Figures
- FIGURE 1
Variation in the incidence of adult pneumococcal community-acquired pneumonia (CAP) and CAP by year, according to serotype categories. PCV7 CAP: CAP due to serotypes included in the 7-valent pneumococcal conjugate vaccine; additional PCV13 CAP: CAP due to additional serotypes included in PCV13; other CAP: CAP due to “other” serotypes.
- FIGURE 2
Variation in individual serotype numbers by study year among adults with pneumococcal community-acquired pneumonia.
Tables
- TABLE 1
Baseline characteristics, disease severity and outcomes of community-acquired pneumonia (CAP) cohort and pneumococcal cohort
CAP cohort Pneumococcal cohort Patients 2229 653 Demographics Age years 71.0 (55.1–80.5) 69.2 (50.2–79.8) Male 1237 (55.5) 326 (49.9) Nursing home residence 93 (4.2) 30 (4.6) WHO performance status ≥2 346 (15.5) 57 (16.0) Comorbid illness Charlson Comorbidity Index 4.0 (3.0–6.0) 4.0 (2.0–6.0) Malignancy 170 (7.6) 40 (6.1) Liver disease 22 (1.0) 10 (1.5) Congestive cardiac failure 144 (6.5) 36 (5.5) Ischaemic heart disease 396 (17.8) 112 (17.2) Chronic kidney disease 155 (7.0) 48 (7.4) Asthma 265 (11.9) 85 (13.0) COPD 475 (21.3) 117 (17.9) Diabetes 307 (13.8) 84 (12.9) Stroke 201 (9.0) 68 (10.4) Dementia 47 (2.1) 21 (3.2) HIV 11 (0.5) 4 (0.6) Disease severity CURB-65 0–1 1042 (46.8) 272 (41.7) CURB-65 2 673 (30.2) 199 (30.5) CURB-65 3–5 514 (23.1) 182 (27.9) Outcomes ICU admission 267 (12.0) 95 (14.5) 30-day in-patient mortality 183 (8.2) 41 (6.3) -
Data are presented as n, median (interquartile range) or n n (%). WHO: World Health Organization; COPD: chronic obstructive pulmonary disease; CURB-65: confusion, urea >7 mmol·L−1, respiratory rate >30 breaths·min−1, blood pressure <90 mmHg (systolic) ≤60 mmHg (diastolic), age ≥65 years; ICU: intensive care unit.
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- TABLE 2
Incidence rates of community-acquired pneumonia (CAP), pneumococcal CAP, and CAP due to 7-valent pneumococcal conjugate vaccination (PCV7), additional PCV13 and other serotypes by study year
Patient age years Year 1, 2008–2009 Year 2, 2009–2010 Year 3, 2010–2011 Year 4, 2011–2012 Year 5, 2012–2013 n Incidence# (95% CI) n Incidence# (95% CI) n Incidence# (95% CI) n Incidence# (95% CI) n Incidence# (95% CI) CAP 506 90.7 (83.0–99.0) 439 78.7 (71.5–86.4) 359 64.4 (57.9–71.4) 560 100.4 (92.3–109.1) 365 65.4 (58.9–72.5) 16–24 16 14.0 (8.0–22.7) 6 5.3 (1.9–11.4) 11 9.6 (4.8–17.2) 23 20.1 (12.8–30.2) 15 13.1 (7.4–21.6) 25–44 50 27.9 (20.7–36.7) 60 33.4 (25.5–43.0) 51 28.4 (21.2–37.4) 61 34.0 (26.0–43.7) 49 27.3 (20.2–36.1) 45–64 97 59.7 (48.4–72.8) 91 56.0 (45.1–68.7) 82 50.4 (40.1–62.6) 131 80.6 (67.4–95.6) 95 58.4 (47.3–71.4) 65–74 113 201.4 (166.0–242.2) 89 158.7 (127.4–195.2) 77 137.2 (108.3–171.6) 107 190.7 (156.3–230.5) 77 137.2 (108.3–171.6) 75–84 129 360.3 (300.8–428.1) 111 310.1 (255.1–373.4) 91 254.2 (204.7–312.1) 148 413.4 (349.5–485.6) 88 245.8 (197.2–302.8) >85 101 1052.1 (856.9–1278.4) 82 854.2 (679.3–1060.2) 47 489.6 (359.7–651.0) 90 937.5 (753.9–1152.3) 41 427.1 (306.5–579.4) Pneumococcal CAP 196 35.1 (30.4–40.4) 150 26.9 (22.8–31.6) 100 17.9 (14.6–21.8) 92 16.5 (13.3–20.2) 115 20.6 (17.0–24.8) 16–24 6 5.2 (1.9–11.4) 4 3.5 (1.0–9.0) 3 2.6 (0.5–7.7) 3 2.6 (0.5–7.7) 6 5.2 (1.9–11.4) 25–44 22 12.3 (7.7–18.6) 26 14.5 (9.5–21.2) 22 12.3 (7.7–18.6) 10 5.6 (2.7–10.2) 19 10.6 (6.4–16.5) 45–64 40 24.6 (17.6–33.5) 31 19.1 (13.0–27.1) 24 14.8 (9.5–22.0) 20 12.3 (7.5–19.0) 26 16.0 (10.4–23.4) 65–74 39 69.5 (49.4–95.0) 28 49.9 (33.2–72.1) 22 39.2 (24.6–59.4) 20 35.6 (21.8–55.1) 23 41.0 (26.0–61.5) 75–84 49 136.9 (101.3–181.0) 34 95.0 (65.8–132.7) 18 50.3 (29.8–79.5) 24 67.0 (43.0–99.8) 25 69.8 (45.2–103.1) >85 40 416.7 (297.7–567.4) 27 281.2 (185.3–409.2) 11 114.6 (57.2–205.0) 15 156.2 (87.4–257.7) 16 166.7 (95.3–270.7) PCV7 CAP 62 11.1 (8.5–14.2) 9 1.6 (0.7–3.1) 8 1.4 (0.6–2.8) 2 0.4 (0.0–1.3) 13 2.3 (1.2–4.0) 16–24 0 0 1 0.9 (0.0–4.9) 0 0 0 0 0 0 25–44 4 2.2 (0.6–5.7) 0 0 1 0.6 (0.0–3.1) 0 0 3 1.7 (0.3–4.9) 45–64 12 7.4 (3.8–12.9) 3 1.8 (0.4–5.4) 2 1.2 (0.0–4.4) 1 0.6 (0.0–3.4) 1 0.6 (0.0–3.4) 65–74 15 26.7 (15.0–44.1) 1 1.8 (0.0–9.9) 3 5.3 (1.1–15.6) 1 1.8 (0.0–9.9) 4 7.1 (1.9–18.3) 75–84 14 39.1 (21.4–65.6) 1 2.8 (0.1–15.6) 1 2.8 (0.1–15.6) 0 0 2 5.6 (0.7–20.2) >85 17 177.1 (103.2–283.5) 3 31.2 (6.4–91.3) 1 10.4 (0.3–58.0) 0 0 3 31.2 (6.4–91.3) Additional PCV13 CAP 59 10.6 (8.0–13.6) 64 11.5 (8.8–14.6) 45 8.1 (5.9–10.8) 44 7.9 (5.7–10.6) 35 6.3 (4.4–8.7) 16–24 1 0.9 (0.0–4.9) 1 8.7 (4.2–16.1) 2 1.7 (0.2–6.3) 3 2.6 (0.5–7.7) 3 2.6 (0.5–7.7) 25–44 9 5.0 (2.3–9.5) 15 8.4 (4.7–13.8) 13 7.2 (3.9–12.4) 4 2.2 (0.6–5.7) 6 3.3 (1.2–7.3) 45–64 10 6.2 (3.0–11.3) 16 9.8 (5.6–16.0) 11 6.7 (3.4–12.1) 12 7.4 (3.8–12.9) 9 5.5 (2.5–10.5) 65–74 13 23.2 (12.3–39.6) 11 19.6 (9.8–35.1) 10 17.8 (8.6–32.8) 13 23.2 (12.3–39.6) 7 12.5 (5.0–25.7) 75–84 16 44.7 (25.6–72.6) 11 30.7 (15.3–55.0) 4 11.2 (3.0–28.6) 7 19.6 (7.9–40.3) 8 22.3 (9.6–44.0) >85 10 104.2 (50.0–191.6) 10 104.2 (50.0–191.6) 5 52.1 (16.9–121.6) 5 52.1 (16.9–121.6) 2 20.8 (2.5–75.3) Other CAP 24 4.3 (2.8–6.4) 23 4.1 (2.6–6.2) 15 2.7 (1.5–4.4) 12 2.1 (1.1–3.8) 21 3.8 (2.3–5.8) 16–24 0 0 1 0.9 (0.0–4.9) 0 0 0 0 0 0 25–44 7 3.9 (1.6–8.0) 3 1.7 (0.3–4.9) 2 1.1 (0.1–4.0) 2 1.1 (0.1–4.0) 4 2.2 (0.7–5.7) 45–64 7 4.3 (1.7–8.9) 7 4.3 (1.7–8.9) 4 2.5 (0.7–6.3) 4 2.5 (0.7–6.3) 7 4.3 (1.7–8.9) 65–74 2 3.6 (0.4–12.9) 4 7.1 (1.9–18.3) 4 7.1 (1.9–18.3) 1 1.8 (0.0–9.9) 5 8.9 (2.9–20.8) 75–84 6 16.8 (6.2–36.5) 6 16.8 (6.2–36.5) 4 11.2 (3.0–28.6) 3 8.4 (1.7–24.5) 3 8.4 (1.7–24.5) >85 2 20.8 (2.5–75.3) 2 20.8 (2.5–75.3) 1 10.4 (0.2–58.0) 2 20.8 (2.5–75.3) 2 20.8 (2.5–75.3) -
PCV7 CAP: CAP due to serotypes included in PCV7; additional PCV13 CAP: CAP due to additional serotypes included in PCV13; other CAP: CAP due to “other” serotypes. #: per 100 000.
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- TABLE 3
Linear trends and year to year variation in community-acquired pneumonia (CAP), pneumococcal CAP, CAP due to serotype groups and “untyped” pneumococcal CAP
Year 1, 2008–2009 Year 2, 2009–2010 Year 3, 2010–11 Year 4, 2011–2012 Year 5, 2012–13 Change in IRR per year p-value for trend CAP 1.00 0.9 (0.8–1.0) 0.7 (0.6–0.8) 1.1 (1.0–1.2) 0.7 (0.6–0.8) 0.96 (0.94–0.99) 0.016 Pneumococcal CAP 1.00 0.8 (0.6–0.9) 0.5 (0.4–0.6) 0.5 (0.4–0.6) 0.6 (0.5–0.7) 0.84 (0.80–0.89) <0.001 PCV7 CAP 1.00 0.15 (0.07–0.29) 0.13 (0.06–0.27) 0.03 (0.01–0.13) 0.21 (0.12–0.38) 0.52 (0.43–0.62) <0.001 Additional PCV13 CAP 1.00 1.08 (0.76–1.54) 0.76 (0.52–1.12) 0.75 (0.50–1.50) 0.59 (0.39–0.90) 0.87 (0.80–0.95) 0.002 Other CAP 1.00 0.95 (0.54–1.70) 0.62 (0.33–1.19) 0.50 (0.25–1.00) 0.88 (0.49–1.57) 0.91 (0.79–1.05) 0.218 Untyped pneumococcal CAP 1.00 1.04 (0.70–1.54) 0.65 (0.42–1.01) 0.67 (0.43–1.04) 0.90 (0.60–1.34) 0.94 (0.85–1.03) 0.171 -
Data are presented as incidence rate ratio (95% confidence interval) unless otherwise stated. PCV7 CAP: CAP due to serotypes included in the 7-valent pneumococcal conjugate vaccine; additional PCV13 CAP: CAP due to additional serotypes included in PCV13; other CAP: CAP due to “other” serotypes. Bold indicates statistically significant.
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- TABLE 4
Comparison of incidence rates pre-13-valent pneumococcal conjugate vaccine (PCV13)# and post-PCV13¶ introduction
Overall incidence+ IRR (95%CI) p-value Pre-PCV13 Post-PCV13 CAP 90.7 (83.0–99.0) 76.7 (72.6–81.0) 0.85 (0.76–0.94) 0.001 Pneumococcal CAP 35.1 (30.4–40.4) 18.3 (16.3–20.5) 0.52 (0.44–0.62) <0.001 PCV7 CAP 11.1 (8.5–14.2) 1.4 (0.9–2.1) 0.12 (0.08–0.20) <0.001 Additional PCV13 CAP 10.6 (8.0–13.6) 7.4 (6.2–8.8) 0.70 (0.51–0.96) 0.024 Other CAP 4.3 (2.8–6.4) 2.9 (2.1–3.8) 0.67 (0.41–1.09) 0.105 -
Data are presented as incidence rates (interquartile range), unless otherwise stated. IRR: incidence rate ratio; CAP: community-acquired pneumonia; PCV7 CAP: CAP due to serotypes included in the PCV7 vaccine; additional PCV13 CAP: CAP due to serotypes included in the PCV13 vaccine; other CAP: CAP due to “other” serotypes. #: years 2008–2009; ¶: years 2010–2013; +: per 100 000 population. Bold indicates statistically significant.
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Supplementary material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Files in this Data Supplement:
- Supplementary table - Table S1
- Supplementary figure - Figure S2
- Supplementary figure - Figure S1
