法国实施 7 价肺炎球菌结合疫苗前后儿童急性中耳炎鼻咽部菌群的变化。
Nasopharyngeal flora in children with acute otitis media before and after implementation of 7 valent pneumococcal conjugate vaccine in France.
机构信息
ACTIV, Association Clinique Thérapeutique Infantile du Val de Marne, 27 rue Inkermann, F94100 Saint Maur des Fossés, France.
出版信息
BMC Infect Dis. 2012 Mar 7;12:52. doi: 10.1186/1471-2334-12-52.
BACKGROUND
Several studies have investigated the impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal (Sp) and staphylococcal (Sa) nasopharyngeal (NP) carriage. Few have investigated the impact on Haemophilus influenzae (Hi) and Moraxella catarrhalis (Mc) carriage. We aimed to compare the NP carriage rates in young children with acute otitis media (AOM) before and after PCV7 implementation in France.
METHODS
Prior to PCV7 implementation, we performed 4 successive randomized trials with NP samples. These studies compared several antibiotic regimens for treating AOM in young children (6 to 30 months). After PCV7 implementation, to assess the impact of the vaccination program on NP flora, young children with AOM were enrolled in a prospective surveillance study. In each study, we obtained an NP sample to analyze the carriage rates of Sp, Hi, Mc and Sa and the factors influencing the carriage. Standardized history and physical examination findings were recorded; the methods used for NP swabs (sampling and cultures) were the same in all studies.
RESULTS
We enrolled 4,405 children (mean age 13.9 months, median 12.8). Among the 2,598 children enrolled after PCV7 implementation, 98.3% were vaccinated with PCV7. In comparing the pre- and post-PCV7 periods, we found a slight but non-significant decrease in carriage rates of pneumococcus (AOR = 0.85 [0.69;1.05]), H. influenzae (AOR = 0.89 [0.73;1.09]) and S. aureus (AOR = 0.92 [0.70;1.19]). By contrast, the carriage rate of M. catarrhalis increased slightly but not significantly between the 2 periods (AOR = 1.08 [0.95;1.2]). Among Sp carriers, the proportion of PCV7 vaccine types decreased from 66.6% to 10.7% (P < 0.001), penicillin intermediate-resistant strains increased from 30.3% to 43.4% (P < 0.001), and penicillin-resistant strains decreased greatly from 22.8% to 3.8% (P < 0.001). The proportion of Hi ß-lactamase-producing strains decreased from 38.6% to 17.1% (P < 0.001).
CONCLUSION
The carriage rates of otopathogen species (Sp, Hi, Mc) and Sa did not significantly change in children with AOM after PCV7 implementation in France. However, we observed significant changes in carriage rates of PCV7 vaccine serotypes and penicillin non-susceptible Sp.
背景
已有多项研究调查了 7 价肺炎球菌结合疫苗（PCV7）对肺炎球菌（Sp）和葡萄球菌（Sa）鼻咽（NP）携带的影响。但很少有研究调查其对流感嗜血杆菌（Hi）和卡他莫拉菌（Mc）携带的影响。我们旨在比较法国实施 PCV7 前后急性中耳炎（AOM）患儿的 NP 携带率。
方法
在实施 PCV7 之前，我们进行了 4 项连续的随机试验，均涉及 NP 样本。这些研究比较了几种治疗 6 至 30 个月大儿童 AOM 的抗生素方案。在实施 PCV7 后，为评估疫苗接种计划对 NP 菌群的影响，患有 AOM 的儿童被纳入前瞻性监测研究。在每项研究中，我们均获得 NP 样本以分析 Sp、Hi、Mc 和 Sa 的携带率以及影响携带的因素。记录了标准化的病史和体格检查结果；所有研究均使用相同的 NP 拭子（采样和培养）方法。
结果
我们共纳入了 4405 名儿童（平均年龄 13.9 个月，中位数 12.8）。在实施 PCV7 后纳入的 2598 名儿童中，98.3%接种了 PCV7。在比较 PCV7 实施前后的时期时，我们发现肺炎球菌（AOR=0.85 [0.69；1.05]）、流感嗜血杆菌（AOR=0.89 [0.73；1.09]）和金黄色葡萄球菌（AOR=0.92 [0.70；1.19]）的携带率略有但无统计学意义的下降。相比之下，两个时期之间卡他莫拉菌的携带率略有但无统计学意义的增加（AOR=1.08 [0.95；1.2]）。在 Sp 携带者中，PCV7 疫苗类型的比例从 66.6%降至 10.7%（P＜0.001），中介度青霉素耐药株的比例从 30.3%升至 43.4%（P＜0.001），且青霉素耐药株的比例大幅从 22.8%降至 3.8%（P＜0.001）。β-内酰胺酶产生型 Hi 的比例从 38.6%降至 17.1%（P＜0.001）。
结论
法国实施 PCV7 后，AOM 患儿的病原体物种（Sp、Hi、Mc 和 Sa）携带率未发生显著变化。但我们观察到 PCV7 疫苗血清型和青霉素不敏感 Sp 的携带率发生了显著变化。
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