{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T15:54:33Z","timestamp":1769356473001,"version":"3.49.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Non-invasive pneumococcal pneumonia (NIPP) is possibly the most frequent infection by <jats:italic>Streptococcus pneumoniae<\/jats:italic> in adults. However, the herd effect of vaccinating children in adult NIPP (aNIPP) remains poorly characterized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We determined the serotype distribution and antimicrobial susceptibility of isolates causing aNIPP (&amp;gt;18 years) in 2016\u20132018 in Portugal; 3 years with near universal vaccination of children with the 13-valent conjugate vaccine (PCV13), following over a decade of significant PCV use in children in the private market.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and discussion<\/jats:title><jats:p>Among the 1,149 aNIPP isolates, the most frequent serotypes detected were: 3 (<jats:italic>n<\/jats:italic> = 168, 14.6%), 11A (<jats:italic>n<\/jats:italic> = 102, 8.9%), 19F (<jats:italic>n<\/jats:italic> = 70, 6.1%), 23A and 23B (<jats:italic>n<\/jats:italic> = 62, 5.4% each), 9N (<jats:italic>n<\/jats:italic> = 60, 5.2%), 8 and 29\/35B (<jats:italic>n<\/jats:italic> = 43, 3.7% each); together accounting for 53% of all isolates. The serotype distribution causing aNIPP was stable in 2016\u20132018, with the serotypes included in PCV7 still being important causes of disease and serotype 3, a PCV13 serotype, remaining the leading cause of aNIPP. There was an increase in penicillin non-susceptibility from 17% in 2016 to 24% in 2018 (<jats:italic>p<\/jats:italic> = 0.018). Some PCV13 serotypes, such as 14, 19A and 19F were associated to resistance, which may have contributed to their persistence. The fact that close to 20% of aNIPP is caused by four non-vaccine serotypes (23A, 23B, 9N, and 29\/35B) and that there were significant differences in serotype distribution relative to invasive disease, stress the importance of maintaining the surveillance of these infections. The lack of a continued herd effect from vaccinating children and the significant fraction of aNIPP potentially preventable by PCV13 (30%), PCV15 (34%), PCV20 (53%) and the 23-valent polysaccharide vaccine (61%) underscore the importance of considering the broader use of pneumococcal vaccines in adults.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1279656","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T19:02:26Z","timestamp":1703098946000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Adult non-invasive pneumococcal pneumonia in Portugal is dominated by serotype 3 and non-PCV13 serotypes 3-years after near universal PCV13 use in children"],"prefix":"10.3389","volume":"11","author":[{"given":"Catarina","family":"Silva-Costa","sequence":"first","affiliation":[]},{"given":"Joana","family":"Gomes-Silva","sequence":"additional","affiliation":[]},{"given":"Andreia","family":"Santos","sequence":"additional","affiliation":[]},{"given":"M\u00e1rio","family":"Ramirez","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9","family":"Melo-Cristino","sequence":"additional","affiliation":[]},{"name":"The Portuguese Group for the Study of Streptococcal Infections","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1016\/S0140-6736(03)15021-0","article-title":"Community-acquired pneumonia","volume":"362","author":"File","year":"2003","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e60273","DOI":"10.1371\/journal.pone.0060273","article-title":"Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques","volume":"8","author":"Said","year":"2013","journal-title":"PLoS ONE."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1093\/cid\/ciaa1483","article-title":"Nationwide trends of invasive pneumococcal disease in Spain (2009-2019) in children and adults during the pneumococcal conjugate vaccine era","volume":"12","author":"de Miguel","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1136\/thoraxjnl-2018-211767","article-title":"Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination","volume":"74","author":"Hanquet","year":"2019","journal-title":"Thorax."},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0206912","DOI":"10.1371\/journal.pone.0206912","article-title":"Conjugate vaccine serotypes persist as major causes of non-invasive pneumococcal pneumonia in Portugal despite declines in serotypes 3 and 19A (2012-2015)","volume":"13","author":"Hor\u00e1cio","year":"2018","journal-title":"PLoS ONE"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e73704","DOI":"10.1371\/journal.pone.0073704","article-title":"Portuguese Group for the study of streptococcal infections. 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