Instituto Nacional de Salud Bogotá, Bogotá, Colombia.
BMC Infect Dis. 2012 May 28;12:124. doi: 10.1186/1471-2334-12-124.
Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.
We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.
We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.
Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.
肺炎球菌结合疫苗（PCV）正在拉丁美洲实施。发达国家的经验表明，它们可降低侵袭性和非侵袭性疾病的发病率。然而，有证据表明，在普遍的大规模疫苗接种计划中引入 PCV 疫苗，再加上抗生素的不适当和广泛使用，可能与非 PCV 血清型的变化有关，包括血清型 19A。我们进行了一项系统评价，以确定该地区血清型 19A 的分布、肺炎球菌疾病负担和抗生素耐药性。
我们对该地区 1990 年至 2010 年期间进行的观察性和随机临床试验中有关血清型 19A 的数据进行了系统评价，纳入对象为 6 岁以下儿童。通过计算带有置信区间的监测活动中的汇总患病率估计值来评估结果。
我们纳入了 22 个国家的 100 项研究，并从 63 项研究中提取了数据。这些数据报告了 19733 例血清型侵袭性肺炎球菌分离株，其中 3.8%为血清型 19A。血清型 19A 分离株导致 2.4%的急性中耳炎发作，分别占 4380 例来自健康儿童和住院/患病儿童的鼻咽分离株的 4.1%和 4.4%。该血清型在该地区 20 年的监测中保持稳定。脑膜炎病例中分离出的 Spn19A 菌株中有 53.7%对青霉素耐药，而非脑膜炎病例中只有 14%对青霉素耐药。
在该地区广泛实施 PCV 之前，血清型 19A 导致的肺炎球菌疾病病例相对较少。随着 PCV 使用的增加和更多血清型被纳入，监测肺炎球菌血清型分布对于了解肺炎球菌疾病的流行病学至关重要。
