Department of Pediatrics and Adolescent Medicine, American University of Beirut, Cairo Street, Beirut, Lebanon.
Vaccine. 2012 Dec 31;30 Suppl 6:G11-7. doi: 10.1016/j.vaccine.2012.07.020.
Invasive pneumococcal disease (IPD) associated with Streptococcus pneumonia is a major public health problem worldwide for all age groups, including in Lebanon. Prevention through vaccination remains the most valuable tool to decrease the burden of disease. Pneumococcal conjugate vaccine 7 (PCV7), marketed internationally including in the Middle East and North Africa region for the prevention of IPD, was introduced in Lebanon in 2006, followed by PCV10 and PCV13 in 2010. However, none of these is currently part of the Extended Program of Immunization schedule and published data on IPD incidence, pneumococcal serotypes and vaccine coverage in the region are lacking. The Lebanese Inter-Hospital Pneumococcal Surveillance Program is a surveillance system set up to determine the burden of IPD and the prevalent serotypes responsible. The aim of this prospective 6-year study carried out in 78 hospitals throughout Lebanon was to obtain such data to help health authorities make informed decisions on the implementation of pneumococcal vaccination at the national level. A total of 257 isolates of culture-confirmed Streptococcus pneumoniae were evaluated. Considering all age groups, vaccine coverage was 41.4%, 53.9%, and 67.2% for PCV7, PCV10, and PCV13 serotypes, respectively; for patients <2, 2-5, and >60 years of age, PCV7 coverage was 50%, 51%, and 35%, respectively; PCV10 coverage was 53%, 74%, 45%, respectively; and PCV13 coverage was 63%, 80%, and 68%, respectively. Overall, 17.4% of these isolates were penicillin-G non-susceptible using the latest established breakpoints and mortality occurred in 23.5% of the patients with non-susceptible isolates. In addition, 10.9% of isolates were multi-drug-resistant. The highest mortality rates were observed in the eldest (>60 years of age) and youngest (<2 years of age) patients. The most prevalent invasive serotypes identified were those found in currently available pneumococcal conjugate vaccines, emphasizing the importance of implementing the vaccine in the routine immunization schedule at the national level. Continuation of current surveillance practices will help assess the impact of vaccine implementation on IPD epidemiology, serotype distribution and antibiotic resistance patterns.
侵袭性肺炎球菌病（IPD）与肺炎链球菌有关，是全球所有年龄段人群的一个主要公共卫生问题，包括黎巴嫩。通过疫苗接种进行预防仍然是降低疾病负担的最有价值的工具。肺炎球菌结合疫苗 7（PCV7）在国际上销售，包括在中东和北非地区用于预防 IPD，并于 2006 年在黎巴嫩推出，随后于 2010 年推出了 PCV10 和 PCV13。然而，这些疫苗目前都不属于扩展免疫规划的一部分，该地区缺乏关于 IPD 发病率、肺炎球菌血清型和疫苗覆盖率的已发表数据。黎巴嫩医院间肺炎球菌监测计划是一个监测系统，旨在确定 IPD 的负担和负责的流行血清型。这项在黎巴嫩 78 家医院进行的为期 6 年的前瞻性研究旨在获得这些数据，以帮助卫生当局就国家一级的肺炎球菌疫苗接种做出明智的决定。共评估了 257 株培养确认的肺炎链球菌分离株。考虑到所有年龄段，PCV7、PCV10 和 PCV13 血清型的疫苗覆盖率分别为 41.4%、53.9%和 67.2%；对于<2 岁、2-5 岁和>60 岁的患者，PCV7 的覆盖率分别为 50%、51%和 35%；PCV10 的覆盖率分别为 53%、74%、45%；PCV13 的覆盖率分别为 63%、80%和 68%。总体而言，使用最新建立的断点，这些分离株中有 17.4%对青霉素 G 不敏感，对非敏感分离株的患者死亡率为 23.5%。此外，10.9%的分离株为多药耐药。最高的死亡率发生在年龄最大（>60 岁）和年龄最小（<2 岁）的患者中。鉴定出的最常见侵袭性血清型与目前可用的肺炎球菌结合疫苗中的血清型相同，这强调了在国家一级常规免疫计划中实施疫苗的重要性。继续目前的监测做法将有助于评估疫苗实施对 IPD 流行病学、血清型分布和抗生素耐药模式的影响。
