Merck Vaccines, 770 Sumneytown Pike, WP97-B364, West Point, PA 19426, USA.
Merck Research Laboratories, Upper Gwynedd, PA 19454, USA.
Vaccine. 2014 May 1;32(21):2399-405. doi: 10.1016/j.vaccine.2014.02.096. Epub 2014 Mar 14.
Infections due to Streptococcus pneumoniae serotypes differ in clinical manifestations among adults, varying in propensity for severity, invasiveness, and lethality. To characterize differences in serious outcomes between pneumococcal serotypes, we systematically reviewed the literature.
After distilling 676 hits to 28 relevant articles, statistically significant differences in individual serotypes associated with serious clinical outcomes were assessed. Serotypes associated with elevated risk of serious clinical outcomes were evaluated in terms of serotypes included in licensed adult pneumococcal vaccines (i.e., 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13)). Repeated findings were considered a measure of robustness.
Among adult studies evaluating serious clinical outcomes, the following serotypes were associated with elevated risk: Empyema (serotypes 1, 3, 5, 7F, 8, 19A), necrotizing pneumonia (serotype 3), septic shock (serotypes 3, 19A), meningitis (repeatedly serotypes 10A, 15B, 19F, 23F), reduced quality-adjusted life years (QALYs, serotypes 15B, 3, 10A, 9N, 19F, 11A, 31), and increased case-fatality rates (repeatedly serotypes 3, 6B, 9N, 11A, 16F, 19F, 19A).
Both vaccine formulations include multiple pneumococcal serotypes associated with increased risk for serious clinical outcomes. Three studies found elevated risk from serotype 6A (unique to PCV13). Fourteen studies found elevated risk from nine serotypes unique to PPSV23 (repeatedly: case-fatality-11A & 9N, meningitis-10A & 15B). Seven studies found elevated risk from serotypes not represented in either vaccine formulation (notably 16F). The pneumococcal serotypes repeatedly associated with elevated risk of serious outcomes in adults are an important consideration for vaccine policy making.
肺炎链球菌血清型引起的感染在成人中的临床表现不同，严重程度、侵袭性和致死率也各不相同。为了描述不同血清型导致严重后果的差异，我们系统地回顾了文献。
在对 676 条记录进行筛选，得到 28 篇相关文章后，我们评估了与严重临床结局相关的个别血清型的统计学差异。我们根据已获得许可的成人肺炎球菌疫苗（即 23 价肺炎球菌多糖疫苗[PPSV23]和 13 价肺炎球菌结合疫苗[PCV13]）中包含的血清型，评估与严重临床结局风险增加相关的血清型。我们将重复发现视为稳健性的衡量标准。
在评估严重临床结局的成人研究中，以下血清型与风险增加相关：脓胸（血清型 1、3、5、7F、8、19A）、坏死性肺炎（血清型 3）、感染性休克（血清型 3、19A）、脑膜炎（反复出现血清型 10A、15B、19F、23F）、降低质量调整生命年（QALYs，血清型 15B、3、10A、9N、19F、11A、31）和增加病死率（反复出现血清型 3、6B、9N、11A、16F、19F、19A）。
两种疫苗都包含多个与严重临床结局风险增加相关的肺炎球菌血清型。有三项研究发现血清型 6A（仅存在于 PCV13 中）风险增加。有 14 项研究发现 PPSV23 中 9 种血清型的风险增加（重复出现：病死率-11A 和 9N，脑膜炎-10A 和 15B）。有 7 项研究发现两种疫苗均未包含的血清型风险增加（特别是 16F）。在成人中，与严重后果风险增加反复相关的肺炎球菌血清型是疫苗政策制定的一个重要考虑因素。
