Department of Infectious Diseases, University of Maryland, 725 West Lombard Street, Baltimore, MD 21201, USA.
Eur J Clin Microbiol Infect Dis. 2013 Sep;32(9):1135-41. doi: 10.1007/s10096-013-1859-z. Epub 2013 Mar 24.
Invasive pneumococcal disease (IPD) has an all-cause mortality of 5-35 % in the developed world. Pneumococcal vaccination is recommended for at-risk groups, including those infected with human immunodeficiency virus (HIV) and those over 65 years of age. However, adherence to vaccination guidelines is low. We reviewed all cases of IPD in our tertiary referral hospital from 2006 to 2010. IPD was defined as the isolation of Streptococcus pneumoniae from a normally sterile site with a compatible clinical syndrome. Demographics, risk factors, susceptibilities, pneumococcal serotype, mortality, and vaccination status for each patient were analyzed. There were 127 IPD episodes in 122 patients. The overall case fatality rate was 21.2 %. Seventy-two percent of the patients had two or more risk factors that should have prompted pneumococcal vaccination. However, the overall pneumococcal vaccination provision was only 9 %: 64.6 % of all typed isolates were contained in the pneumococcal polysaccharides vaccine 23 (PPV23), 48.8 % in the 7-valent pneumococcal conjugate vaccine (PCV7), and 60.1 % in PCV13. All isolates were fully sensitive to penicillin and cefotaxime. Recurrent IPD was seen in 11 % of the HIV-infected patients, highlighting a particular at-risk group. IPD has a high mortality rate. There is low vaccine provision in our study, although most IPD patients had risk factors that should have prompted vaccination. HIV-positive people are particularly at risk; vaccinating those with persisting CD4 counts less than 200 cells/mm(3) and the use of "prime-boost" strategies may decrease incidence in the future. Newer models of care such as a dedicated vaccine clinic as described in this study may help increase vaccine provision and uptake.
在发达国家，侵袭性肺炎球菌病（IPD）的全因死亡率为 5-35%。肺炎球菌疫苗接种推荐用于高危人群，包括感染人类免疫缺陷病毒（HIV）和 65 岁以上的人群。然而，疫苗接种的依从性很低。我们回顾了 2006 年至 2010 年期间我们的三级转诊医院的所有 IPD 病例。IPD 定义为从正常无菌部位分离出肺炎链球菌，同时伴有相符的临床综合征。分析了每位患者的人口统计学、危险因素、药敏性、肺炎球菌血清型、死亡率和疫苗接种状况。122 例患者中有 127 例发生 IPD。总病死率为 21.2%。72%的患者有两个或更多应提示接种肺炎球菌疫苗的危险因素。然而，总的肺炎球菌疫苗接种率仅为 9%：所有定型分离株中有 64.6%包含在肺炎球菌多糖疫苗 23（PPV23）中，48.8%包含在 7 价肺炎球菌结合疫苗（PCV7）中，60.1%包含在 PCV13 中。所有分离株对青霉素和头孢噻肟完全敏感。11%的 HIV 感染患者出现复发性 IPD，这突显了一个特定的高危人群。IPD 死亡率很高。尽管大多数 IPD 患者有应提示接种疫苗的危险因素，但我们的研究中疫苗接种率较低。HIV 阳性者风险特别高；对持续 CD4 计数小于 200 个细胞/mm（3）的人群进行疫苗接种，并使用“初免-加强”策略，可能会降低未来的发病率。如本研究所述的新型护理模式，如专门的疫苗接种诊所，可能有助于提高疫苗接种率和接种率。
