The impact of 13-valent pneumococcal conjugate vaccination on virus-associated community-acquired pneumonia in elderly S.M. Huijts, F.E.J. Coenjaerts,

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The impact of 13-valent pneumococcal conjugate vaccination on virus-associated community-acquired pneumonia in elderly S.M. Huijts, F.E.J. Coenjaerts, M. Bolkenbaas, C.H. van Werkhoven, D.E. Grobbee, M.J.M. Bonten Clinical Microbiology and Infection Volume 24, Issue 7, Pages 764-770 (July 2018) DOI: 10.1016/j.cmi.2017.10.006 Copyright © 2017 The Authors Terms and Conditions

Fig. 1 (a) Flow-chart of ‘confirmed CAP’ study population (n = 1653). $ No confirmed CAP = episodes not fulfilling the definition ‘confirmed CAP’, i.e. chest X-ray not consistent with pneumonia and/or less than two clinical symptoms. (b) Flow-chart of ‘suspected pneumonia’ study population (n = 2917). *Symptom onset <14 days after vaccination. Abbreviations used: PCV13, 13-valent pneumococcal conjugate vaccine; CAP, community-acquired pneumonia; UAD, urinary antigen detection assay. Clinical Microbiology and Infection 2018 24, 764-770DOI: (10.1016/j.cmi.2017.10.006) Copyright © 2017 The Authors Terms and Conditions

Fig. 2 Diagram of available diagnostic methods for individuals with confirmed CAP and a oropharyngeal swab available (n = 1653). Abbreviations used: CAP, community-acquired pneumonia; UAD, urinary antigen detection assay; Culture, either a sterile (e.g. blood) or non-sterile (e.g. sputum) sample available for culture; pneumococcal UAD, either conventional pneumococcal urinary antigen detection assay (i.e. Binax) or serotype-specific urinary antigen detection assay. Please note that this diagram excludes 16 patients who did not have any of these diagnostic methods available (i.e. only an oropharyngeal swab for viral analyses). Clinical Microbiology and Infection 2018 24, 764-770DOI: (10.1016/j.cmi.2017.10.006) Copyright © 2017 The Authors Terms and Conditions

Fig. 3 Proportion of IA-CAP among confirmed CAP episodes with swab (n = 1653), stratified by year. Abbreviations used: IA-CAP, influenza associated community-acquired pneumonia; INFL A, influenza A; INFL B, influenza B; Non-typ, non-typeable influenza, i.e. subtyping failed. The proportion represents the part of IA-CAP cases among all confirmed CAP cases with oropharyngeal swab available, admitted in that period. Year 2008/9 starts at 1 September 2008 until 31 August 2009, this also applies to the following years. Clinical Microbiology and Infection 2018 24, 764-770DOI: (10.1016/j.cmi.2017.10.006) Copyright © 2017 The Authors Terms and Conditions