Serotype distribution and coverage by pneumococcal vaccines in hospitalised adults with pneumococcal pneumonia in Germany

Background Understanding the prevalence of pneumococcal serotypes in hospitalised patients with community-acquired pneumonia (CAP) is critical for vaccine development and implementation of future public health policies. Pneumococcal conjugate vaccines (PCVs) have been implemented to decrease the burden of pneumococcal disease. This study aims to identify the serotype distribution of pneumococcal CAP in Germany. Methods This interim analysis of a multicentre, prospective, active observational study includes patients aged ⩾18 years hospitalised with CAP in seven German hospitals. Patients were enrolled between August 2022 and September 2024. To determine CAP aetiology, microbiological tests were performed according to local standard of care. Urinary antigen testing for Streptococcus pneumoniae (BinaxNOW) was performed in all patients, and two serotype-specific urinary antigen detection (SSUAD) assays were used to detect serotypes in pneumococcal vaccines PCV15 and PCV20. Results S. pneumoniae was detected in 16.5% (85/514) of participants by all diagnostic tests. SSUAD assays detected S. pneumoniae as pathogen in 13.2% (68/514) of participants. In six patients, two pneumococcal serotypes were detected. The seven most detected serotypes were: 3, 11A, 8, 23B, 9N, 18C and 22F. Among 74 serotype detections, 64 (86.9%) are included in V116 compared with 56 (75.8%) in PCV20. The difference in coverage between PCV20 and V116 was 10.8% (95% CI −3.2–24.8%). Conclusion Among adults hospitalised with CAP in Germany, S. pneumoniae was detected in 13% of cases by SSUAD assays. While the findings suggest that V116 may offer broader serotype coverage compared with PCV20, these differences were not statistically significant.