Pneumococcal conjugate serotype distribution and predominating role of serotype 3 in German adults with community-acquired pneumonia

Research output: Contribution to journalResearch articleContributedpeer-review


  • CAPNETZ Study Group - (Author)
  • Department of internal Medicine I
  • Jena University Hospital
  • Division of Pulmonology
  • University Hospital Carl Gustav Carus Dresden
  • Thorax Center in the Ruhr Area
  • University Hospital Frankfurt
  • German Center for Lung Research (DZL)
  • University Hospital Schleswig-Holstein Campus Kiel
  • Leibniz University Hannover (LUH)


INTRODUCTION: Implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in infant vaccination programs has substantially reduced the burden of PCV7 serotypes also in adult community-acquired pneumonia (CAP). Currently, it is unclear, if this extensive herd protection effect can be extrapolated to the additional 6 serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13), which replaced PCV7 in Germany in 2010.

OBJECTIVES: We investigated changing trends for PCV13 serotypes in adult CAP patients between three to seven years after implementation of PCV13 infant immunization in Germany.

METHODS: Between December 2012 and January 2017, urine samples from German adult patients with radiologically confirmed CAP were prospectively collected by the multi-center cohort study CAPNETZ and analyzed by the serotype-specific multiplex urinary antigen detection assay (SSUAD) allowing for the detection of PCV13 serotypes.

RESULTS: PCV13 serotypes were found in 59 of 796 (7.4%) patients with all-cause CAP, most prevalent was serotype 3 (30 of 59 patients, 50.8%). All patients with serotype 3-CAP were admitted to hospital and the majority required oxygen at admission (83.3% of patients with serotype 3-CAP versus 50.9% of patients with pneumococcal CAP by other serotypes, p = 0.005). Compared to SSUAD testing, conventional microbiological workup missed 27 of 30 (90.0%) serotype 3-CAP cases. We could not observe a time trend in the proportions of PCV13 serotypes and serotype 3 in all-cause CAP between 2013 and 2016 (OR trend per year 0.84, 95% CI 0.64-1.11 for PCV13 serotypes and OR trend per year 0.95, 95% CI 0.70-1.28 for serotype 3).

CONCLUSIONS: Conventional methods underestimate serotype 3-CAP that can cause severe disease. Changes in overall PCV13 coverage were not detected during the years 2013 to 2016, mostly driven by a high proportion of serotype 3.


Original languageEnglish
Pages (from-to)1129-1136
Number of pages8
Issue number5
Publication statusPublished - 29 Jan 2020

External IDs

ORCID /0000-0001-6022-6827/work/127321417
Scopus 85075878854


Sustainable Development Goals


  • Aged, Cohort Studies, Community-Acquired Infections/microbiology, Female, Germany/epidemiology, Humans, Male, Middle Aged, Pneumococcal Vaccines, Pneumonia, Pneumococcal/epidemiology, Serogroup, Streptococcus pneumoniae/classification, Urinalysis, Vaccines, Conjugate