Distribution of 13-Valent pneumococcal conjugate vaccine serotype streptococcus pneumoniae in adults 50 Years and Older presenting with community-acquired pneumonia in Israel

Figures & data

Table 1. Demographics of patients with radiographically confirmed community-acquired pneumonia.

		Streptococcus pneumoniae Status
	Total n = 498^a	Positive n = 80^a	Negative n = 418^a
Mean (SD) age, y	72.6 (10.9)	71.3 (10.8)	72.8 (10.8)
Age groups, n (%)
50–<65 y	134 (26.9)	20 (25.0)	114 (27.3)
65–<80 y	225 (45.2)	38 (47.5)	187 (44.7)
≥80 y	139 (27.9)	22 (27.5)	117 (28.0)
Ethnicity, n (%)
Asian	0	0	0
White	498 (100)	80 (100)	418 (100)
Black	0	0	0
Male, n (%)	310 (62.2)	50 (62.5)	260 (62.2)
Antibiotic use	393/498 (78.9)	56/80 (70.0)	337/418 (80.6)
Comorbidities, n/N (%)^b
None	53/498 (10.6)	11/80 (13.8)	42/418 (10.0)
Diabetes mellitus	203/498 (40.8)	30/80 (37.5)	173/418 (41.4)
Coronary artery disease	166/498 (33.3)	25/80 (31.3)	141/418 (33.7)
Chronic obstructive pulmonary disease	160/498 (32.1)	23/80 (28.8)	137/418 (32.8)
Cancer	112/498 (22.5)	17/80 (21.3)	95/417 (22.8)
Congestive heart failure	95/498 (19.1)	10/80 (12.5)	85/418 (20.3)
PPSV23 vaccine history, n (%)	249/498 (50.0)	45/80 (56.3)	204/418 (48.8)
Risk factors
Smoking	91/498 (18.3)	15/80 (18.8)	76/418 (18.2)
Immunosuppressive therapy	48/498 (9.6)	4/80 (5.0)	44/418 (10.5)
Nursing home	5/498 (1.0)	3/80 (3.8)	2/418 (0.5)

CAP = community-acquired pneumonia; PPSV23 = 23-valent pneumococcal polysaccharide vaccine; SD = standard deviation.

^a Values are for radiographically-confirmed CAP population and S pneumoniae-positive or -negative subpopulations.

^b Denominators are based on the population with nonmissing values for the corresponding item and are indicated for each entry.

Figure 1. Identification of S. pneumoniae by multiple diagnostic methods. UAD = urinary antigen detection assay. *n = number of subjects with nonmissing results from ≥1 diagnostic method. Results in this figure are mutually exclusive from group to group. Total number of subjects positive for S. pneumoniae (n = 80).

Table 2. Overall identification of S. pneumoniae by diagnostic method.

	Subjects (N = 498)^*
	S. pneumoniae Positive, n (%)
Any diagnostic method	80 (16.1)
UAD	38 (7.6)
UAD alone	23 (4.6)
BinaxNOW	48 (9.6)
BinaxNOW alone	29 (5.8)
Culture	17 (3.7)
Culture alone	7 (1.4)

UAD = urinary antigen detection assay.

* N = number of subjects with nonmissing results from ≥1 diagnostic method

Figure 2. S. pneumoniae serotype distribution among isolates from S pneumoniae–positive patients tested by UAD assay and culture. PCV7 = 7-valent pneumococcal conjugate vaccine; PCV13 = 13-valent pneumococcal conjugate vaccine; NVT = non–vaccine type; UAD = urinary antigen detection.

Table 3. PCV7 and PCV13 serotype distribution by patient demographics among isolates from patients with a positive S. pneumoniae isolate.

	Age Group, y	Risk	Pneumonia
	50–<65	65–<80	≥80	High risk	At risk	None	HCAP	CAP
Positive isolates (any test),^a n	20	38	22	33	36	11	n/a	n/a
Positive isolates (UAD/culture),^b n	16	25	13	22	25	7	12	42
Total vaccine serotypes^c, n (%)	10	18	10	12	21	5	7	31
Serotypes covered in PCV7, n (%)
4	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
6B	1 (6.3)	0 (0.0)	1 (7.7)	1 (4.5)	0 (0.0)	1 (14.3)	0 (0.0)	2 (4.8)
9V	0 (0.0)	1 (4.0)	0 (0.0)	1 (4.5)	0 (0.0)	0 (0.0)	1 (8.3)	0 (0.0)
14	0 (0.0)	0 (0.0)	1 (7.7)	0 (0.0)	1 (4.0)	0 (0.0)	0 (0.0)	1 (2.4)
18C	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
19F	0 (0.0)	1 (4.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (14.3)	0 (0.0)	1 (2.4)
23F	5 (31.3)	2 (8.0)	0 (0.0)	1 (4.5)	6 (24.0)	0 (0.0)	1 (8.3)	6 (14.3)
Total PCV7 serotypes, n (%)	6	4	2	3	7	2	2	10
6 additional serotypes in PCV13, n (%)
1	1 (6.3)	1 (4.0)	0 (0.0)	0 (0.0)	1 (4.0)	1 (14.3)	0 (0.0)	2 (4.8)
3	1 (6.3)	8 (32.0)	3 (23.1)	4 (18.2)	6 (24.0)	2 (28.6)	0 (0.0)	12 (28.6)
5	0 (0.0)	2 (8.0)	0 (0.0)	0 (0.0)	2 (8.0)	0 (0.0)	1 (8.3)	1 (2.4)
6A	1 (6.3)	0 (0.0)	2 (15.4)	2 (9.1)	1 (4.0)	0 (0.0)	1 (8.3)	2 (4.8)
7F	1 (6.3)	1 (4.0)	0 (0.0)	1 (4.5)	1 (4.0)	0 (0.0)	1 (8.3)	1 (2.4)
19A	0 (0.0)	2 (8.0)	3 (23.1)	2 (9.1)	3 (12.0)	0 (0.0)	2 (16.7)	3 (7.1)
Total additional PCV13 serotypes, n (%)	4	14	8	9	14	3	5	21
Total non-PCV13 isolates (any test), ^an	10	20	12	21	15	6	n/a	n/a
Typed non-PCV13 related serotypes,^dn	6	4	3	9	2	2	3	10

CAP = community-associated pneumonia; HCAP = healthcare-associated pneumonia; PCV7 = 7-valent pneumococcal conjugate vaccine; PCV13 = 13-valent pneumococcal conjugate vaccine; UAD = urinary antigen detection.

^a Number of isolates identified from Binax, UAD or culture.

^b Number of isolates identified from UAD or culture. The values in this row are used as denominators for percentages of individual serotype isolates.

^c Identified from UAD and/or culture.

^d Identified from culture only.