Factors Associated With Severe Nonmeningitis Invasive Pneumococcal Disease in Adults in France

auteurs du collaborative working group SIIPA : Isabelle Peloux, Olivier Epaulard, Aurélie Haudour, Christine Recule, A. Blachon, Hélène Petitprez, Céline Janssen, Virginie Vitrat, Pauline Tremeaux, J. Ducruet, Laurence Legout, Farid Sifaoui, Marion Levast, Emmanuel Forestier, Tarik Habet, Charlotte Telini, Marc Fabre, Anne Tixier, Isabelle Vray, Mathilde Guillaume, Henry, Pascale Verger, Philippe Lanotte, Cécile Lebrun, C. Carvalhoschneider, Marie-Fréderique Lartigue, Louis Bernard, Laura Courtellemont, Jerome Guinard, Camelia Gubavu, Camille Petillon, Nathalie Brieu, Laurence Maulin, Véronique Vernet-Garnier, Claire Launois, Yohan Nguyen, Yannick Madoux, Christophe Strady, Franck Noel, Simona Pavel, Maxime Thouvenin, Jean-Marc Galempoix, Nathalie Prieur, Stéphanie Mestrallet, Laure Zucchini, Véronique Vernet-Garnier, Pascal Chavanet, Jennifer Tetu, André Pechinnot, Anthony Texier, Jean-Paul Kisterman, Josephine Chapalain, Catherine Simonin, A. Paleau, Martha Benoit, Bianca Podac, Agathe Ogier Desserrey, Jerome Poirot, Guillaume Gautier, Alain Gravet, Joy Mootien, Orlando Saraceni,Abdo Mohareb.

International audience

English. 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 >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.