高 HIV 流行率的农村非洲社区中，常规婴儿肺炎球菌免疫接种后肺炎球菌定植的时间变化。
Temporal changes in pneumococcal colonization in a rural African community with high HIV prevalence following routine infant pneumococcal immunization.
机构信息
From the *Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases; †Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; ‡Department of Global Health, Rollins School of Public Health; and §Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia; ¶MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; ‖Centre for Global Health Research, Umeå University, Umeå, Sweden; **INDEPTH Network, Accra, Ghana; and ††National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa.
出版信息
Pediatr Infect Dis J. 2013 Nov;32(11):1270-8. doi: 10.1097/01.inf.0000435805.25366.64.
BACKGROUND
Pneumococcal conjugate vaccine (PCV) immunization of children decreases their risk of nasopharyngeal acquisition of vaccine serotypes. We studied the impact of routine infant PCV immunization alone on the epidemiology of nasopharyngeal pneumococcal colonization among a rural African community with high prevalence of HIV positivity.
METHODS
Two cross-sectional surveys were undertaken in a rural South African community from May to October 2009 (period 1) and 2011 (period 2). Seven-valent PCV was introduced into the public immunization program for infants in April 2009, without catch-up campaign for older children. Randomly selected households with at least 1 child<2 years of age were recruited. Nasopharyngeal swabs from all consenting household members were obtained for Streptococcus pneumoniae culture and serotyping by Quellung method.
RESULTS
The median ages (SD) of children enrolled were 4.32 (SD, 3.4) and 3.80 (SD, 3.4) years in periods 1 and 2, respectively. Overall, the prevalence of vaccine serotype colonization declined from 18.3% (368/2010) in period 1 to 11.4% (418/3659) by period 2 (P<0.0001). This included reductions (adjusted risk ratio) of 50% [95% confidence interval (95% CI): 0.42-0.59], 34% (95% CI: 0.48-0.92) and 64% (95% CI: 0.18-0.74) in age groups<2 years, 6-12 years and adults. The prevalence of vaccine serotype colonization among primary caregivers decreased from 10.2% to 5.4% (P≤0.001) by period 2. The prevalence of nonvaccine serotype colonization increased by 35% (95% CI: 1.17-1.56) among <2-year-old children by period 2, while it declined by 45-54% among adolescents and adults.
CONCLUSIONS
An indirect effect of PCV7 was realized in a high HIV prevalence setting within 2 years of PCV introduction. The unexpected decline in nonvaccine serotypes colonization among adolescents/adults may indicate lag in replacement colonization by nonvaccine serotypes in this group.
背景
儿童接种肺炎球菌结合疫苗（PCV）可降低其鼻咽部感染疫苗血清型的风险。我们研究了在一个艾滋病毒阳性率较高的农村非洲社区中，常规婴儿 PCV 免疫接种对鼻咽部肺炎球菌定植的流行病学的影响。
方法
2009 年 5 月至 10 月（第 1 期）和 2011 年（第 2 期）在南非农村社区进行了两项横断面调查。2009 年 4 月，7 价 PCV 被引入婴儿公共免疫计划，而没有对大龄儿童进行补种运动。随机选择至少有 1 名<2 岁儿童的家庭进行招募。从所有同意的家庭成员中采集鼻咽拭子，通过 Quellung 法进行肺炎链球菌培养和血清分型。
结果
第 1 期和第 2 期分别纳入儿童的中位年龄（标准差）为 4.32（标准差，3.4）岁和 3.80（标准差，3.4）岁。总体而言，疫苗血清型定植率从第 1 期的 18.3%（368/2010）下降到第 2 期的 11.4%（418/3659）（P<0.0001）。这包括<2 岁、6-12 岁和成年人年龄组中 50%的降幅[调整后的风险比（95%置信区间[95%CI]）：0.42-0.59]、34%（95%CI：0.48-0.92）和 64%（95%CI：0.18-0.74）。第 2 期时，主要照顾者中疫苗血清型定植率从 10.2%降至 5.4%（P≤0.001）。第 2 期时，<2 岁儿童中非疫苗血清型定植率增加了 35%（95%CI：1.17-1.56），而青少年和成年人中则下降了 45-54%。
结论
在 PCV7 引入后的 2 年内，在艾滋病毒阳性率较高的环境中实现了 PCV7 的间接影响。青少年/成年人中非疫苗血清型定植率的意外下降可能表明该组中非疫苗血清型的定植替代延迟。
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