Journal Article

Invasive Pneumococcal Disease among Adults: Associations among Serotypes, Disease Characteristics, and Outcome

Angelique G. S. C. Jansen, Gerwin D. Rodenburg, Arie van der Ende, Loek van Alphen, Reinier H. Veenhoven, Lodewijk Spanjaard, Elisabeth A. M. Sanders and Eelko Hak

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 2, pages e23-e29
Published in print July 2009 | ISSN: 1058-4838
Published online July 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/600045
Invasive Pneumococcal Disease among Adults: Associations among Serotypes, Disease Characteristics, and Outcome

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Background.The Streptococcus pneumoniae polysaccharide capsule may be related to invasive pneumococcal disease (IPD) course.

Methods.We performed a retrospective cohort study with nationally representative surveillance data from 1075 hospitalized patients with IPD from the Netherlands from 1 June 2004 through 31 May 2006 in the prevaccination era. Serotypes were grouped according to invasive disease potential, rate of the most serious clinical syndromes of meningitis and bacteremia without focus, and case-fatality rates. Multivariable logistic regression analysis was performed to obtain odds ratios adjusted for baseline confounders for the association of serotypes and these outcomes, using the serotypes with the lowest rates as reference.

Results.IPD caused by serogroups with low invasive disease potential concerned meningitis or bacteremia without focus in 22% of cases, and 74% of patients had an underlying comorbidity. For highly invasive serogroups these figures were 10% (P<.01) and 56% (P<.01). Individual serotypes varied in the relative rate by which they caused meningitis or bacteremia without focus. Compared with the reference group composed of serotypes 1, 5, 7F, 15B, 20, and 33F, the group of serotypes 3, 19F, 23A, 16F, 6B, 9N, and 18C was associated with increased case-fatality rates (group adjusted odds ratio, 2.6; 95% confidence interval, 1.5-4.7).

Conclusions.The serotype appeared to be independently associated with IPD severity in adults, which indicates that careful monitoring of IPD after implementation of conjugate vaccines is necessary.

Journal Article.  3728 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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