Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Both authors contributed equally.
Dept of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden Both authors contributed equally.
Eur Respir J. 2014 Dec;44(6):1646-57. doi: 10.1183/09031936.00080814. Epub 2014 Oct 16.
Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored. Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children. The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality. PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.
肺炎球菌结合疫苗（PCV）已显示出对疫苗血清型侵袭性肺炎球菌病的保护作用，但观察到非疫苗血清型疾病的增加。需要探讨对临床表现的特定影响。将 2096 名成人和 192 名儿童侵袭性肺炎球菌病的临床数据与肺炎球菌分子血清型相关联。使用来自儿童的 165 个侵袭性和 550 个携带分离株计算了肺炎球菌血清型的侵袭性疾病潜力。与疫苗型菌株相比，非 PCV13 型的侵袭性疾病潜力较低。感染非 PCV13 菌株的患者有更多的基础疾病，不太可能患有肺炎，并且在成年人中，死亡率往往更高。此外，感染仅表达非 PCV13 荚膜的克隆血清型肺炎球菌的患者发生败血症和死亡的风险更高。PCV 疫苗接种可能会导致侵袭性肺炎球菌病减少，但侵袭性肺炎球菌病的临床表现会发生变化。引起成人侵袭性肺炎球菌病的遗传谱系经常表达非疫苗血清型，在接种疫苗后这些血清型的感染风险增加，从而使患有基础疾病的患者的感染风险扩大。
