Cho Ying-Chun, Chiu Nan-Chang, Lu Chun-Yi, Huang Daniel Tsung-Ning, Huang Fu-Yuan, Chang Luan-Yin, Huang Li-Min, Chi Hsin
From the *Division of Pediatric Infectious Diseases, Department of Pediatrics, Mackay Children's Hospital and Mackay Memorial Hospital, Taipei, Taiwan; †Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan; ‡Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; §Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; ¶Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; and ‖Department of Medical Research, Mackay Memorial Hospital, Tamshui, Taiwan.
Pediatr Infect Dis J. 2017 Dec;36(12):e334-e340. doi: 10.1097/INF.0000000000001664.
After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) against Streptococcus pneumoniae, public health officials in Taiwan monitored a decline in circulating vaccine serotypes and the emergence of nonvaccine serotypes in children with invasive pneumococcal disease. A gradually expanded PCV13 national immunization program was launched in 2013 in Taiwan. Here, we evaluate the changes in the distribution of pneumococcal serotypes and antimicrobial nonsusceptibility in children during the evolution of vaccination policy.
S. pneumoniae isolates from children with pneumococcal disease were collected and serotyped from 2010 to 2015 in northern Taiwan. PCVs were administered at the recipients' expense between 2010 and 2012, and then PCV13 was partially reimbursed by the government beginning in 2013. The distribution and diversity of serotypes were analyzed along with their antimicrobial susceptibilities.
Among a total of 498 isolates, the proportion of invasive pneumococcal disease isolates declined (47.1%-10.6%) during the study period, and serotype diversity increased after 2011. Between 2010 and 2012, the dominant serotypes were 19A, 19F, 3, 6B and 14, and serotype 19A rose from 44.1% to 57.5%. Serotypes 19A, 15A, 19F and 15B were more prevalent from 2013 to 2015, and serotype 19A decreased from 42.1% to 4.5%. Serotypes 19F and 15A became the most commonly detected serotypes in 2015. Overall, PCV13 additional serotypes were reduced by 80% (P < 0.0001) but nonvaccine serotypes increased from 8.8% to 51.5% (P < 0.0001).
The step-by-step PCV13 national immunization program is effective against pneumococcal disease in Taiwanese children, mainly by reducing PCV13 additional serotypes.
在引入针对肺炎链球菌的13价肺炎球菌结合疫苗（PCV13）后，台湾的公共卫生官员监测到侵袭性肺炎球菌病患儿中循环疫苗血清型的下降以及非疫苗血清型的出现。台湾于2013年启动了逐步扩大的PCV13国家免疫规划。在此，我们评估疫苗接种政策演变期间儿童肺炎球菌血清型分布和抗菌药物不敏感性的变化。
2010年至2015年在台湾北部收集肺炎球菌病患儿的肺炎链球菌分离株并进行血清分型。2010年至2012年期间，PCV由受种者自费接种，然后自2013年起PCV13由政府部分报销。分析血清型的分布和多样性及其抗菌药物敏感性。
在总共498株分离株中，侵袭性肺炎球菌病分离株的比例在研究期间下降（47.1%-10.6%），2011年后血清型多样性增加。2010年至2012年期间，主要血清型为19A、19F、3、6B和14，19A血清型从44.1%上升至57.5%。2013年至2015年期间，19A、15A、19F和15B血清型更为普遍，19A血清型从42.1%降至4.5%。19F和15A血清型在2015年成为最常检测到的血清型。总体而言，PCV13额外血清型减少了80%（P<0.0001），但非疫苗血清型从8.8%增加至51.5%（P<0.0001）。
逐步实施的PCV13国家免疫规划对台湾儿童的肺炎球菌病有效，主要是通过减少PCV13额外血清型来实现。
