Abstract
Objectives: To analyse by serotype (St) clinical presentations of Invasive Pneumococcal Disease (IPD) in adults previously vaccinated with PPV23 in Spain.
Methods: A prospective, hospital-based surveillance of culture-confirmed IPD episodes in hospitalized adults (≥18 years) was performed in 9 Spanish hospitals (August 2010-June 2013). IPD was considered as isolation of S. pneumoniae from sterile fluids. Clinical presentations were: complicated pneumonia-CP-(pneumonia with pleural effusion and/or empyema and/or multilobar infiltration), non-complicated pneumonia(N-CP) and others(O;including meningitis, primary bacteremia and peritonitis).
Results: 637 patients were included and, 120 (18.8%) reported PPV23 vaccination history. Among the vaccinated 95% had ≥1 underlying condition considered as risk factor for IPD, being the most frequent chronic obstructive pulmonary disease (43%). Pneumonia accounted for 74.1% of the cases (44.1% N-CP and 30% CP).
68 (56.7%) vaccinated subjects presented an IPD episode caused by a PPV23 St (vaccine failures). Fatality rate was 14.2% and 47% of the deaths were caused by a PPV23 St.
Conclusions: The high number of vaccination failures among PPV23 vaccinated patients raises concerns regarding the effectiveness of PPV23 in preventing IPD. New preventive approaches should be taken into account.
- © 2014 ERS
