van der Linden Mark, Falkenhorst Gerhard, Perniciaro Stephanie, Imöhl Matthias
National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Aachen, Germany.
Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
PLoS One. 2015 Jul 1;10(7):e0131494. doi: 10.1371/journal.pone.0131494. eCollection 2015.
This study describes the effects of the introduction of universal infant pneumococcal conjugate vaccination in 2006 on invasive pneumococcal disease (IPD) among children and adults in Germany with a focus on the dynamics of serotype distribution in vaccinated and non-vaccinated age groups. Over a period of 22 years (1992-2014), microbiological diagnostic laboratories from all over Germany have been sending isolates of IPD cases to the German National Reference Center for Streptococci on a voluntary basis. Streptococcus pneumoniae isolates were serotyped using Neufeld's Quellung method. Among children <16 years, the proportion of PCV7 serotypes among isolates from IPD cases decreased from 61.8% before vaccination (1997-2006) to 23.5% in the early vaccination period (2007-2010; p = 1.30E-72) and sank further to 5.2% in the late vaccination period (2010-2014; p = 4.59E-25). Similar reductions were seen for the separate age groups <2 years, 2-4 years and 5-15 years. Among adults, the proportion of PCV7 serotypes decreased from 43.4% in the pre-vaccination period (1992-2006) to 24.7% (p = 3.78E-88) in the early vaccination period and 8.2% (p = 5.97E-161) in the late vaccination period. Both among children and among adults, the non-PCV7 serotypes 1, 3, 7F and 19A significantly increased in the early vaccination period. After the switch from PCV7 to PVC10/PCV13 for infant vaccination in 2010, serotypes 1, 6A and 7F significantly decreased. A decrease in serotype 19A was only observed in 2013-2014, as compared to 2010-2011 (children p = 4.16E-04, adults p = 6.98E-06). Among adults, serotype 3, which strongly increased in the early vaccination period (p = 4.44E-15), remained at a constant proportion in the late vaccination period. The proportion of non-PCV13 vaccine serotypes increased over the whole vaccination period, with serotypes 10A, 12F, 23B, 24F and 38 most significantly increasing among children and serotypes 6C, 12F, 15A, 22F and 23B increasing among adults. Eight years of childhood pneumococcal conjugate vaccination have had a strong effect on the pneumococcal population in Germany, both among the target group for vaccination as well as among older children and adults.
本研究描述了2006年引入通用婴儿肺炎球菌结合疫苗对德国儿童和成人侵袭性肺炎球菌疾病（IPD）的影响，重点关注接种疫苗和未接种疫苗年龄组血清型分布的动态变化。在22年期间（1992 - 2014年），德国各地的微生物诊断实验室自愿将IPD病例的分离株送交德国国家链球菌参考中心。肺炎链球菌分离株采用诺伊费尔德荚膜肿胀法进行血清分型。在16岁以下儿童中，IPD病例分离株中PCV7血清型的比例从疫苗接种前（1997 - 2006年）的61.8%降至疫苗接种早期（2007 - 2010年）的23.5%（p = 1.30E - 72），并在疫苗接种后期（2010 - 2014年）进一步降至5.2%（p = 4.59E - 25）。在2岁以下、2 - 4岁和5 - 15岁的不同年龄组中也观察到了类似的下降。在成年人中，PCV7血清型的比例从疫苗接种前期（1992 - 2006年）的43.4%降至疫苗接种早期的24.7%（p = 3.78E - 88）和疫苗接种后期的8.2%（p = 5.97E - 161）。在儿童和成年人中，非PCV7血清型1、3、7F和19A在疫苗接种早期均显著增加。2010年婴儿疫苗接种从PCV7转换为PVC10/PCV13后，血清型1、6A和7F显著下降。与2010 - 2011年相比，仅在2013 - 2014年观察到血清型19A下降（儿童p = 4.16E - 04，成人p = 6.98E - 06）。在成年人中，在疫苗接种早期大幅增加的血清型3（p = 4.44E - 15）在疫苗接种后期保持恒定比例。在整个疫苗接种期间，非PCV13疫苗血清型的比例增加，其中血清型10A、12F、23B、24F和38在儿童中增加最为显著，血清型6C、12F、15A、22F和23B在成年人中增加。八年的儿童肺炎球菌结合疫苗接种对德国的肺炎球菌菌群产生了强烈影响，无论是在疫苗接种目标群体中，还是在大龄儿童和成年人中。
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