Ludwig Endre, Mészner Zsófia
Egyesített Szent István és Szent László Kórház, Semmelweis Egyetem Általános Orvostudományi Kar, Infektológiai Tanszéki Csoport Budapest Albert Flórián út 5-7. 1097.
Országos Gyermekegészségügyi Intézet Budapest.
Orv Hetil. 2014 Dec 14;155(50):1996-2004. doi: 10.1556/OH.2014.30070.
Infections caused by Streptococcus pneumoniae (pneumococcus) are still meaning a serious health problem, about 40% of community acquired pneumonia (CAP) is due to pneumococcal bacteria in adults requiring hospitalization. The incidence and mortality rate of pneumococcal infections is increasing in the population above 50 years of age. Certain congenital and acquired immunocompromised conditions make the individual susceptible for pneumococcal infection and other chronic comorbidities should be considered as a risk factor as well, such as liver and renal diseases, COPD, diabetes mellitus. Lethality of severe pneumococcal infections with bacteraemia still remains about 12% despite adequate antimicrobial therapy in the past 60 years. Underestimation of pneumococcal infections is mainly due to the low sensitivity of diagnostic tools and underuse of bacteriological laboratory confirmation methods. 13-valent pneumococcal conjugate vaccine (PCV-13) became available recently beyond the 23-valent polysacharide vaccine (PPV-23) which has been using for a long time.The indication and proper administration of the two vaccines are based on international recommendations and vaccination guideline published by National Centre for Epidemiology (NCE):Pneumococcal vaccination is recommended for: Every person above 50 years of age. Patients of all ages with chronic diseases who are susceptible for severe pneumococcal infections: respiratory (COPD), heart, renal, liver disease, diabetes, or patients under immunsuppressive treatment. Smokers regardless of age and comorbidities. Cochlear implants, cranial-injured patients. Patients with asplenia.Recommendation for administration of the two different vaccines:Adults who have not been immunized previously against pneumococcal disease must be vaccinated with a dose of 13-valent pneumococcal conjugate vaccine first. This protection could be extended with administration of 23-valent pneumococcal polysaccharide vaccine at least two month later. Adults who have been immunized previously, but above 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. Adults who have been immunized previously, but under 65 years of age, with a 23-valent polysaccharide vaccine are recommended to get one dose of conjugate vaccine at least one year later. After a minimal interval of two months one dose of 23-valent pneumococcal polysaccharide vaccine is recommended if at least 5 years have elapsed since their previous PPSV23 dose. Vaccination of immuncompromised patients (malignancy, transplantation, etc.) and patients with asplenia should be defined by vaccinology specialists. Pneumococcal vaccines may be administered concommitantly or any interval with other vaccines.
肺炎链球菌（肺炎球菌）引起的感染仍然是一个严重的健康问题，在需要住院治疗的成年人中，约40%的社区获得性肺炎（CAP）是由肺炎球菌引起的。在50岁以上人群中，肺炎球菌感染的发病率和死亡率正在上升。某些先天性和后天获得性免疫功能低下的情况会使个体易患肺炎球菌感染，其他慢性合并症也应被视为危险因素，如肝脏和肾脏疾病、慢性阻塞性肺疾病（COPD）、糖尿病。尽管在过去60年中有足够的抗菌治疗，但伴有菌血症的严重肺炎球菌感染的致死率仍约为12%。对肺炎球菌感染的低估主要是由于诊断工具的敏感性低以及细菌学实验室确认方法使用不足。13价肺炎球菌结合疫苗（PCV - 13）最近已上市，此前长期使用的是23价多糖疫苗（PPV - 23）。这两种疫苗的适应症和正确接种方法基于国际建议以及国家流行病学中心（NCE）发布的疫苗接种指南：
每一位50岁以上的人。
所有年龄段患有易导致严重肺炎球菌感染的慢性疾病的患者：呼吸系统疾病（COPD）、心脏病、肾病、肝病、糖尿病患者，或接受免疫抑制治疗的患者。
无论年龄和是否有合并症的吸烟者。
接受耳蜗植入者、颅脑损伤患者。
无脾患者。
以前未接种过肺炎球菌疫苗的成年人必须首先接种一剂13价肺炎球菌结合疫苗。至少两个月后可接种23价肺炎球菌多糖疫苗以增强保护效果。
以前接种过23价多糖疫苗但年龄在65岁以上的成年人，建议至少一年后接种一剂结合疫苗。
以前接种过23价多糖疫苗但年龄在65岁以下的成年人，建议至少一年后接种一剂结合疫苗。
自上次接种PPSV23疫苗至少已过去5年，在间隔至少两个月后，建议接种一剂23价肺炎球菌多糖疫苗。
免疫功能低下患者（恶性肿瘤、移植等）和无脾患者的疫苗接种应由疫苗学专家确定。肺炎球菌疫苗可与其他疫苗同时接种或在任何间隔时间接种。
