Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel.
Vaccine. 2013 May 1;31(19):2387-94. doi: 10.1016/j.vaccine.2013.02.059. Epub 2013 Mar 19.
Pneumococcal infections in adults vary in severity and incidence is affected by childhood vaccination policy. Here, we try to define the host determinants and the interaction with specific serotypes that result in invasive pneumococcal disease (IPD) before an expected effect of pneumococcal conjugate vaccines. A nationwide active surveillance was initiated on July 2009, at the time of national implementation of PCV7 in Israel. The surveillance included all 27 laboratories and medical centers performing blood cultures in Israel, providing all blood and CSF pneumococcal isolates from persons ≥18y. Capture-recapture method assured that >95% of all cases were reported. IPD outcome and medical history were recorded and isolates were serotyped. Four hundred and sixty IPD cases were reported (annual incidence [/100,000] of 9.25). Incidence increased with age, from 2.6 among 18-34y to 66.8 among ≥85y. The most common diagnosis was pneumonia (72.4%), followed by bacteremia with no apparent focus (20.2%). Case fatality rate increased with age and number of comorbidities (34.5% for ≥75y or those with ≥3 comorbidities vs. 9.2-11.2% among <65y or those with no comorbidities; p=0.015). Variables independently associated with mortality were: age ≥75, chronic renal failure, malignancy, neurosurgery, alcohol abuse, multi-lobar pneumonia and sepsis with no apparent focus. The predominant serotypes in patients 18-49y were 1, 5, 8, 7F and 9V (constituting 56.3% in this age-group vs. 11.9% in ≥75y; p<0.01). The predominant serotypes among patients ≥75y were 3, 19A, 23F and 14 (40.3% of this age-group vs. 12.9% of 18-49y; p<0.01). Overall, PCV7 and PCV13 covered 25.6% and 63.7% of isolates, respectively, and 30.9% and 67.9% of isolates in mortality cases respectively. This nationwide active surveillance provides the baseline incidence, mortality rates and risk group distributions of IPD in adults before expected PCV effect.
成人肺炎球菌感染的严重程度和发生率因儿童疫苗接种政策而异。在这里，我们试图在肺炎球菌结合疫苗（PCV）产生预期效果之前，确定导致侵袭性肺炎球菌病（IPD）的宿主决定因素和与特定血清型的相互作用。2009 年 7 月，以色列开始了一项全国性的主动监测，当时该国正在实施 PCV7。该监测包括以色列所有 27 个进行血液培养的实验室和医疗中心，为所有 18 岁以上的人提供血液和脑脊液肺炎球菌分离株。捕获再捕获方法确保了报告了>95%的所有病例。记录了 IPD 结果和病史，并对分离株进行了血清分型。报告了 460 例 IPD 病例（发病率[每 100,000 人]为 9.25）。发病率随年龄增长而增加，18-34 岁人群为 2.6，85 岁以上人群为 66.8。最常见的诊断是肺炎（72.4%），其次是无明显病灶的菌血症（20.2%）。病死率随年龄和合并症数量的增加而增加（≥75 岁或有≥3 种合并症者为 34.5%，而<65 岁或无合并症者为 9.2-11.2%；p=0.015）。与死亡率相关的独立变量为：年龄≥75 岁、慢性肾功能衰竭、恶性肿瘤、神经外科手术、酒精滥用、多叶肺炎和无明显病灶的败血症。18-49 岁患者中主要血清型为 1、5、8、7F 和 9V（占该年龄组的 56.3%，而≥75 岁者为 11.9%；p<0.01）。≥75 岁患者中主要血清型为 3、19A、23F 和 14（占该年龄组的 40.3%，而 18-49 岁者为 12.9%；p<0.01）。总体而言，PCV7 和 PCV13 分别覆盖了 25.6%和 63.7%的分离株，以及 30.9%和 67.9%的死亡病例分离株。这项全国性的主动监测提供了在预期 PCV 效果之前，成人 IPD 的基础发病率、死亡率和高危人群分布情况。
