Bruyn G A, van Furth R
Department of Infectious Diseases, University Hospital, Leiden, The Netherlands.
Eur J Clin Microbiol Infect Dis. 1991 Nov;10(11):897-910. doi: 10.1007/BF02005442.
Streptococcus pneumoniae is the primary cause of community-acquired pneumonia, meningitis in adults and otitis media in infants and children and the third cause of meningitis in infants and children. Despite the availability of effective therapeutic agents against this pathogen, mortality has remained high, particularly for infections complicated by bacteremia. For many years, there has been a plea for vaccination. The first steps, using whole bacterial vaccines, were taken during the early decades of this century in the gold mining camps of South Africa, where pneumonia was endemic. The efficacy of purified pneumococcal polysaccharide vaccines has since been demonstrated in young adults, such as gold miners and military recruits, as well as for several other groups at risk, such as institutionalized elderly, patients with sickle cell anemia or those who have undergone a splenectomy, and elderly patients with underlying conditions such as chronic obstructive pulmonary disease and chronic cardiovascular disease, but not in infants and severely immunocompromised patients. Serological studies on the immune response to inoculation of pneumococcal polysaccharide antigens have demonstrated a severely impaired antibody response in the last two groups. Therefore, development of more highly immunogenic vaccines, e.g. by linking pneumococcal polysaccharides or parts of them to protein carriers, should be continued in an attempt to offer adequate protection to those who are insufficiently protected by the current 23-valent polysaccharide vaccine. Opportunities to immunize other patients who are at risk for pneumococcal infection and are capable of responding to the current vaccine should not be missed.
肺炎链球菌是社区获得性肺炎、成人脑膜炎以及婴幼儿中耳炎的主要病因，也是婴幼儿脑膜炎的第三大病因。尽管有针对该病原体的有效治疗药物，但死亡率仍然很高，尤其是对于并发菌血症的感染。多年来，一直有人呼吁接种疫苗。本世纪初的头几十年，在南非的金矿营地采取了第一步措施，使用全细菌疫苗，当时肺炎在那里流行。此后，纯化肺炎球菌多糖疫苗的有效性已在年轻成年人中得到证实，如金矿工人和新兵，以及其他几个高危群体，如机构养老的老年人、镰状细胞贫血患者或接受过脾切除术的患者，以及患有慢性阻塞性肺疾病和慢性心血管疾病等基础疾病的老年患者，但在婴儿和严重免疫功能低下的患者中未得到证实。对肺炎球菌多糖抗原接种的免疫反应的血清学研究表明，后两组的抗体反应严重受损。因此，应继续开发免疫原性更高的疫苗，例如通过将肺炎球菌多糖或其部分与蛋白质载体连接，试图为那些未得到当前23价多糖疫苗充分保护的人提供足够的保护。不应错过为其他有肺炎球菌感染风险且能够对当前疫苗产生反应的患者进行免疫接种的机会。
