Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

• Published in: The Brazilian journal of infectious diseases Vol. 27; no. 2; p. 102746
• Main Authors: Kfouri, Renato A., Brandileone, Maria-Cristina C., Sáfadi, Marco Aurélio P., Richtmann, Rosana, Gilio, Alfredo E., Rossi, Flavia, Guimarães, Thais, Bierrenbach, Ana Luiza, Moraes, José C.
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-03-2023; Elsevier; Brazilian Society of Infectious Diseases
• Subjects: Adolescent; Adult; Aged; Anti-Infective Agents; Antimicrobial resistance; Brazil - epidemiology; Child; Child, Preschool; Chronic diseases; Comorbidity; Hospitals, Teaching; Humans; Infant; INFECTIOUS DISEASES; Inpatients; Invasive pneumococcal diseases; Original; Pneumococcal conjugate vaccine; Pneumococcal Infections - epidemiology; Pneumococcal Infections - prevention & control; Pneumococcal serotypes; Pneumococcal vaccine; Pneumococcal Vaccines - therapeutic use; Retrospective Studies; Serogroup; Vaccines, Conjugate; Brazil; Pneumococcal conjugate vaccine; Comorbidity; Invasive pneumococcal diseases; Pneumococcal serotypes; Chronic diseases; Antimicrobial resistance; Pneumococcal vaccine
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2023.102746

Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions.
A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others
406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis.
Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.