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- 1 National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- 2 University of Sydney, Sydney, NSW
- 3 Austin Health, Melbourne, VIC
- 4 University of New South Wales, Sydney, NSW
Correspondence: jk.yin@hotmail.com
Acknowledgements:
The Australian Government Department of Health supported the National Centre for Immunisation Research and Surveillance (NCIRS) of vaccine preventable diseases in Australia. However, the views expressed are not necessarily those of the department. The study was undertaken as part of the regular policy deliberations of the Australian Technical Advisory Group on Immunisation. We thank the members of the Australian Community-acquired Pneumonia Study Collaboration.
Competing interests:
Since the completion of this study and the submission of the manuscript for publication, J Kevin Yin left his employment at the NCIRS to work for Sanofi Pasteur Australia and New Zealand.
- 1. Janssens JP, Krause KH. Pneumonia in the very old. Lancet Infect Dis 2004; 4: 112-124.
- 2. Fuller A, Pickles R, Spelman D, et al. Community acquired pneumonia at the Alfred Hospital, Melbourne: a prospective study with particular reference to Chlamydia pneumoniae [abstract]. Proceedings for the Annual Scientific Meeting of the Australasian Society for Infectious Diseases; Darwin (Australia), 21-24 May 1995.
- 3. Lim WS, Macfarlane JT, Boswell TC, et al. Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax 2001; 56: 296-301.
- 4. van der Eerden MM, Vlaspolder F, de Graaff CS, et al. Value of intensive diagnostic microbiological investigation in low- and high-risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2005; 24: 241-249.
- 5. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-S72.
- 6. Said MA, Johnson HL, Nonyane BAS, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One 2013; 8: e60273.
- 7. Musher DM, Thorner AR. Community-acquired pneumonia. N Engl J Med 2014; 371: 1619-1628.
- 8. Bonten MJM, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med 2015; 372: 1114-1125.
- 9. Pharmaceutical Benefits Advisory Committee. Recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC) in March 2015: 1st time decisions not to recommend. Canberra: PBAC; 2015. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2015-03 (accessed July 2015).
- 10. Pharmaceutical Benefits Advisory Committee. Recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC) in July 2015: positive recommendations. Canberra: PBAC; 2015. http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/pbac-outcomes-2015-07 (accessed Aug 2015).
- 11. Pharmaceutical Benefits Advisory Committee. Recommendations made by the Pharmaceutical Benefits Advisory Committee (PBAC) in July 2016 meetings: positive recommendations. Canberra: PBAC; 2016. https://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2016-07/positive-recommendations-2016-07.pdf (accessed Sept 2016).
- 12. Smith MD, Sheppard CL, Hogan A, et al. Diagnosis of Streptococcus pneumoniae infections in adults with bacteremia and community-acquired pneumonia: clinical comparison of pneumococcal PCR and urinary antigen detection. J Clin Microbiol 2009; 47: 1046-1049.
- 13. Effective Public Health Practice Project. Quality assessment tool for quantitative studies. Ontario: EPHPP; 2009. http://www.ephpp.ca/tools.html (accessed Nov 2016).
- 14. Armijo-Olivo S, Stiles CR, Hagen NA, et al. Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. J Eval Clin Pract 2012; 18: 12-18.
- 15. Charles PG, Whitby M, Fuller AJ, et al. The etiology of community-acquired pneumonia in Australia: why penicillin plus doxycycline or a macrolide is the most appropriate therapy. Clin Infect Dis 2008; 46: 1513-1521.
- 16. Elliott JH, Anstey NM, Jacups SP, et al. Community-acquired pneumonia in northern Australia: low mortality in a tropical region using locally-developed treatment guidelines. Int J Infect Dis 2005; 9: 15-20.
- 17. Jacups SP, Cheng A. The epidemiology of community acquired bacteremic pneumonia, due to Streptococcus pneumoniae, in the Top End of the Northern Territory, Australia — over 22 years. Vaccine 2011; 29: 5386-5392.
- 18. Jeremiah CJ, Hannan LM, Baird R, et al. Low utilisation of diagnostic microbiology for community acquired pneumonia in regional Victoria. Pathology 2013; 45: 162-166.
- 19. Lim I, Shaw DR, Stanley DP, et al. A prospective hospital study of the aetiology of community-acquired pneumonia. Med J Aust 1989; 151: 87-91.
- 20. Rémond MG, Ralph AP, Brady SJ, et al. Community-acquired pneumonia in the central desert and north-western tropics of Australia. Intern Med J 2010; 40: 37-44.
- 21. Skull SA, Andrews RM, Byrnes GB, et al. Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study. Epidemiol Infect 2009; 137: 194-202.
- 22. Thompson JE. Community acquired pneumonia in north eastern Australia–a hospital based study of aboriginal and non-aboriginal patients. Aust N Z J Med 1997; 27: 59-61.
- 23. Tramontana AR, Sinickas V. Microbiological diagnostic tests for community-acquired pneumonia are useful. Med J Aust 2010; 192: 235-236. <MJA full text>
- 24. Weatherall C, Paoloni R, Gottlieb T. Point-of-care urinary pneumococcal antigen test in the emergency department for community acquired pneumonia. Emerg Med J 2008; 25: 144-148.
- 25. Wilson PA, Ferguson J. Severe community-acquired pneumonia: an Australian perspective. Intern Med J 2005; 35: 699-705.
- 26. Waight PA, Andrews NJ, Ladhani SN, et al. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis 2015; 15: 629.
- 27. Moore MR, Link-Gelles R, Schaffner W, et al. Effect of use of 13-valent pneumococcal 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.
- 28. Rodrigo C, Bewick T, Sheppard C, et al. Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia. Eur Respir J 2015; 45: 1632-1641.
- 29. Torres A, Blasi F, Peetermans WE, et al. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis 2014; 33: 1065-1079.
- 30. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med 2015; 373: 415-427.
- 31. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012; 67: 71-79.
- 32. Steering Committee for the Review of Government Service Provision. Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Commonwealth of Australia; 2015. http://www.pc.gov.au/research/recurring/overcoming-indigenous-disadvantage/key-indicators-2014#thereport (accessed June 2015).
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Abstract
Objective: To evaluate trends in the proportion and severity of community-acquired pneumonia (CAP) attributable to Streptococcus pneumoniae (pneumococcus) in Australians aged 18 years and over.
Study design: Systematic review with unpublished data from the largest study.
Data sources: Multiple key bibliographic databases to June 2016.
Study selection: Australian studies on the aetiology of CAP in adults.
Data synthesis: In the 12 studies identified, pneumococcus was the most common cause of CAP. Four studies were assessed as being of good quality. Participants in two studies were predominantly non-Indigenous (n = 991); the proportion of pneumococcal CAP cases declined from 26.4% in 1987–88 to 13.9% in 2004–06, and the proportion with bacteraemia decreased from 7.8% to 3.8%. In two studies with predominantly Indigenous participants (n = 252), the proportion with pneumococcal bacteraemia declined from 6.8% in 1999–2000 to 4.2% in 2006–07. In the largest study (n = 885; 2004–06), 50.8% (60/118) of pneumococcal CAP occurred in people who were ≥ 65 years old. Among patients aged ≥ 65 years, intensive care unit admission and death were more common in patients who were ≥ 85 years old compared with younger patients (12.5% v 6.8%; 18.8% v 6.8% respectively), and also more common in the 19 patients with bacteraemia than in those without it (15.8% v 2.6%; 10.5% v 7.9% respectively). Of 17 cases of bacteraemia serotyped, 12 were due to 13-valent pneumococcal conjugate vaccine (13vPCV) serotypes and three to additional serotypes in 23-valent pneumococcal polysaccharide vaccine (23vPPV).
Conclusions: Available data suggest that the proportion of CAP attributable to pneumococcus (both bacteraemic and non-bacteraemic) has been declining in Australian adults. Should 13vPCV replace the 23vPPV currently funded by the National Immunisation Program for persons aged ≥ 65 years, surveillance to track non-bacteraemic pneumococcal CAP will be essential to evaluate the impact.