Bigham Mark, Patrick David M, Bryce Elizabeth, Champagne Sylvie, Shaw Carol, Wu Wrency, Ng Helen, Roscoe Diane, Roy Jacques, Isaac-Renton Judy
Canadian Blood Services, British Columbia/Yukon Centre, Vancouver, British Columbia.
Can J Infect Dis. 2003 Sep;14(5):261-6. doi: 10.1155/2003/924325.
This study examined the epidemiology, antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae associated with invasive pneumococcal disease (IPD) in British Columbia.
Six hospitals and one private laboratory network participated in a prospective, sentinel laboratory based surveillance study of IPD, between October 1999 and October 2000. At each site, S pneumoniae isolates were collected and epidemiological data were gathered using a structured questionnaire, for all cases of IPD meeting the study case definition. Isolates were serotyped and tested for antimicrobial susceptibility. Bivariate associations were analyzed and multivariate logistic regression was used to identify independent risk factors associated with hospitalization or death.
One hundred three reports and isolates were collected. Seventy-nine per cent of cases were community-acquired, 64% required hospitalization and 5% died. Cases with one or more assessed risk factor for IPD and of female sex were independent variables associated with hospitalization or death. One-third of isolates had reduced penicillin susceptibility and 96% of these represented serotypes contained in the 23-valent pneumococcal polysaccharide vaccine (PPV-23). Overall, 89% of serotypes identified are included in the PPV-23 vaccine and 88% of isolates from children under five years of age are found in the 7-valent pneumococcal conjugate vaccine (PCV-7). Forty-one per cent of cases qualified for publicly funded pneumococcal vaccine and 34% of eligible persons were vaccinated.
Overall, pneumococcal serotypes associated with IPD in this study closely matched serotypes included in PPV-23 products currently licensed in Canada. Most serotypes associated with IPD in children under five years of age are included in a recently licenced PCV-7. One third of isolates demonstrated reduced penicillin susceptibility, most involving serotypes included in PPV-23. Effective delivery of current public health immunization programs using PPV-23 and extending protection to infants and young children using the PCV-7 will prevent many cases of IPD.
本研究调查了不列颠哥伦比亚省侵袭性肺炎球菌疾病（IPD）相关肺炎链球菌的流行病学、抗生素敏感性及血清型分布情况。
1999年10月至2000年10月期间，六家医院和一个私立实验室网络参与了一项基于前瞻性哨兵实验室的IPD监测研究。在每个研究地点，收集所有符合研究病例定义的IPD病例的肺炎链球菌分离株，并用结构化问卷收集流行病学数据。对分离株进行血清分型和抗菌药物敏感性检测。分析双变量关联，并采用多因素逻辑回归来确定与住院或死亡相关的独立危险因素。
共收集到103份报告及分离株。79%的病例为社区获得性感染，64%的病例需要住院治疗，5%的病例死亡。有一项或多项IPD评估危险因素且为女性的病例是与住院或死亡相关的独立变量。三分之一的分离株对青霉素的敏感性降低，其中96%的分离株代表23价肺炎球菌多糖疫苗（PPV - 23）所含的血清型。总体而言，所鉴定的血清型中有89%包含在PPV - 23疫苗中，5岁以下儿童分离株中有88%包含在7价肺炎球菌结合疫苗（PCV - 7）中。41%的病例符合公费肺炎球菌疫苗接种条件，34%的符合条件者接种了疫苗。
总体而言，本研究中与IPD相关的肺炎球菌血清型与加拿大目前获批的PPV - 23产品中所含血清型密切匹配。5岁以下儿童中与IPD相关的大多数血清型包含在最近获批的PCV - 7中。三分之一的分离株对青霉素的敏感性降低，大多数涉及PPV - 23中所含的血清型。利用PPV - 23有效实施当前的公共卫生免疫计划，并通过PCV - 7将保护范围扩大到婴幼儿，将预防许多IPD病例。
