{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:20:50Z","timestamp":1791663650943,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,7,24]],"date-time":"2021-07-24T00:00:00Z","timestamp":1627084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001729","name":"Swedish Foundation for Strategic Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001729","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004348","name":"Stockholm County Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004063","name":"Knut and Alice Wallenberg Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Demography is changing, with people living longer with comorbidities. In this nationwide population-based study, we investigated the serotype-specific invasive pneumococcal disease (IPD) risk in individuals with comorbidities, and effects of the pneumococcal conjugated vaccine (PCV) child immunization program.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cases included 14 096 IPD episodes in Sweden during 2006\u20132015. Controls (n = 137 289), matched to cases by age, sex, region, and calendar time, were selected from the general population. Comorbidity data was obtained through health registers and grouped as immunocompromising (IC) or chronic medical conditions (CMC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The prevalence of CMC and IC among elderly cases was 33.9% and 39.4%. New risks identified for IPD were sarcoidosis, inflammatory polyarthropathies, systemic connective tissue, and neurological diseases. The odds ratio (OR) for IPD caused by non-PCV13 compared with PCV13 serotypes was higher in individuals with CMC\/IC. Serotypes associated with the highest risk were 16F, 15C, 35F, 19F, and 23A (OR 3\u20135 for CMC, &amp;gt;10 for IC). Most comorbidities increased post-vaccination, and absolute increases of IPD caused by non-PCV13, PPV23\u2013non-PCV13, and non-PCV13\/non-PPV23 serotypes were higher in individuals with IC\/CMC compared with healthy persons. Non-PCV13 serotypes 6C, 9N, 11A, 22F, 23A and 35F increased more in those with comorbidities. Mortality due to non-PCV13 serotypes increased in individuals with IC\/CMC, while remaining stable in persons without comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The PCV child immunization program associates with an increased disease burden of non-vaccine serotypes in individuals with comorbidities. These data are important for vaccine design and optimization of current vaccination strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab651","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T19:11:14Z","timestamp":1626981074000},"page":"1338-1349","source":"Crossref","is-referenced-by-count":19,"title":["Chronic Disease and Immunosuppression Increase the Risk for Nonvaccine Serotype Pneumococcal Disease: A Nationwide Population-based Study"],"prefix":"10.1093","volume":"74","author":[{"given":"Pontus","family":"Naucler","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Galanis","sequence":"additional","affiliation":[{"name":"Public Health Agency of Sweden, Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Petropoulos","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredrik","family":"Granath","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Morfeldt","sequence":"additional","affiliation":[{"name":"Public Health Agency of Sweden, Solna, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c5ke","family":"\u00d6rtqvist","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitta","family":"Henriques-Normark","sequence":"additional","affiliation":[{"name":"Public Health Agency of Sweden, Solna, Sweden"},{"name":"Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,7,24]]},"reference":[{"key":"2022042817000634600_CIT0001","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/S1473-3099(18)30310-4","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016.","volume":"18","author":"GBD 2016 Lower Respiratory Infections Collaborators.","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2022042817000634600_CIT0002","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/1471-2334-8-96","article-title":"Invasive pneumococcal infections among persons with and without underlying medical conditions: implications for prevention strategies.","volume":"8","author":"Klemets","year":"2008","journal-title":"BMC Infect Dis"},{"key":"2022042817000634600_CIT0003","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1086\/431521","article-title":"The influence of chronic illnesses on the incidence of invasive pneumococcal disease in adults.","volume":"192","author":"Kyaw","year":"2005","journal-title":"J Infect Dis"},{"key":"2022042817000634600_CIT0004","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jinf.2012.02.017","article-title":"The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England.","volume":"65","author":"van Hoek","year":"2012","journal-title":"J Infect"},{"key":"2022042817000634600_CIT0005","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/cid\/civ803","article-title":"Invasive pneumococcal disease among immunocompromised persons: implications for vaccination programs.","volume":"62","author":"Shigayeva","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2022042817000634600_CIT0006","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1056\/NEJM199111213252101","article-title":"The protective efficacy of polyvalent pneumococcal polysaccharide vaccine.","volume":"325","author":"Shapiro","year":"1991","journal-title":"N Engl J Med"},{"key":"2022042817000634600_CIT0007","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1001\/jama.1993.03510150060030","article-title":"Pneumococcal polysaccharide vaccine efficacy. 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