UMass Chan Medical School Faculty Publications

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type

Article Postprint


Bacterial Infections and Mycoses | Biological Factors | Emergency Medicine | Immunoprophylaxis and Therapy | Infectious Disease | Respiratory Tract Diseases


BACKGROUND: Streptococcus pneumoniae is a causative agent of community-acquired pneumonia (CAP). The 13-valent pneumococcal conjugate vaccine (PCV13) has significantly decreased the burden of PCV13-serotype pneumococcal disease; however, disease due to nonvaccine serotypes remains substantial. A recent study documented the persistence of PCV13 serotypes among US adults hospitalized with radiographically confirmed CAP. The current analysis used a recently developed urinary antigen detection (UAD) assay (UAD2) to extend these results to additional serotypes included in an investigational PCV20 vaccine.

METHODS: This prospective study enrolled adults aged > /=18 years hospitalized with radiographically confirmed CAP between October 2013-September 2016. Presence of S pneumoniae was determined by blood and respiratory sample culture, BinaxNOW(R) urine testing, and UAD. In addition to Quellung on cultured isolates when available, serotypes were identified from urine specimens using UAD1 for PCV13 serotypes and UAD2 for 7 PCV20-unique serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F) and 4 additional serotypes (2, 9N, 17F, and 20).

RESULTS: Among 12,055 subjects with radiographically confirmed CAP, 1482 were positive for S pneumoniae. PCV13 and PCV20-unique serotypes were associated with 37.7% (n=559) and 27.0% (n=400) of cases, respectively; 288 subjects were exclusively diagnosed as positive for S pneumoniae by UAD2. Demographic and clinical disease characteristics were similar between subjects with CAP caused by PCV13 and PCV20-unique serotypes.

CONCLUSIONS: The current analysis using UAD2 identified a sizeable proportion of hospitalized adult CAP associated with PCV20-unique serotypes. PCV20 may therefore address the burden of CAP caused by the additional serotypes present in the vaccine.


20-valent pneumococcal conjugate vaccine, adult, pneumonia, serotypes, urinary antigen detection

Rights and Permissions

© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (, which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact

DOI of Published Version



Isturiz R, Grant L, Gray S, Alexander-Parrish R, Jiang Q, Jodar L, Peyrani P, Ford KD, Pride MW, Self WH, Counselman F, Volturo G, Ostrosky-Zeichner L, Wunderink RG, Sherwin R, Overcash JS, File T, Ramirez J. Expanded Analysis of 20 Pneumococcal Serotypes Associated With Radiographically Confirmed Community-Acquired Pneumonia in Hospitalized US Adults. Clin Infect Dis. 2021 May 13:ciab375. doi: 10.1093/cid/ciab375. Epub ahead of print. PMID: 33982098. Link to article on publisher's site


Full author list omitted for brevity. For the full list of authors, see article.

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

PubMed ID


Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.