Ahead of Print -Risk Factors for Death from Invasive Pneumococcal Disease, Europe, 2010 - Volume 21, Number 3—March 2015 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Risk Factors for Death from Invasive Pneumococcal Disease, Europe, 2010 - Volume 21, Number 3—March 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 3—March 2015

Research

Risk Factors for Death from Invasive Pneumococcal Disease, Europe, 2010

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• Materials and Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2
• Table 3
• Table 4
• Table 5
• Table 6
• Table 7

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Adoración Navarro-Torné , Joana Gomes Dias, Frantiska Hruba, Pier Luigi Lopalco, Lucia Pastore-Celentano, Andrew J. Amato Gauci, and Invasive Pneumococcal Disease Study Group

Author affiliations: Universidad Autónoma de Barcelona, Barcelona, Spain (A. Navarro-Torné); European Centre for Disease Prevention and Control, Stockholm, Sweden (A. Navarro-Torné, J. Gomes Dias, F. Hruba, P.L. Lopalco, L. Pastore-Celentano, A.J. Amato Gauci)

Suggested citation for this article

Abstract

We studied the possible association between patient age and sex, clinical presentation, Streptococcus pneumoniae serotype, antimicrobial resistance, and death in invasive pneumococcal disease cases reported by 17 European countries during 2010. The study sample comprised 2,921 patients, of whom 56.8% were men and 38.2% were >65 years of age. Meningitis occurred in 18.5% of cases. Death was reported in 264 (9.0%) cases. Older age, meningitis, and nonsusceptibility to penicillin were significantly associated with death. Non–pneumococcal conjugate vaccine (PCV) serotypes among children <5 years of age and 7-valent PCV serotypes among persons 5–64 years of age were associated with increased risk for death; among adults >65 years of age, risk did not differ by serotype. These findings highlight differences in case-fatality rates between serotypes and age; thus, continued epidemiologic surveillance across all ages is crucial to monitor the long-term effects of PCVs.

Streptococcus pneumoniae causes severe invasive disease that results in considerable illness and death. The incidence of invasive pneumococcal disease (IPD) is higher during the early years of life and among elderly persons (1). Geographic and ethnic differences also exist (1,2). Environmental factors (i.e., ambient temperature, humidity, and air pollution) affect IPD incidence (3,4). IPD has also been related to recent respiratory viral infection (4).

The ability of the different S. pneumoniae serotypes to cause disease has been related to serotype-specific characteristics and the molecular size of the capsular polysaccharide and chemical composition, among other factors (5). Therefore, it seems plausible that different serotypes exhibit different virulence and propensity to cause certain clinical presentation (5).

Brueggemann et al. studied the invasive disease potential of different S. pneumoniae serotypes (6). They concluded that so-called “highly invasive” serotypes (including 4, 1, 14, 18C, and 7F), convey a higher risk for invasive disease than do the “low invasive” serotypes (including 3, 15B/C, and 6B), which are more frequently isolated as colonizers (7). Furthermore, serotype distribution varies with patient age, both in disease and in nasopharyngeal colonization (2,8–10). However, evidence exists that pneumococcal invasiveness does not necessarily mean lethality (7). Low invasive serotypes usually account for higher case-fatality rates (CFRs).

The availability of 7-valent, 10-valent, and 13-valent pneumococcal conjugate vaccines (PCV7, PCV10, and PCV13, respectively) and their introduction as part of national immunization schedules have contributed to reducing illnesses and death from IPD (10–12). Nevertheless, the subsequent replacement of vaccine serotypes by nonvaccine serotypes is an accepted and global phenomenon (13,14).

The incidence of drug- and multidrug-resistant S. pneumoniae strains is increasing worldwide (15). Antimicrobial use and abuse is a main driver for the emergence of antimicrobial resistance in respiratory pathogens. Persons who carry (nasopharyngeal colonization), and hence share the potential to transmit resistant pneumococci, also are more susceptible to IPD caused by resistant strains (16).

Monitoring antimicrobial resistance trends and serotype distribution is paramount because this information is essential in helping to determine risk factors and optimizing the appropriate clinical management of cases and public health interventions. We studied the possible association between age, sex, serotype, clinical presentation, antimicrobial resistance, and death among persons reported to have IPD in European countries during 2010.

Dr. Navarro-Torné is an expert in vaccine preventable diseases at the European Centre for Disease Prevention and Control. Her primary research interest is surveillance of vaccine preventable diseases, particularly on IPD and pertussis.

Acknowledgment

Members of the Invasive Pneumococcal Disease Study Group who contributed data this article: Martine Sabbe, Antoaneta Detcheva, Teodora Georgieva, Despo Pieridou Bagatzouni,Pavla Křížová, Palle Valentiner-Branth, Asunción Fenoll, Anni Virolainen-Julkunen,Theano Georgakopoulou, Georgina Tzanakaki, Márta Melles, Imelda Vickers, Suzanne Cotter, Hilary Humphreys, Karl G. Kristinsson, Maria Grazia Caporali, Fortunato Paolo D’Ancona, Stefania Iannazzo, Annalisa Pantosti, Jelena Galajeva, Paul Caruana, Jackie Maistre Melillo, Tanya Melillo Fenech, Hester De Melker, Mirjam Knol, Arie Van Der Ende, Martin Steinbakk, Didrik F Vestrheim,Waleria Hryniewicz, Alicja Kuch, Iwona Paradowska-Stankiewicz, Anna Skoczynska, Marina Pana, Birgitta Henriques-Normak, Alenka Kraigher, Maja Sočan, Helena Hupkova, Eisin MacDonald, Mary P.E. Slack, Pauline A. Waight.

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Figures

• Figure 1. Flow of invasive pneumococcal disease cases through the study, Europe, 2010. *Sex was unknown for 1 patient. AST, antimicrobial susceptibility testing; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13,...
• Figure 2. Invasive pneumococcal disease study variables and PCV coverage of Streptococcus pneumoniae serotypes, Europe, 2010. A) Age group. B) Clinical presentation. C) Penicillin susceptible. D) Erythromycin susceptible. For all 4...

Tables

• Table 1. Characteristics of patients with invasive pneumococcal disease, Europe, 2010
• Table 2. Associations between invasive pneumococcal disease study variables and death, Europe, 2010
• Table 3. Streptococcus pneumoniae serotype in invasive pneumococcal disease and association with death, Europe, 2010
• Table 4. Association between invasive pneumococcal disease study variables and death, Europe, 2010
• Table 5. Stratified analysis of Streptococcus pneumoniae serotype distribution in a study of invasive pneumococcal disease, Europe, 2010
• Table 6. Characteristics of national pneumococcal vaccination programs in European Union/European Economic Area countries, 2010
• Table 7. Geographic distribution of cases and deaths of invasive pneumoccal disease for which Streptococcus pneumoniae serotype and disease outcome were known, Europe, 2010

Suggested citation for this article: Navarro-Torné A, Gomes Dias J, Hruba F, Lopalco PL, Pastore-Celentano L, Amato Gauci AJ, et al. Risk factors for death from invasive pneumococcal disease, Europe, 2010. Emerg Infect Dis [Internet]. 2015 Mar [date cited]. http://dx.doi.org/10.3201/eid2103.140634

DOI: 10.3201/eid2103.140634

1Members of the Invasive Pneumococcal Disease Study Group who contributed data are listed at the end of this article.