{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T03:46:24Z","timestamp":1772509584102,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,5,8]],"date-time":"2021-05-08T00:00:00Z","timestamp":1620432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["PTDC\/DTP-EPI\/1555\/2014"],"award-info":[{"award-number":["PTDC\/DTP-EPI\/1555\/2014"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["Unrestricted Investigator Initiated Project"],"award-info":[{"award-number":["Unrestricted Investigator Initiated Project"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Increasing the uptake of the 13-valent pneumococcal conjugate vaccine (PCV13) in children is expected to alter the serotypes causing invasive pneumococcal disease (IPD) in adults due to herd protection. We characterized 2172 cases of adult IPD in 2015\u20132018 in Portugal after the introduction of PCV13 in the national immunization plan of 2015. Among the 58 detected serotypes, serotypes 8 (n = 413; 19%), 3 (n = 334; 15%), 22F (n = 148; 7%), 14 (n = 138; 6%), and 19A (n = 116; 5%) were the most frequent. Among PCV13 serotypes, 7F and 19A IPD decreased, but serotype 3 IPD remained stable. The non-PCV13 serotypes were a heterogeneous group, with serotypes 23A and 23B enriched among CSF cases; serotype 8 associated with younger patients; and serotypes 22F, 6C, and 31 associated with older patients. The continued increase of serotype 8 IPD was one of the drivers for the increased coverage of the 23-valent pneumococcal polysaccharide vaccine (PPV23; 80% in 2015\u20132018). Antimicrobial resistance was associated with older age and serotypes 6C, 11A, 14, 15A, 19A, and 19F. Three years after the introduction of PCV13 in the NIP with an uptake of &gt;95%, the proportion of PCV13 serotypes causing IPD in adults stabilized in Portugal. The direct vaccination of adults may be important in preventing IPD in this age group.<\/jats:p>","DOI":"10.3390\/microorganisms9051016","type":"journal-article","created":{"date-parts":[[2021,5,9]],"date-time":"2021-05-09T21:32:46Z","timestamp":1620595966000},"page":"1016","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Invasive Pneumococcal Disease in Adults in Portugal: The Importance of Serotypes 8 and 3 (2015\u20132018)"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9681-0574","authenticated-orcid":false,"given":"Catarina","family":"Silva-Costa","sequence":"first","affiliation":[{"name":"Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3658-1102","authenticated-orcid":false,"given":"Joana","family":"Gomes-Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"In\u00eas","family":"Teodoro","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4084-6233","authenticated-orcid":false,"given":"M\u00e1rio","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"given":"Jos\u00e9","family":"Melo-Cristino","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal"}]},{"name":"on behalf of the Portuguese Group for the Study of Streptococcal Infections","sequence":"additional","affiliation":[]}],"member":"1968","published-online":{"date-parts":[[2021,5,8]]},"reference":[{"key":"ref_1","first-page":"1616","article-title":"Serotype 3 Remains the Leading Cause of Invasive Pneumococcal Disease in Adults in Portugal (2012\u20132014) despite Continued Reductions in Other 13-Valent Conjugate Vaccine Serotypes","volume":"7","author":"Lopes","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hor\u00e1cio, A.N., Diamantino-Miranda, J., Aguiar, S.I., Ramirez, M., Melo-Cristino, J., and The Portuguese Group for the Study of Streptococcal Infections (2013). The Majority of Adult Pneumococcal Invasive Infections in Portugal Are Still Potentially Vaccine Preventable in Spite of Significant Declines of Serotypes 1 and 5. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073704"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.vaccine.2011.11.022","article-title":"Serotype Changes in Adult Invasive Pneumococcal Infections in Portugal Did Not Reduce the High Fraction of Potentially Vaccine Preventable Infections","volume":"30","author":"Aguiar","year":"2012","journal-title":"Vaccine"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"De Miguel, S., Domenech, M., Gonz\u00e1lez-Camacho, F., Sempere, J., Vicioso, D., Sanz, J.C., Garc\u00eda Comas, L., Ardanuy, C., Fenoll, A., and Yuste, J. (2021). Nationwide Trends of Invasive Pneumococcal Disease in Spain (2009-2019) in Children and Adults during the Pneumococcal Conjugate Vaccine Era. Clin. Infect. Dis., in press.","DOI":"10.1093\/cid\/ciaa1483"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.vaccine.2015.01.030","article-title":"Early Impact of PCV7\/PCV13 Sequential Introduction to the National Pediatric Immunization Plan, on Adult Invasive Pneumococcal Disease: A Nationwide Surveillance Study","volume":"33","author":"Paran","year":"2015","journal-title":"Vaccine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/S1473-3099(15)70044-7","article-title":"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","volume":"15","author":"Waight","year":"2015","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","first-page":"70","article-title":"de A doen\u00e7a pneumoc\u00f3cica e recomenda\u00e7\u00f5es GRESP para a vacina\u00e7\u00e3o antipneumoc\u00f3cica na popula\u00e7\u00e3o adulta (\u226518 anos)","volume":"32","author":"Costa","year":"2016","journal-title":"Rev. Port. Med. Geral E Fam."},{"key":"ref_8","unstructured":"(2016, May 11). Direc\u00e7\u00e3o Geral de Sa\u00fade Norma 11\/2015\u2014Vacina\u00e7\u00e3o Contra Infe\u00e7\u00f5es Por Streptococcus Pneumoniae de Grupos Com Risco Acrescido Para Doen\u00e7a Invasiva Pneumoc\u00f3cica (DIP). Available online: http:\/\/nocs.pt\/wp-content\/uploads\/2017\/11\/i021902.pdf."},{"key":"ref_9","first-page":"531","article-title":"Avalia\u00e7\u00e3o Da Qualidade Da Prescri\u00e7\u00e3o Da Vacina Anti-Pneumoc\u00f3cica Aos Idosos","volume":"25","author":"Sousa","year":"2009","journal-title":"Rev. Port. Cl\u00edn. Geral"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hurley, D., Griffin, C., Young, M., Scott, D.A., Pride, M.W., Scully, I.L., Ginis, J., Severs, J., Jansen, K.U., and Gruber, W.C. (2020). Safety, Tolerability, and Immunogenicity of a 20-Valent Pneumococcal Conjugate Vaccine (Pcv20) in Adults 60 to 64 Years of Age. Clin. Infect. Dis., in press.","DOI":"10.1093\/cid\/ciaa1045"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1080\/21645515.2018.1532250","article-title":"Safety and Immunogenicity of 15-Valent Pneumococcal Conjugate Vaccine Compared to 13-Valent Pneumococcal Conjugate Vaccine in Adults \u226565 Years of Age Previously Vaccinated with 23-Valent Pneumococcal Polysaccharide Vaccine","volume":"15","author":"Peterson","year":"2019","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1111\/j.1469-0691.2004.00869.x","article-title":"Invasive Streptococcus Pneumoniae from Portugal: Implications for Vaccination and Antimicrobial Therapy","volume":"10","author":"Serrano","year":"2004","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1128\/jcm.31.8.2097-2100.1993","article-title":"Typing of Pneumococci by Using 12 Pooled Antisera","volume":"31","year":"1993","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e00099-17","DOI":"10.1128\/CVI.00099-17","article-title":"The Pneumococcal Serotype 15C Capsule Is Partially O-Acetylated and Allows for Limited Evasion of PPV23-Elicited Anti-Serotype 15B Antibodies","volume":"24","author":"Spencer","year":"2017","journal-title":"Clin. Vaccine Immunol. CVI"},{"key":"ref_15","unstructured":"Clinical and Laboratory Standards Institute (2018). Performance Standards for Antimicrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. [28th ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1089\/107662903764736364","article-title":"Macrolide Resistance in Streptococcus Pneumoniae Isolated from Patients with Community-Acquired Lower Respiratory Tract Infections in Portugal: Results of a 3-Year (1999\u20132001) Multicenter Surveillance Study","volume":"9","author":"Ramirez","year":"2003","journal-title":"Microb. Drug Resist."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2524","DOI":"10.1128\/JCM.02536-05","article-title":"Illustration of a Common Framework for Relating Multiple Typing Methods by Application to Macrolide-Resistant Streptococcus Pyogenes","volume":"44","author":"Pinto","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the False Discovery Rate\u2014A Practical and Powerful Approach to Multiple Testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/S2214-109X(16)30306-0","article-title":"Indirect Effects of Childhood Pneumococcal Conjugate Vaccination on Invasive Pneumococcal Disease: A Systematic Review and Meta-Analysis","volume":"5","author":"Shiri","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_20","doi-asserted-by":"crossref","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":"ref_21","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S1473-3099(20)30165-1","article-title":"Invasive Pneumococcal Disease Incidence in Children and Adults in France during the Pneumococcal Conjugate Vaccine Era: An Interrupted Time-Series Analysis of Data from a 17-Year National Prospective Surveillance Study","volume":"21","author":"Ouldali","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1093\/cid\/ciaa043","article-title":"Characteristics of Invasive Pneumococcal Disease Caused by Emerging Serotypes after the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in England: A Prospective Observational Cohort Study, 2014\u20132018","volume":"71","author":"Collins","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ludwig, G., Garcia-Garcia, S., Lanaspa, M., Ciruela, P., Esteva, C., Fernandez de Sevilla, M., Diaz-Conradi, A., Marti, C., Motje, M., and Galles, C. (2020). Serotype and Clonal Distribution Dynamics of Invasive Pneumococcal Strains after PCV13 Introduction (2011\u20132016): Surveillance Data from 23 Sites in Catalonia, Spain. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228612"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wijayasri, S., Hillier, K., Lim, G.H., Harris, T.M., Wilson, S.E., and Deeks, S.L. (2019). The Shifting Epidemiology and Serotype Distribution of Invasive Pneumococcal Disease in Ontario, Canada, 2007\u20132017. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226353"},{"key":"ref_25","first-page":"189","article-title":"Distribution of PCV13 and PPSV23 Streptococcus Pneumoniae Serotypes in Argentinean Adults with Invasive Disease, 2013\u20132017","volume":"52","author":"Zintgraff","year":"2020","journal-title":"Rev. Argent. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ijid.2020.10.017","article-title":"Serotype Distribution and Antimicrobial Susceptibility of Streptococcus Pneumoniae Associated with Invasive Pneumococcal Disease among Adults in Japan","volume":"102","author":"Yanagihara","year":"2021","journal-title":"Int. J. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e213","DOI":"10.1016\/S1473-3099(18)30660-1","article-title":"Making Sense of Differences in Pneumococcal Serotype Replacement","volume":"19","author":"Lewnard","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.pulmoe.2019.10.003","article-title":"Pneumonia Mortality, Comorbidities Matter?","volume":"26","author":"Hespanhol","year":"2020","journal-title":"Pulmonology"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/5\/1016\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:21Z","timestamp":1760162301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/5\/1016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,8]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["microorganisms9051016"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms9051016","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,8]]}}}