Factors Associated With Severe Nonmeningitis Invasive Pneumococcal Disease in Adults in France
Authors: Danis Kostas , Varon Emmanuelle , Lepoutre Agnès , Janssen Cécile , Forestier Emmanuel , Epaulard Olivier , N’guyen Yohan , Labrunie Anaïs , Lanotte Philippe , Gravet Alain , Pelloux Isabelle , Chavanet Pascal , Levy-Bruhl Daniel , Ploy Marie-Cecile , Gaillat Jacques ,   SIIPA Group, Peloux Isabelle , Epaulard Olivier , Haudour Aurélie , Recule Christine , Blachon A , Petitprez Hélène , Janssen Céline , Vitrat Virginie , Tremeaux Pauline , Ducruet J , Legout Laurence , Sifaoui Farid , Levast Marion , Forestier Emmanuel , Habet Tarik , Telini Charlotte , Fabre Marc , Tixier Anne , Vray Isabelle , Guillaume Mathilde , Henry  , Verger Pascale , Lanotte Philippe , Lebrun Cécile , Carvalhoschneider C , Lanotte Philippe , Lartigue Marie-Fréderique , Bernard Louis , Lanotte Philippe , Courtellemont Laura , Guinard Jerome , Gubavu Camelia , Petillon Camille , Brieu Nathalie , Maulin Laurence , Vernet-Garnier Véronique , Launois Claire , Nguyen Yohan , Madoux Yannick , Strady Christophe , Noel Franck , Pavel Simona , Thouvenin Maxime , Galempoix Jean-Marc , Prieur Natahlie , Mestrallet Stéphanie , Zucchini Laure , Vernet-Garnier Véronique , Chavanet Pascal , Tetu Jennifer , Pechinnot André , Texier Anthony , Kisterman Jean-Paul , Chapalain Josephine , Simonin Catherine , Paleau A , Benoit Martha , Podac Bianca , Desserrey Agathe Ogier , Poirot Jerome , Gautier Guillaume , Gravet Alain , Mootien Joy , Gravet Alain , Saraceni Orlando , Gravet Alain , Mohareb Abdo 
Published: December 2019

Abstract

Background
In France, pneumococcal vaccination in adults is recommended for risk groups (chronic conditions/immunosuppression). We conducted a study on invasive pneumococcal disease (IPD) in adults to identify factors associated with disease severity and death.

Methods
We included IPD cases, excluding meningitis, from 25 acute care hospitals in 6 regions. We defined severe cases as those with shock or severe sepsis or intensive care unit admission/mechanical ventilation. We included deaths occurring within 30 days of hospitalization. Infectious disease specialists collected clinical/microbiological data on cases.

Results
During 2014–2017, 908 nonmeningitis IPD cases were diagnosed; 48% were severe, 84% had comorbidities, 21% died. Ninety percent of cases with comorbidities who previously sought health care were not vaccinated against pneumococcus. Compared with previously healthy cases, the risk of severe IPD increased from 20% (adjusted risk ratio [aRR], 1.2; 95% confidence interval [CI], 1.0–1.4) in cases with 1–2 chronic diseases to 30% (aRR, 1.3; 95% CI, 1.0–7.0) in those with &gt;2 chronic diseases. Among risk groups, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes and 23-valent pneumococcal polysaccharide vaccine (PPSV23) nonPCV13 serotypes were more likely to induce severe IPD compared with nonvaccine serotypes (aRR, 1.5; 95% CI, 1.3–1.9; aRR, 1.3; 95% CI, 1.0–1.5, respectively).

Conclusions
We observed a cumulative effect of concurrent comorbidities on severe IPD. Vaccine serotypes were more likely to induce severe IPD among risk groups. The missed opportunities for vaccination underscore the need to enhance vaccination in risk groups.