Cartwright Keith
Public Health Laboratory, Gloucestershire Royal Hospital, United Kingdom.
Eur J Pediatr. 2002 Apr;161(4):188-95. doi: 10.1007/s00431-001-0907-3.
Streptococcus pneumoniae- the pneumococcus- affects children and adults worldwide. Invasive pneumococcal disease, including pneumonia, meningitis and bacteraemia, has been linked annually to the deaths of millions of children. The pneumococcus is also a significant contributor to mucosal infections such as acute otitis media and sinusitis. Though pneumococcal infections can occur at any age, persons at greatest risk include children younger than 2 years of age and adults aged 65 years or more. Rates of pneumococcal disease and the prevalence of pneumococcal serotypes vary by geographic location and patient age. Accurate ascertainment and sound epidemiological data are essential for the rational development of effective programmes for prevention and treatment. Pneumococcal resistance to penicillin and other antibiotics has emerged rapidly in recent years, highlighting the importance of vaccine development. Newer pneumococcal vaccines, such as those conjugated to protein carriers, can now overcome the limitations of older polysaccharide vaccines. Such conjugated vaccines induce excellent immune responses even in infants and young children and they may also reduce asymptomatic nasopharyngeal carriage of pneumococci. Pneumococcal 7-valent conjugated vaccine PNCRM7 contains common prevalent serotypes coupled to a nontoxic diphtheria variant (CRM197). This vaccine has demonstrated high efficacy against invasive pneumococcal disease in clinical trials in infants and young children and is currently licensed for use in the United States and selected countries in Europe and Latin America.
across Europe, pneumococcal infection is responsible for considerable morbidity and mortality, particularly in the very young and the elderly, groups whose members respond poorly to non-conjugated vaccines. The advent of new conjugated pneumococcal vaccines now offers an exciting opportunity in developed countries to reduce both the current burden of disease and the threat of rising antibiotic resistance. Rolling out the use of such vaccines across Europe must be accompanied by detailed ongoing surveillance in order to detect any changes that might occur in the pattern of pneumococcal serotypes.
肺炎链球菌——肺炎球菌——影响着全球的儿童和成人。侵袭性肺炎球菌疾病，包括肺炎、脑膜炎和菌血症，每年导致数百万儿童死亡。肺炎球菌也是急性中耳炎和鼻窦炎等黏膜感染的重要病因。虽然肺炎球菌感染可发生于任何年龄，但风险最高的人群包括2岁以下儿童和65岁及以上成人。肺炎球菌疾病的发病率和肺炎球菌血清型的流行率因地理位置和患者年龄而异。准确的确诊和可靠的流行病学数据对于合理制定有效的预防和治疗方案至关重要。近年来，肺炎球菌对青霉素和其他抗生素的耐药性迅速出现，凸显了疫苗研发的重要性。新型肺炎球菌疫苗，如与蛋白质载体结合的疫苗，现已克服了旧的多糖疫苗的局限性。这种结合疫苗即使在婴幼儿中也能诱导出良好的免疫反应，并且还可能减少肺炎球菌的无症状鼻咽部携带。肺炎球菌7价结合疫苗PNCRM7包含与无毒白喉变体（CRM197）结合的常见流行血清型。该疫苗在婴幼儿临床试验中已证明对侵袭性肺炎球菌疾病具有高效性，目前已在美国以及欧洲和拉丁美洲的部分国家获得使用许可。
在欧洲，肺炎球菌感染导致了相当高的发病率和死亡率，尤其是在婴幼儿和老年人中，这些人群对非结合疫苗反应不佳。新型结合肺炎球菌疫苗的出现，为发达国家提供了一个令人兴奋地机会，既能减轻当前的疾病负担，又能应对抗生素耐药性上升的威胁。在欧洲推广使用此类疫苗时，必须同时进行详细的持续监测，以便发现肺炎球菌血清型模式可能发生的任何变化。
