Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil.

OBJECTIVES: To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period. DESIGN: Prospective population-based surveillance study. SETTING: Patients from two emergency hospitals in Brazil were consecutively included in this study. PARTICIPANTS: A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020. MAIN OUTCOME MEASURES: Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines. RESULTS: Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to -76.6) per 10 000 in adults 80 years or older. CONCLUSIONS: We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.

Epidemiological burden of meningococcal disease in Brazil: A systematic literature review and database analysis.

OBJECTIVES: The aim of this study was to evaluate the epidemiological profile of invasive meningococcal disease (IMD) in Brazil, the first Latin American country to introduce the group C meningococcal conjugate vaccine (included in the vaccination schedule in 2010). METHODS: A systematic review was conducted, covering the years 2005-2017, to identify epidemiological information on IMD and Neisseria meningitidis carriers in Brazil. Documents from the Brazilian Ministry of Health and two public databases were analyzed to determine annual incidence rates, absolute numbers of diagnosed cases, serogroups identified, the relative distribution of cases per serogroup, and the case fatality rate (CFR). RESULTS: Sixteen studies were selected. The incidence rate ranged from 0.88 to 5.3 cases per 100000 inhabitants per year. According to secondary data, the annual incidence of IMD in 2015 was highest in males <1year old (7.1/100000). The number of diagnosed cases declined significantly over the years. In the literature, IMD showed a CFR from 20.0% to 50.0%, and a higher CFR for serogroup W (17.8%). Secondary data showed an absolute reduction in meningitis-attributable deaths between 2007 and 2015; however, the CFR remained stable (11.1% in 2007 and 8.4% in 2015). In 2015, serogroup W showed the highest CFR (24.1%), followed by serogroups C (19.2%), B (17.7%), and Y (14.3%). CONCLUSIONS: Despite a reduction in cases, the CFR remained stable and similar in the different age groups, even for disease caused by different serogroups. The highest CFR was found to be associated with serogroup W.