Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group

• Published in: International journal of infectious diseases Vol. 74; pp. 136 - 144
• Main Authors: Kim, Jong Hun, Baik, Seung Hee, Chun, Byung Chul, Song, Joon Young, Bae, In-Gyu, Kim, Hyo Youl, Kim, Dong-Min, Choi, Young Hwa, Choi, Won Suk, Jo, Yu Mi, Kwon, Hyun Hee, Jeong, Hye Won, Kim, Yeon-Sook, Kim, Jeong Yeon, Lee, Jacob, Kee, Sae Yoon, Hur, Jian, Chung, Jin Won, Hwang, Ki-Eun, Kim, Min Ja
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.09.2018; Elsevier
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ageism; Female; Hospitalization; Humans; Immunization Programs; Invasive pneumococcal disease; Male; Middle Aged; Mortality; Pneumococcal Infections - epidemiology; Pneumococcal Infections - immunology; Pneumococcal Infections - mortality; Pneumococcal Infections - prevention & control; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - adverse effects; Prospective Studies; Republic of Korea - epidemiology; Risk Factors; Serogroup; Sex Factors; Streptococcus pneumoniae - classification; Streptococcus pneumoniae - genetics; Streptococcus pneumoniae - immunology; Streptococcus pneumoniae - isolation & purification; Vaccination; Young Adult; Invasive pneumococcal disease; Adult; Mortality; Risk factors
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2018.07.018

•National immunization of the elderly with the 23-valent polysaccharide vaccine (PPSV23) was implemented in Korea in 2013.•Overall in-hospital mortality was 34.2% for adult invasive pneumococcal disease (IPD) and 51.0% for patients ≥75 years of age.•Mortality risks were older age, higher bacteremia score, and immunocompromised status.•An effective vaccination strategy for those at higher risk of IPD is needed. This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK). Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015. A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18–49 years, 23.7% in those aged 50–64 years, 33.0% in those aged 65–74 years, and 51.0% in those aged ≥75 years (p<0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50–64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped. This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.