Advertisement

Effect of Age on the Manifestations and Outcomes of Invasive Pneumococcal Disease in Adults

      Abstract

      Background

      Although a considerable amount is known about the effect of age on the manifestations and outcomes of pneumonia, the same is not true for invasive pneumococcal disease.

      Methods

      This was a prospective observational study of all cases (2435) of invasive pneumococcal disease in adults in Northern Alberta from 2000 to 2014. Rates of invasive pneumococcal disease per 100,000, sociodemographic variables, clinical characteristics, and invasive pneumococcal disease–related outcomes were compared for the following age groups: 17-54, 55-64, 65-74, and ≥75 years.

      Results

      The rate of invasive pneumococcal disease per 100,000 increased with increasing age. Although only 27.3% of the cases were in those aged ≥65 years, they accounted for 48% of the deaths. The case fatality rate increased with increasing age, from 9.6% for those aged 17-54 years to 31.7% for those aged ≥75 years. The rate of meningitis decreased with increasing age, as did admission to intensive care and use of mechanical ventilation. There was a marked reduction in the rate of invasive pneumococcal disease due to protein conjugate vaccine 7 and protein conjugate vaccine 13 serotypes in those aged ≥55 years but a much smaller decline in rates for those aged 17-54 years. Replacement with non-vaccine serotypes constituted approximately 50% of the cases.

      Conclusions

      The rate of invasive pneumococcal disease is highest in the very elderly, and manifestations of invasive pneumococcal disease are influenced by age.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Backhaus E.
        • Berg S.
        • Anderson R.
        • et al.
        Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated for age, gender and risk factors.
        BMC Infect Dis. 2016; 16: 367
        • Beatty J.A.
        • Majumdar S.R.
        • Tyrrell G.J.
        • Marrie T.J.
        • Eurich D.T.
        Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia.
        Medicine (Baltimore). 2016; 95: e5179
        • Metlay J.P.
        • Schulz R.
        • Li Y.H.
        • et al.
        Influence of age and symptoms at presentation in patients with community-acquired pneumonia.
        Arch Intern Med. 1997; 157: 1453-1459
      1. (Available at) (Accessed April 26, 2017)
      2. (Available at) (Accessed April 26, 2017)
        • Canada Communicable Disease Report
        Case definitions for diseases under national surveillance.
        Health Canada. 2000; 26: 51
        • Marrie T.J.
        • Tyrrell G.J.
        • Garg S.
        • Venderkooi O.G.
        Factors predicting mortality in invasive pneumococcal disease in Alberta.
        Medicine (Baltimore). 2011; 90: 171-179
        • Facklam R.R.
        • Washington J.A.
        Streptococcus and related catalase-negative gram-positive cocci.
        in: Balows A. Hausler Jr, W.J. Herrmann K.L. Isenberg H.D. Shadomy H.J. Manual of Clinical Microbiology. 5th ed. American Society for Microbiology, Washington, DC1991: 238-257
        • Lund R.
        • Henrichsen J.
        Laboratory diagnosis, serology and epidemiology of Streptococcus pneumoniae.
        in: Methods in Microbiology. Vol. 12. Academic Press, New York1978: 241-262
        • Tyrrell G.J.
        • Lovgren M.
        • Garg S.
        • et al.
        A Streptococcus pneumoniae serotype 5 disease epidemic in western Canada: 2005-2009.
        Emerg Infect Dis. 2012; 18: 733-740
        • Marrie T.J.
        • Huang J.
        Epidemiology of community-acquired pneumonia in Edmonton, Alberta. An emergency room based study.
        Can Respir J. 2005; 13: 139-142
        • de St Maurice A.
        • Schaffner W.
        • Giffin M.R.
        • et al.
        Persistent sex disparities in invasive pneumococcal disease in the conjugate vaccine era.
        J Infect Dis. 2016; 214: 792-796
        • Murphy T.F.
        • Fine B.C.
        Bacteremic pneumococcal pneumonia in the elderly.
        Am J Med Sci. 1984; 288: 114-118
        • Tan C.G.
        • Ostrawski S.
        • Bresnitz E.A.
        A preventable outbreak of pneumococcal pneumonia among unvaccinated nursing home residents in New Jersey during 2001.
        Infect Control Hosp Epidemiol. 2003; 24: 848-852
        • Klemets P.
        • Lyytikainen O.
        • Ruutu P.
        • Ollgren J.
        • Nuroti J.P.
        Invasive pneumococcal infections among persons with and without underlying medical conditions: implications for prevention.
        BMC Infect Dis. 2008; 8: 96
        • Marrie T.J.
        • Tyrrell G.J.
        • Majumdar S.R.
        • Eurich D.T.
        Prevalence, correlates, and outcomes of concurrent infection with hepatitis c and invasive pneumococcal disease.
        Emerg Infect Dis. 2017; (In Press)
        • Huang J.Q.
        • Hooper P.M.
        • Marrie T.J.
        Factors associated with length of stay in hospital for suspected community acquired pneumonia.
        Can Respir J. 2006; 13: 317-324
        • Zampieri F.G.
        • Park M.
        • Machado F.S.
        • Azeuedo L.C.P.
        Sepsis associated encephalopathy and not just delirium.
        Clinics (Sao Paulo). 2011; 66: 1825-1831
        • Alari A.
        • Chaussade H.
        • De Celles M.
        • et al.
        Impact of pneumococcal conjugate vaccine on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis.
        BMC Med. 2016; 14: 211
        • Moore M.R.
        • Link-Gelles R.
        • Schaffner W.
        • et al.
        Effect of 13 valent conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population based surveillance.
        Lancet Infect Dis. 2015; 15: 301-309
        • Kelly M.M.
        • Shadman K.A.
        • Edmonson M.B.
        Treatment trends and outcomes in US hospital stays of children with empyema.
        Pediatr Infect Dis J. 2014; 33: 431-436
        • Deceuninck G.
        • Quach C.
        • Panagopoulos M.
        • et al.
        Pediatric pleural empyema in the province of Quebec: analysis of a 10-fold increase between 1990 and 2007.
        J Pediatric Infect Dis Soc. 2014; 3: 119-126
        • Griffin M.R.
        • Zhu Y.
        • Moore M.R.
        • Whitney C.G.
        • Grijalva C.G.
        U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination.
        N Engl J Med. 2013; 369: 155-163
        • Stockman C.
        • Ampofo K.
        • Pavia A.T.
        • et al.
        Clinical and epidemiological evidence of the Red Queen hypothesis in pneumococcal serotype dynamics.
        Clin Infect Dis. 2016; 63: 619-626
        • Cilloniz C.
        • Amaro R.
        • Torres A.
        Pneumococcal vaccination.
        Curr Opin Infect Dis. 2016; 29: 187-196
        • Golden A.R.
        • Adam H.J.
        • Zhanel G.C.
        • Canadian Antimicrobial Resistance Alliance (CARA)
        Invasive Streptococcus pneumoniae in Canada, 2011-2014: characterization of new candidate 15-valent pneumococcal conjugate vaccine serotypes 22F and 33F.
        Vaccine. 2016; 34: 2527-2530