Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
Department of Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
Clin Infect Dis. 2018 Jun 18;67(1):42-49. doi: 10.1093/cid/ciy009.
The impact of pneumococcal conjugate vaccination on the prevalence of nasopharyngeal carriage with pneumococci and other bacteria in adults is unknown. The direct effects of the 13-valent pneumococcal conjugate vaccine (PCV13) in community dwelling older adults was investigated as part of the randomized controlled Community Acquired Pneumonia immunization Trial in Adults (CAPiTA).
We determined the carriage of Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis before and 6, 12, and 24 months after vaccination using polymerase chain reaction (PCR)-based methods and conventional cultures of nasopharyngeal and oropharyngeal swab samples in 1006 PCV13 recipients and 1005 controls. Serotyping of the 13 vaccine-type (VT) pneumococci was performed by PCR targeting capsular synthesis genes and Quellung reaction of isolates.
Before randomization and based on PCR, 339 of 1891 subjects had nasopharyngeal carriage with any pneumococci (17.9%), and 114 of 1891 (6.0%) carried VT pneumococci. At 6 months after vaccination, VT pneumococcal carriage was significantly lower in PCV13 recipients than in the placebo group (relative risk, 0.53; 95% confidence interval, .35-.80; P = .04). There was no difference between the groups at 12 and 24 months after vaccination. Carriage of non-VT pneumococci, S. aureus, H. influenzae, and M. catarrhalis did not change between groups.
In community-dwelling adults aged ≥65 years, a single dose of PCV13 seems to elicit a small and temporary reduction in VT carriage 6 months after vaccination. Neither replacement by non-VT serotypes nor impact on other nasopharyngeal bacteria was observed.
肺炎球菌结合疫苗对成人鼻咽部携带肺炎球菌和其他细菌的流行情况的影响尚不清楚。作为社区获得性肺炎成人免疫接种试验（CAPiTA）的一部分，我们研究了 13 价肺炎球菌结合疫苗（PCV13）对社区居住的老年人的直接影响。
我们使用聚合酶链反应（PCR）-基于方法和常规培养鼻咽喉拭子样本，在 1006 名 PCV13 接种者和 1005 名对照者中，在接种前以及接种后 6、12 和 24 个月，确定了肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌和卡他莫拉菌的携带情况。对 13 种疫苗型（VT）肺炎球菌的血清型进行了 PCR 靶向荚膜合成基因和分离物的 Quellung 反应。
在随机分组之前，根据 PCR 结果，1891 名受试者中有 339 名（17.9%）鼻咽部携带任何肺炎球菌，1891 名中有 114 名（6.0%）携带 VT 肺炎球菌。接种后 6 个月，PCV13 接种者中 VT 肺炎球菌携带率明显低于安慰剂组（相对风险，0.53；95%置信区间，0.35-0.80；P=0.04）。接种后 12 和 24 个月两组之间无差异。非 VT 肺炎球菌、金黄色葡萄球菌、流感嗜血杆菌和卡他莫拉菌的携带率在两组之间没有变化。
在 65 岁及以上的社区居住的成年人中，单次接种 PCV13 似乎会在接种后 6 个月导致 VT 携带率轻微且暂时下降。未观察到非 VT 血清型替代或对其他鼻咽细菌的影响。
