Kyaw Moe H, Lynfield Ruth, Schaffner William, Craig Allen S, Hadler James, Reingold Arthur, Thomas Ann R, Harrison Lee H, Bennett Nancy M, Farley Monica M, Facklam Richard R, Jorgensen James H, Besser John, Zell Elizabeth R, Schuchat Anne, Whitney Cynthia G
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
N Engl J Med. 2006 Apr 6;354(14):1455-63. doi: 10.1056/NEJMoa051642.
Five of seven serotypes in the pneumococcal conjugate vaccine, introduced for infants in the United States in 2000, are responsible for most penicillin-resistant infections. We examined the effect of this vaccine on invasive disease caused by resistant strains.
We used laboratory-based data from Active Bacterial Core surveillance to measure disease caused by antibiotic-nonsusceptible pneumococci from 1996 through 2004. Cases of invasive disease, defined as disease caused by pneumococci isolated from a normally sterile site, were identified in eight surveillance areas. Isolates underwent serotyping and susceptibility testing.
Rates of invasive disease caused by penicillin-nonsusceptible strains and strains not susceptible to multiple antibiotics peaked in 1999 and decreased by 2004, from 6.3 to 2.7 cases per 100,000 (a decline of 57 percent; 95 percent confidence interval, 55 to 58 percent) and from 4.1 to 1.7 cases per 100,000 (a decline of 59 percent; 95 percent confidence interval, 58 to 60 percent), respectively. Among children under two years of age, disease caused by penicillin-nonsusceptible strains decreased from 70.3 to 13.1 cases per 100,000 (a decline of 81 percent; 95 percent confidence interval, 80 to 82 percent). Among persons 65 years of age or older, disease caused by penicillin-nonsusceptible strains decreased from 16.4 to 8.4 cases per 100,000 (a decline of 49 percent). Rates of resistant disease caused by vaccine serotypes fell 87 percent. An increase was seen in disease caused by serotype 19A, a serotype not included in the vaccine (from 2.0 to 8.3 per 100,000 among children under two years of age).
The rate of antibiotic-resistant invasive pneumococcal infections decreased in young children and older persons after the introduction of the conjugate vaccine. There was an increase in infections caused by serotypes not included in the vaccine.
2000年在美国用于婴儿的肺炎球菌结合疫苗中的7种血清型中有5种是大多数耐青霉素感染的病因。我们研究了这种疫苗对耐药菌株引起的侵袭性疾病的影响。
我们使用基于实验室的主动细菌核心监测数据来测量1996年至2004年期间由抗生素不敏感肺炎球菌引起的疾病。侵袭性疾病病例定义为由从通常无菌部位分离出的肺炎球菌引起的疾病，在8个监测地区进行了识别。分离株进行了血清分型和药敏试验。
耐青霉素菌株和对多种抗生素不敏感菌株引起的侵袭性疾病发病率在1999年达到峰值，到2004年下降，分别从每10万人6.3例降至2.7例（下降57%；95%置信区间，55%至58%）和从每10万人4.1例降至1.7例（下降59%；95%置信区间，58%至60%）。在2岁以下儿童中，耐青霉素菌株引起的疾病从每10万人70.3例降至13.1例（下降81%；95%置信区间，80%至82%）。在65岁及以上人群中，耐青霉素菌株引起的疾病从每10万人16.4例降至8.4例（下降49%）。疫苗血清型引起的耐药疾病发病率下降了87%。19A血清型（疫苗中未包含的血清型）引起的疾病有所增加（2岁以下儿童中从每10万人2.0例增至8.3例）。
引入结合疫苗后，幼儿和老年人中耐抗生素侵袭性肺炎球菌感染率下降。疫苗未包含的血清型引起的感染有所增加。
