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O078 - PREVALENCE OF PNEUMOCOCCAL SEROTYPES CAUSING COMMUNITY-ACQUIRED PNEUMONIA IN THE ELDERLY IN ITALY USING URINARY ANTIGEN DETECTION TEST: THE PUMA STUDY, 2017-2020 (ID 433)
Abstract
Background
In Italy, pneumococcal conjugate vaccines (PCVs) have been included in the National Immunization Program for infant since 2005 (PCV13 since 2010) and for adults aged ≥50 years since 2011. Our study assessed pneumococcal serotype distribution of community-acquired pneumonia (CAP) among older adults hospitalized from September 2017 to February 2020.
Methods
PUMA was a 3-year cohort study that enrolled adults aged ≥65 years old, hospitalized with clinical and radiographically confirmed CAP in 8 hospital centres from 4 Italian regions (Veneto, Liguria, Apulia and Sicily). Pneumococcus was identified using serotype-specific urinary antigen detection assays (UAD 1/2) and BinaxNow®. UAD1 detects serotypes in PCV13, UAD2 detects additional serotypes in 23-valent pneumococcal polysaccharide vaccine (PPV23).
Results
Among 1155 hospitalized CAP patients, 59.2% were male and 51.5% were ≥80 years old. Overall, 92.2% of patients had ≥1 pre-existing risk factor for CAP: most frequently chronic obstructive pulmonary disease (33.3%), chronic cardiac disease (32.6%), and diabetes mellitus (30.0%). 21.7% of CAP patients had been ever vaccinated with PCV13 only (8.1%), PPV23 only (6.8%) or both (6.8%). Pneumococcus was identified in 144 patients (12.5%). 73.6% of pCAP was caused by a non-PCV13 serotype (Table 1).
Conclusions
In the context of high pediatric and limited adult PCV13 immunization, older adult vaccine-serotype CAP has declined, although serotype 3 remains the most frequent serotype identified. Non-vaccine serotypes now cause most hospitalized pCAP in older adults, often from serotypes in newer expanded valency PCVs (PCV15 and PCV20) recently licensed in the United States.