Background Changes over the last 5 years (2013–18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown. Methods We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses. Findings Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013–18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10). Interpretation The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.

中文翻译：

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2013-18 年英国成人肺炎的肺炎球菌血清型趋势、监测和危险因素

背景 过去 5 年（2013-18 年）与成人肺炎球菌肺炎有关的血清型的变化以及与疫苗型疾病相关的患者群体在很大程度上是未知的。方法 我们对 2013 年 9 月至 2018 年 8 月期间因社区获得性肺炎 (CAP) 入住两家大型大学医院的成年人进行了一项基于人群的前瞻性队列研究。使用新型 24 价尿单克隆抗体测定法和血液鉴定肺炎球菌血清型文化。将发病率趋势与国家侵袭性肺炎球菌疾病 (IPD) 数据进行比较。有疫苗型肺炎风险的人（肺炎球菌结合疫苗 (PCV)13 和肺炎球菌多糖疫苗 (PPV)23）是通过多变量分析确定的。结果 在 2934 名因 CAP 住院的成年人中，1075 名 (36. 6%) 患有肺炎球菌性肺炎。肺炎球菌肺炎的年发病率从每 10 万人口 32.2 例增加到 48.2 例（2013-18 年），主要是由于 PCV13non7 血清型和非疫苗型 (NVT) 血清型肺炎的增加（年发病率比 1.12，95% CI 1.04 至 1.21 和 1.19，95% CI 分别为 1.10 至 1.28）。发病率趋势与 IPD 数据大致相似。PCV13non7（56.9% 血清型 3）和 PPV23non13（44.1% 血清型 8）血清型分别在 349（32.5%）和 431（40.1%）名肺炎球菌肺炎患者中被鉴定。PCV13 血清型肺炎（以血清型 3 为主）在英国肺炎球菌疫苗接种临床风险组（调整后 OR (aOR) 1.73，95% CI 1.31 至 2.28）的患者中更有可能发生，而 PPV23 血清型肺炎在英国肺炎球菌疫苗接种临床风险组的患者中更可能发生临床风险组（aOR 1.54，95% CI 1. 13 至 2.10）。解释 肺炎球菌 CAP 的发病率正在增加，主要是由于 NVT 血清型和血清型 3。PPV23 血清型肺炎更可能发生在目前确定的临床风险组之外的成人中。