Mitchell Patrick K, Lipsitch Marc, Hanage William P
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Philos Trans R Soc Lond B Biol Sci. 2015 Jun 5;370(1670):20140342. doi: 10.1098/rstb.2014.0342.
Pneumococcal conjugate vaccines target the limited subset of the more than 90 known serotypes of Streptococcus pneumoniae responsible for the greatest burden of pneumococcal disease and antibiotic resistance. Following the introduction of these vaccines, serotypes not targeted were able to expand and resistance became more common within these types. Here we use a stochastic dynamic model of pediatric pneumococcal carriage to evaluate potential influences on the emergence of new resistant lineages following the introduction of a vaccine targeting more common resistant types. Antibiotic pressure was the strongest driver, with no emergence at low levels and universal emergence at high levels. At intermediate levels of antibiotic pressure, higher carriage burden and a greater degree of dual carriage promoted emergence. This may have implications for current plans to introduce childhood pneumococcal vaccination in several high-burden countries.
肺炎球菌结合疫苗针对已知的90多种肺炎链球菌血清型中的有限子集，这些血清型导致了肺炎球菌疾病和抗生素耐药性的最大负担。在引入这些疫苗后，未被靶向的血清型得以扩展，并且耐药性在这些类型中变得更加普遍。在此，我们使用儿童肺炎球菌携带的随机动态模型来评估引入针对更常见耐药类型的疫苗后对新耐药谱系出现的潜在影响。抗生素压力是最强的驱动因素，低水平时无新耐药谱系出现，高水平时普遍出现。在中等抗生素压力水平下，较高的携带负担和更大程度的双重携带促进了新耐药谱系的出现。这可能对当前在几个高负担国家引入儿童肺炎球菌疫苗接种的计划产生影响。
