Comorbidities were grouped into three main categories; (i) chronic disease, (ii) immunosuppression and (iii) underlying respiratory disease. In brief, ‘chronic disease’ included reported chronic kidney disease, nephrotic syndrome, diabetes mellitus, heart and liver disease. ‘Immunosuppression’ included reported immunosuppression, splenectomy/hemoglobinopathy, cancer, HIV and transplantation. ‘Underlying respiratory disease’ contained recurrent airway disease, recurrent otitis, chronic lung disease and nicotine abuse. Patients could belong to multiple categories. All clinical microbiology laboratories are asked to send isolates of Streptococcus pneumoniae from

a sterile site to the National Reference Laboratory for Invasive Pneumococcal http://www.selleckchem.com/products/3-methyladenine.html Disease (NZPn). At the NZPn, isolates were confirmed as S. pneumoniae using alpha hemolysis morphology on blood agar plates, bile solubility, optochin sensitivity and molecular

typing [15]. Serotypes of confirmed S. pneumoniae were determined by the Quellung reaction. For the serotype trend analysis, all adult Swiss residents ≥16 years with culture-confirmed IPD of known serotype and which were notified during 2003–2012 were included. If a patient suffered from more than one IPD episode per calendar year, only the first was included in the analysis. As for this time period, 8698 cases were registered at the FOPH. Of these, 659 (84%), 733 (86%), 783 (89%), 743 (89%), 798 (88%), 871 (90%), 893 (88%), 719 (92%), 776 S3I-201 in vivo (90%) and 703 (86%) cases could be linked with pneumococcal serotype isolate collected at the NZPn, in 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011 and 2012, respectively. For the investigation of the effect of serotype/serogroup

on various outcomes, all adult Swiss residents ≥16 years with culture-confirmed IPD of known serotype and which were notified during 2007–2010 were included. The IPD surveillance is part of the governmental public health surveillance based on the law for epidemics and is therefore exempted from approval by Institutional Review Boards. Temporal changes from 2003 to 2012 were analyzed using the Cochran–Armitage test for trend and P < 0.05 was considered as being statistically significant. The dynamics of serotypes/serogroups were also evaluated using the Cochran–Armitage test as previously described [16]. (-)-p-Bromotetramisole Oxalate Differences in the proportions of pneumococcal serotypes in adult patients with and without PPV23 were tested using 3 × 2 and 2 × 2 χ2-test, respectively (the latter excluding patients for whom vaccination status were not available). Incidence of IPD cases with known serotype from 2007 to 2010 were calculated and stratified by age, clinical manifestation, comorbidities and death. The Swiss population aged ≥16 years was 6.3, 6.4, 6.5 and 6.6 million for 2007, 2008, 2009 and 2010 respectively [17]. The effect of serotype/serogroup on various outcomes was investigated by multivariable logistic regression analyses.