1003. Clinical implications of emerging nonvaccine-serotype invasive pneumococcal disease among adults in the Republic of Korea in the era of protein conjugated pneumococcal vaccine
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Background: In the Republic of Korea (ROK), protein conjugated vaccines (PCV13 and PCV10) in replacement of PCV7 have been used in children since 2010, and then included in the childhood national immunization program (NIP) in 2014. This study investigated indirect effect of PVCs on serotypes in PCV-naïve adult invasive pneumococcal disease (IPD) and its clinical implications.

Methods: A prospective observational cohort study was conducted, through the serotype surveillance program following the NIP implementation of 23-valent pneumococcal polysaccharide vaccine (PPV23) for elderly population (≥ 65 years) from 2013 to 2015. Clinical data and pneumococcal isolates from adult IPD patients (≥ 18 years) were collected from 20 hospitals. Clinical characteristics were compared between vaccine-serotype (VT) and nonvaccine-serotype (NVT) groups.

Results: Of a total of 319 IPD patients enrolled, 189 cases (59.2%) were available for serotypes. Among them, the proportion of PCV-naïve cases was 99.5% (188/189) and 189 patients consisted of NVT (n=64, 33.9%) and VT group (n=125, 66.1%). Compared to the previous study in the ROK (2004-2010), the proportion of PCV13 serotypes was decreased (61.4% vs 37.0%, P < 0.001) and PPV23 serotypes were stationary (71.5% vs 65.6%), but NVT serotypes were increased (23.4% vs 33.9%, P=0.033) in our study. The most common serotype was 3 (20.8%) and 34 (23.4%) in VT and NVT group, respectively. VT group had more bacteremic pneumonia (72.0% vs 48.4%, P=0.002). There was no difference of the case fatality rate between NVT and VT groups (29.7% vs 35.2%, P=0.447). Multiple logistic regression analysis showed that chronic kidney disease (odds ratio [OR] 10.26, 95% confidence interval [CI] 1.94-54.44, P=0.006), younger age of 18-49 years (OR 4.04, 95% CI 1.29-12.71, P=0.017), deep-seated infection (OR 3.73, 95% CI 1.34-10.39, P=0.012), meropenem resistance (OR 3.21, 95% CI 1.49-6.91, P=0.003) were significantly associated with NVT-IPD cases.

Conclusion: Our study indicates that emerging and expanding NVT-IPD among adults, probably due to indirect herd effect of widespread use of pediatric PCV. Further changes of IPD serotypes might occur and IPD serotypes should be monitored for developing better pneumococcal vaccination policy.

Jong Hun Kim, MD1, Seung Hee Baik, MD2, Joon Young Song, MD3, In-Gyu Bae, MD4, Hyo Youl Kim, MD, PhD5, Dong-Min Kim, MD6, Young Hwa Choi, MD, PhD7, Won Suk Choi, MD, PhD3, Y.H. Jeong, MD8, Hyun Hee Kwon, M.D9, Hye Won Jeong, M.D. Ph.D.10, Yeon-Sook Kim, MD11, Jeong Yeon Kim, M.D., Ph.D.12, Jacob Lee, M.D.13, Sae Yoon Kee, MD14, Jin-Won Chung, MD15, Moon H. Nahm, MD16 and Min-Ja Kim, MD., Ph.D17, (1)Division of Infectious Diseases, Korea University College of Medicine, Seoul, Korea, Republic of (South), (2)Cheju Halla General Hospital, Jeju-si, Korea, Republic of (South), (3)Korea University College of Medicine, Seoul, Korea, Republic of (South), (4)Gyeongsang National University Hospital, Jinju, Korea, Republic of (South), (5)Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju, Korea, Republic of (South), (6)School of Medicine, Chosun University, gwang ju, Korea, Republic of (South), (7)Department of Infectious Diseases, Ajou University School of Medicine, Suwon, Korea, Republic of (South), (8)Konyang University Hospital,, Daejon, Korea, Republic of (South), (9)Infectious Disease, Catholic University of Daegu School of Medicine, Daegu, Korea, Republic of (South), (10)Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea, Republic of (South), (11)Chungnam National University School Of Medicine, Daejon, Korea, Republic of (South), (12)Sahmyook Medical Center, Seoul, Korea, Republic of (South), (13)Department of Internal Medicine, Hallym University Medical Center, Seoul, Korea, Republic of (South), (14)Keonkuk University Hospital, Chungju, Korea, Republic of (South), (15)Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea, Republic of (South), (16)Department of Med., Univ. of Alabama at Birmingham, Birmingham, AL, (17)Division of Infectious Disease, Depart of Internal Medicine, Korea University Medical Center, Seoul, Korea, Republic of (South)

Disclosures:

J. H. Kim, None

S. H. Baik, None

J. Y. Song, None

I. G. Bae, None

H. Y. Kim, None

D. M. Kim, None

Y. H. Choi, None

W. S. Choi, None

Y. H. Jeong, None

H. H. Kwon, None

H. W. Jeong, None

Y. S. Kim, None

J. Y. Kim, None

J. Lee, None

S. Y. Kee, None

J. W. Chung, None

M. H. Nahm, None

M. J. Kim, None

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