23-valent pneumococcal polysaccharide vaccine and developer of 15-valent pneumococcal conjugate vaccine.
Acknowledgements
The authors acknowledge publication searches and critiques by Scott Dolder, Julie Sievert, Brandon Palermo, Leora Suprun, and Mel Kohn.
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