LeBlanc Jason J, ElSherif May, Ye Lingyun, MacKinnon-Cameron Donna, Li Li, Ambrose Ardith, Hatchette Todd F, Lang Amanda L, Gillis Hayley, Martin Irene, Andrew Melissa K, Boivin Guy, Bowie William, Green Karen, Johnstone Jennie, Loeb Mark, McCarthy Anne, McGeer Allison, Moraca Sanela, Semret Makeda, Stiver Grant, Trottier Sylvie, Valiquette Louis, Webster Duncan, McNeil Shelly A
Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada.
Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada.
Vaccine. 2017 Jun 22;35(29):3647-3654. doi: 10.1016/j.vaccine.2017.05.049. Epub 2017 May 26.
Pneumococcal community acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) cause significant morbidity and mortality worldwide. Although childhood immunization programs have reduced the overall burden of pneumococcal disease, there is insufficient data in Canada to inform immunization policy in immunocompetent adults. This study aimed to describe clinical outcomes of pneumococcal disease in hospitalized Canadian adults, and determine the proportion of cases caused by vaccine-preventable serotypes.
Active surveillance for CAP and IPD in hospitalized adults was performed in hospitals across five Canadian provinces from December 2010 to 2013. CAP were identified using sputum culture, blood culture, a commercial pan-pneumococcal urine antigen detection (UAD), or a serotype-specific UAD. The serotype distribution was characterized using Quellung reaction, and PCR-based serotyping on cultured isolates, or using a 13-valent pneumococcal conjugate vaccine (PCV13) serotype-specific UAD assay.
In total, 4769 all-cause CAP cases and 81 cases of IPD (non-CAP) were identified. Of the 4769 all-cause CAP cases, a laboratory test for S. pneumoniae was performed in 3851, identifying 14.3% as CAP. Of CAP cases among whom all four diagnostic test were performed, S. pneumoniae was identified in 23.2% (144/621). CAP cases increased with age and the disease burden of illness was evident in terms of requirement for mechanical ventilation, intensive care unit admission, and 30-day mortality. Of serotypeable CAP or IPD results, predominance for serotypes 3, 7F, 19A, and 22F was observed. The proportion of hospitalized CAP cases caused by a PCV13-type S. pneumoniae ranged between 7.0% and 14.8% among cases with at least one test for S. pneumoniae performed or in whom all four diagnostic tests were performed, respectively. Overall, vaccine-preventable pneumococcal CAP and IPD were shown to be significant causes of morbidity and mortality in hospitalized Canadian adults in the three years following infant PCV13 immunization programs in Canada.
肺炎球菌社区获得性肺炎（CAP）和侵袭性肺炎球菌病（IPD）在全球范围内导致了显著的发病和死亡。尽管儿童免疫规划已减轻了肺炎球菌病的总体负担，但在加拿大，关于免疫功能正常成年人的免疫政策的数据不足。本研究旨在描述加拿大住院成年人肺炎球菌病的临床结局，并确定由疫苗可预防血清型引起的病例比例。
2010年12月至2013年期间，在加拿大五个省份的医院对住院成年人中的CAP和IPD进行了主动监测。通过痰培养、血培养、商用全肺炎球菌尿抗原检测（UAD）或血清型特异性UAD来识别CAP。使用荚膜肿胀反应、对培养分离株进行基于PCR的血清分型或使用13价肺炎球菌结合疫苗（PCV13）血清型特异性UAD检测来表征血清型分布。
总共识别出4769例全因性CAP病例和81例IPD（非CAP）病例。在4769例全因性CAP病例中，对3851例进行了肺炎链球菌的实验室检测，其中14.3%被确定为CAP。在所有四项诊断检测均进行的CAP病例中，23.2%（144/621）被鉴定为肺炎链球菌。CAP病例随年龄增加，并且从机械通气需求、重症监护病房入住率和30天死亡率来看，疾病负担明显。在可分型的CAP或IPD结果中，观察到血清型3、7F、19A和22F占优势。在至少进行了一项肺炎链球菌检测的病例中，或在所有四项诊断检测均进行的病例中，由PCV13型肺炎链球菌引起的住院CAP病例比例分别在7.0%至14.8%之间。总体而言，在加拿大实施婴儿PCV13免疫规划后的三年里，疫苗可预防的肺炎球菌CAP和IPD被证明是加拿大住院成年人发病和死亡的重要原因。
