Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Epidemics. 2010 Jun;2(2):80-4. doi: 10.1016/j.epidem.2010.03.005.
Invasive pneumococcal disease (IPD) has been reduced in the US following conjugate vaccination (PCV7) targeting seven pneumococcal serotypes in 2000. However, increases in IPD due to other serotypes have been observed, in particular 19A. How much this "serotype replacement" will erode the benefits of vaccination and over what timescale is unknown. We used a population genetic approach to test first whether the selective impact of vaccination could be detected in a longitudinal carriage sample, and secondly how long it persisted for following introduction of vaccine in 2000. To detect the selective impact of the vaccine we compared the serotype diversity of samples from pneumococcal carriage in Massachusetts children collected in 2001, 2004 and 2007 with others collected in the pre-vaccine era in Massachusetts, the UK and Finland. The 2004 sample was significantly (p >0.0001) more diverse than pre-vaccine samples, indicating the selective pressure of vaccination. The 2007 sample showed no significant difference in diversity from the pre-vaccine period, and exhibited similar population structure, but with different serotypes. In 2007 the carriage frequency of 19A was similar to that of the most common serotype in pre-vaccine samples. We suggest that serotype replacement involving 19A may be complete in Massachusetts due to similarities in population structure to pre-vaccine samples. These results suggest that the replacement phenomenon occurs rapidly with high vaccine coverage, and may allay concerns about future increases in disease due to 19A. For other serotypes, the future course of replacement disease remains to be determined.
在美国,2000 年针对 7 种肺炎球菌血清型的结合疫苗(PCV7)接种后,侵袭性肺炎球菌病(IPD)有所减少。然而,由于其他血清型引起的 IPD 增加已经被观察到,特别是 19A。这种“血清型替代”会在多大程度上削弱疫苗的效果,以及持续多长时间尚不清楚。我们使用群体遗传学方法首先检测疫苗接种的选择压力是否可以在纵向携带样本中检测到,其次检测在 2000 年引入疫苗后这种选择压力能持续多久。为了检测疫苗的选择压力,我们比较了 2001 年、2004 年和 2007 年在马萨诸塞州儿童中收集的肺炎球菌携带样本的血清型多样性与在疫苗接种前的马萨诸塞州、英国和芬兰收集的样本。2004 年的样本明显(p >0.0001)比疫苗接种前的样本更加多样化,这表明了疫苗接种的选择压力。2007 年的样本在多样性方面与疫苗接种前没有显著差异,并且表现出相似的种群结构,但血清型不同。2007 年,19A 的携带频率与疫苗接种前样本中最常见的血清型相似。我们认为,19A 涉及的血清型替代可能在马萨诸塞州已经完成,这是由于与疫苗接种前样本的种群结构相似。这些结果表明,在高疫苗覆盖率的情况下,替代现象发生迅速,可能减轻了对未来由于 19A 引起的疾病增加的担忧。对于其他血清型,替代疾病的未来进程仍有待确定。
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