Community Acquired Pneumonia (CAP)
Conditions
Brief summary
Low interventional, prospective, multicentre, hospital-based study involving adults 60 years of age and older hospitalised with CAP at participating sites.
Detailed description
PCV13 efficacy for the prevention of vaccine-type community-acquired pneumonia (VT-CAP) and invasive pneumococcal disease (IPD) was established in the Community-acquired Pneumonia Immunization Trial in Adults (CAPITA) aged 65 and older. However, there are still few available real-life effectiveness estimates in adults. The aim of this study is to evaluate the PCV13 vaccine effectiveness (VE) against hospitalised VT-pneumococcal CAP among adults aged ≥60 years in the Region of Madrid (Spain). Determination of the effectiveness of PCV13 to prevent hospitalised vaccine-type (VT)-pneumococcal CAP among adults aged ≥60 years in Madrid will be evaluated using a test-negative design study, overall and among immunocompetent persons only.
Interventions
Serotype specific UAD (urinary antigen detection) test
Streptococcus pneumonia identification in saliva samples by culture or PCR / RSV identification in saliva samples by PCR
Sponsors
Study design
Eligibility
Inclusion criteria
1. Age ≥60 years. 2. Evidence of pneumonia within first 48 hours of hospital admission 3. Evidence of a personally signed and dated informed consent document indicating that the patient (or a legally acceptable representative) has been informed of all pertinent aspects of the study.
Exclusion criteria
1. Any patient who develops signs and symptoms of pneumonia after being hospitalized for ≥48 hours (either at current hospital, another transferring hospital, or a combination of these). 2. Previously enrolled subjects readmitted ≤14 days after discharge for their study qualifying admission. 3. At the time of enrollment, pneumonia has been excluded as the diagnosis or another diagnosis confirmed.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: Overall | Approximately 30 months | Cases were participants with CAP with a valid urinary antigen detection (UAD) result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of CAP Participants Categorized Per Pneumococcal Serotypes Identified | Approximately 30 months | Percentage of CAP participants in whom streptococcus pneumoniae was identified for PCV13 and 20-valent pneumococcal conjugate vaccine (PCV20) serotypes is reported. |
| Percentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR) | Approximately 30 months | Respiratory pneumococcal carriage was determined by testing saliva specimens using both conventional culture and the sensitive molecular method of PCR for the detection of two target genes (lytA and piaB). |
| Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Approximately 30 months | Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure. |
| Percentage of CAP Participants With Underlying at High-Risk Medical Conditions | Approximately 30 months | High-risk medical conditions included: asplenia, cancer/malignancy (hematologic), cancer/malignancy (solid tumor), chronic kidney disease, human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS), HIV - No AIDS, immunodeficiency, immunosuppressant drug therapy, multiple myeloma, organ transplantation. |
| Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Approximately 30 months | Percentage of SP isolates with antibiotic resistance to penicillin, amoxicillin, cefotaxime, erythromycin, tetracycline, levofloxacin were reported in this outcome measure. |
| Percentage of CAP Participants With Underlying At-risk Medical Conditions | Approximately 30 months | At-risk medical conditions included: alcoholism, asthma, celiac disease, chronic liver disease with hepatic failure, chronic liver disease without hepatic failure, chronic neurologic diseases, chronic obstructive pulmonary disease, coagulation factor replacement therapy, cochlear implant, congestive heart failure, coronary artery disease, cerebrospinal fluid leak, diabetes treated with medication, down syndrome, living in a nursing home, living in a long-term care facility, occupational risk with exposure to metal fumes, other chronic heart disease, other chronic lung disease, other pneumococcal disease risk factors, previous invasive pneumococcal disease, tobacco smoking (tobacco/e-cigarettes). |
Countries
Spain
Participant flow
Recruitment details
Participants were evaluated for effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) \[received previously at least 30 days before hospitalization\] in preventing vaccine-type (VT) pneumococcal hospitalized community acquired pneumonia (CAP) among adults aged greater than or equal to (\>=) 60 years in Madrid in this observational study.
Pre-assignment details
A total of 1821 participants were enrolled in this study and 51 participants did not meet inclusion/exclusion of the study. In this study, a) pandemic period included data from 12 March 2021 to 31 July 2022 when last relevant coronavirus disease 2019 (COVID-19) wave in target population (aged \>=60 years) ended in Madrid; b) post-pandemic period included data from 01 August 2022 to 13 September 2023.
Participants by arm
| Arm | Count |
|---|---|
| All Participants Eligible participants who were hospitalized with CAP in one of the study hospitals, their data were observed for effectiveness of PCV13 (received previously, not in this study) in this observational study. | 1,770 |
| Total | 1,770 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Death | 198 |
| Overall Study | Withdrawal by Subject | 3 |
Baseline characteristics
| Characteristic | All Participants | — |
|---|---|---|
| Age, Continuous | 78.08 Years STANDARD_DEVIATION 9.14 | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Sex: Female, Male Female | 761 Participants | — |
| Sex: Female, Male Male | 1009 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 198 / 1,680 |
| other Total, other adverse events | 0 / 1,680 |
| serious Total, serious adverse events | 0 / 1,680 |
Outcome results
Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: Overall
Cases were participants with CAP with a valid urinary antigen detection (UAD) result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure.
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: Overall | Cases | 105 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP: Overall | Controls | 1407 Participants |
Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall
Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure.
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number Analyzed signifies participants who were evaluable for each category.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in <2 years or not received PCV13 | Cases | 66 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in <2 years or not received PCV13 | Controls | 910 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in 2-<5 years or not received PCV13 | Cases | 89 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in 2-<5 years or not received PCV13 | Controls | 1116 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in >=5 years or not received PCV13 | Cases | 66 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Overall | Received PCV13 in >=5 years or not received PCV13 | Controls | 833 Participants |
Percentage of CAP Participants Categorized Per Pneumococcal Serotypes Identified
Percentage of CAP participants in whom streptococcus pneumoniae was identified for PCV13 and 20-valent pneumococcal conjugate vaccine (PCV20) serotypes is reported.
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Participants | Percentage of CAP Participants Categorized Per Pneumococcal Serotypes Identified | PCV13 Serotypes | 6.9 Percentage of CAP participants |
| All Participants | Percentage of CAP Participants Categorized Per Pneumococcal Serotypes Identified | PCV20 Serotypes | 13.2 Percentage of CAP participants |
Percentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR)
Respiratory pneumococcal carriage was determined by testing saliva specimens using both conventional culture and the sensitive molecular method of PCR for the detection of two target genes (lytA and piaB).
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants who had a valid saliva specimen test result.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Participants | Percentage of CAP Participants in Whom Pneumococcus Identified From Saliva by Culture or Polymerase Chain Reaction (PCR) | 11.6 Percentage of CAP participants |
Percentage of CAP Participants With Underlying at High-Risk Medical Conditions
High-risk medical conditions included: asplenia, cancer/malignancy (hematologic), cancer/malignancy (solid tumor), chronic kidney disease, human immunodeficiency virus (HIV) - acquired immunodeficiency syndrome (AIDS), HIV - No AIDS, immunodeficiency, immunosuppressant drug therapy, multiple myeloma, organ transplantation.
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Participants | Percentage of CAP Participants With Underlying at High-Risk Medical Conditions | 35.6 Percentage of CAP participants |
Percentage of CAP Participants With Underlying At-risk Medical Conditions
At-risk medical conditions included: alcoholism, asthma, celiac disease, chronic liver disease with hepatic failure, chronic liver disease without hepatic failure, chronic neurologic diseases, chronic obstructive pulmonary disease, coagulation factor replacement therapy, cochlear implant, congestive heart failure, coronary artery disease, cerebrospinal fluid leak, diabetes treated with medication, down syndrome, living in a nursing home, living in a long-term care facility, occupational risk with exposure to metal fumes, other chronic heart disease, other chronic lung disease, other pneumococcal disease risk factors, previous invasive pneumococcal disease, tobacco smoking (tobacco/e-cigarettes).
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Participants | Percentage of CAP Participants With Underlying At-risk Medical Conditions | 55.2 Percentage of CAP participants |
Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance
Percentage of SP isolates with antibiotic resistance to penicillin, amoxicillin, cefotaxime, erythromycin, tetracycline, levofloxacin were reported in this outcome measure.
Time frame: Approximately 30 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed = participants in CAP UAD population from whom valid SP isolates were obtained; Number of SP isolates analyzed = number of SP isolates with antimicrobial susceptibility tests performed. Only isolates with antimicrobial susceptibility tests performed were included in analysis.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Penicillin | 9.1 Percentage of SP isolates |
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Amoxicillin | 9.1 Percentage of SP isolates |
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Cefotaxime | 3.0 Percentage of SP isolates |
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Erythromycin | 12.1 Percentage of SP isolates |
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Tetracycline | 12.1 Percentage of SP isolates |
| All Participants | Percentage of Streptococcus Pneumoniae (SP) Isolates With Antibiotic Resistance | Levofloxacin | 3.0 Percentage of SP isolates |
Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period
Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. Data is presented in this outcome by time since vaccination. VE is reported as part of statistical data in this outcome measure.
Time frame: Approximately 13.5 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants in CAP UAD population for post-pandemic period and Number Analyzed signifies participants who were evaluable for each category.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in <2 years or not received PCV13 | Cases | 55 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in <2 years or not received PCV13 | Controls | 723 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in 2-<5 years or not received PCV13 | Cases | 79 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in 2-<5 years or not received PCV13 | Controls | 920 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in >=5 years or not received PCV13 | Cases | 57 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine Vaccine Effectiveness (VE) of PCV13 Against Hospitalized VT CAP By Time Since Vaccination: Post-pandemic Period | Received PCV13 in >=5 years or not received PCV13 | Controls | 667 Participants |
Number of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic Period
Cases were participants with CAP with a valid UAD result in whom PCV13 serotypes were identified by any method. Controls were participants with CAP with a valid UAD result and without having PCV13 serotype. VE was calculated as 1 minus the odd ratio comparing the odds of having received PCV13 for cases and controls, multiplied by 100%. VE is reported as part of statistical data in this outcome measure.
Time frame: Approximately 13.5 months
Population: CAP UAD population included all enrolled population who met all inclusion/exclusion criteria and who had a final diagnosis consistent with CAP with a valid UAD result. Here, Number of Participants Analyzed signifies participants in CAP UAD population for post-pandemic period.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| All Participants | Number of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic Period | Cases | 89 Participants |
| All Participants | Number of Participants Categorized as Cases and Controls to Determine VE of PCV13 Against Hospitalized VT CAP: Post-Pandemic Period | Controls | 1152 Participants |