title: Declining mortality from adult pneumococcal infections linked to children's vaccination.
abstract: OBJECTIVE
  To determine changes in mortality among adults with invasive pneumococcal disease (IPD) after introducing pneumococcal conjugate vaccines (PCVs) in children.
  
  
  METHODS
  An active surveillance of adults with culture-proven IPD in Barcelona. Serotype-specific mortality and rates of disease and death were analysed in three periods: baseline (1994-2001), PCV7 (2002-2009) and PCV13 (2010-2013).
  
  
  RESULTS
  Overall, IPD caused by PCV7 serotypes was associated with increased case fatality rate (24 percent). In patients 18-64 years (baseline vs. PCV7 vs. PCV13 periods), case fatality rate from IPD decreased (22 vs.14 vs. 12 percent), and it was associated with a decline in PCV7 serotypes (3.56 vs. 2.80 vs. 1.49 cases/10(5) person-years) and in PCV7 serotypes-specific death (0.74 vs. 0.53 vs. 0.09 deaths/10(5) person-years). In patients ≥65 years, case fatality rate did not change (24 vs. 22 vs. 24 percent); however, there was a decline in PCV7 serotypes-specific death (4.94 vs. 3.58 vs. 2.45 deaths/10(5) person-years), and an increase in non-PCV serotypes-specific death (2.55 vs. 3.70 vs. 4.09 deaths/10(5) person-years).
  
  
  CONCLUSIONS
  The use of PCVs for children was associated with a reduction of mortality from IPD in adults 18-64 years, through the indirect effect of herd protection. In older adults, age-related factors could play a role in IPD mortality.
authors: Infectious Diseases Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: igrau@idibell.cat.
authors: Imma
authors: I
authors: Grau
authors: Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: c.ardanuy@bellvitgehospital.cat.
authors: Carmen
authors: C
authors: Ardanuy
authors: Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: meritxellcubero@gmail.com.
authors: Meritxell
authors: M
authors: Cubero
authors: Microbiology Department, Hospital Moises Broggi, Sant Joan Despi, Barcelona, Spain. Electronic address: mabenitez@cli.scs.es.
authors: Miguel A
authors: MA
authors: Benitez
authors: Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: fina.linares@bellvitgehospital.cat.
authors: Josefina
authors: J
authors: Liñares
authors: Infectious Diseases Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, Barcelona, Spain. Electronic address: rpallares@ub.edu.
authors: Roman
authors: R
authors: Pallares
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D006801:Humans; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000276:immunology / Q000382:microbiology / Q000401:mortality* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000276:immunology*; D055815:Young Adult
chemical_list: D022242:Pneumococcal Vaccines
keywords: Mortality; Pneumococcal vaccines; Pneumonia; Serotypes; Streptococcus pneumoniae