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

Abstract

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable popula-tions. In Brazil, pneumococcal vaccines are included in the National Immunization Pro-gram (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. Methods: 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 antimicro-bial-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 immu-nocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical condi-tions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity pre-vailed 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 dis-eases (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. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad preven-tion to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. (c) 2023 Sociedade Brasileira de Infectologia.