Menéndez Rosario, España Pedro Pablo, Pérez-Trallero Emilio, Uranga Ane, Méndez Raul, Cilloniz Catia, Marimón José María, Cifuentes Isabel, Méndez Cristina, Torres Antoni
H. Universitario y Politécnico la Fe, Valencia, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain.
H. Galdakao-Usansolo, Galdácano, Spain.
Vaccine. 2017 Sep 18;35(39):5264-5270. doi: 10.1016/j.vaccine.2017.08.007. Epub 2017 Aug 18.
Streptococcus pneumoniae serotypes distribution in community-acquired pneumonia (CAP) requiring hospitalization in adults after introduction of PCV13 in children is not well known. Our aim was to evaluate the distribution of serotypes in pneumococcal pneumonia according to risk factors and comorbidity conditions after the introduction of PCV13 in children in 2010.
A prospective study from 2011 to 2014 was performed in immunocompetent adults hospitalized with CAP in 3 Spanish hospitals. Microbiological confirmation was obtained using a serotype specific urinary antigen detection test (UAD test), Binax Now and conventional cultures.
1258 adults were enrolled and pneumococcal pneumonia (invasive disease in 17.7%) was confirmed in 368 (29.3%) and 17.6% of the any-cause CAP were caused by PVC13 serotypes (3.5% PCV7 serotypes). Around 60% of pneumococcal CAP were caused by PCV13 serotypes (74.6% in invasive episodes vs 57.4% in non-invasive ones). The most prevalent serotypes in invasive disease were 1, 3, 7F, 19A and 14. No significant differences were observed in the distribution of PCV13 serotypes across the study periods. Regarding comorbidity, the rate of PCV13 serotypes was similar among them, and it was slightly higher in those with no underlying conditions.
Serotypes included in PCV13 caused a significant proportion of CAP in adults with underlying conditions and in healthy adults, with no significant changes in cases due to PCV7 or PCV13 from 2011 to 2014, suggesting an insufficient indirect protection from childhood vaccination. Strategies for implementing pneumococcal vaccination of adults are encouraged to reduce the incidence of pneumococcal episodes.
在儿童中引入13价肺炎球菌结合疫苗（PCV13）后，社区获得性肺炎（CAP）成年住院患者中肺炎链球菌血清型的分布情况尚不清楚。我们的目的是评估2010年儿童引入PCV13后，肺炎球菌肺炎血清型根据危险因素和合并症情况的分布。
2011年至2014年在西班牙3家医院对因CAP住院的免疫功能正常成年人进行了一项前瞻性研究。使用血清型特异性尿抗原检测试验（UAD试验）、Binax Now和传统培养方法进行微生物学确诊。
共纳入1258名成年人，368例（29.3%）确诊为肺炎球菌肺炎（侵袭性疾病占17.7%），17.6%的任何原因CAP由PCV13血清型引起（PCV7血清型占3.5%）。约60%的肺炎球菌CAP由PCV13血清型引起（侵袭性发作中占74.6%，非侵袭性发作中占57.4%）。侵袭性疾病中最常见的血清型为1、3、7F、19A和14。在整个研究期间，PCV13血清型的分布未观察到显著差异。关于合并症，PCV13血清型的发生率在它们之间相似，在无基础疾病的患者中略高。
PCV13中包含的血清型在有基础疾病的成年人和健康成年人中导致了相当比例的CAP，2011年至2014年因PCV7或PCV13导致的病例无显著变化，提示儿童疫苗接种的间接保护作用不足。鼓励实施成人肺炎球菌疫苗接种策略以降低肺炎球菌发作的发生率。
