Department of Nephrology, Royal Children's Hospital, Parkville, Victoria, Australia.
Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Arch Dis Child. 2018 Oct;103(10):957-961. doi: 10.1136/archdischild-2017-313923. Epub 2018 Apr 19.
Pneumococcal infection is a leading cause of haemolytic uraemic syndrome (HUS) and is potentially vaccine preventable. Published data suggest high mortality and poor renal outcomes. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV) has seen the emergence of disease caused by non-vaccine strains, particularly 19A. We sought to describe serotype prevalence and outcomes, particularly after the introduction of the 13-valent PCV.
We performed a retrospective chart review, using hospital medical records to identify cases of HUS in a tertiary paediatric hospital in Australia over a 20-year period (January 1997-December 2016). Associated pneumococcal infection was identified, and serotype data were categorised according to vaccine era: prevaccine (January 1997-December 2004), PCV7 (January 2005-June 2011) and PCV13 (July 2011-December 2016).
We identified 66 cases of HUS. Pneumococcal infection was proven in 11 cases, representing 4% (1/26) of cases prior to the introduction of PCV7, 20% (3/15) in the PCV7 era and 28% (7/25) in the PCV13 era. Subtype 19A was the most prevalent pneumococcal serotype (6/11). All four patients who received PCV7 were infected with a non-vaccine serotype. Four of the five patients who received PCV13 were classed as vaccine failures. Median follow-up was 14 (range 1-108) months. Chronic kidney disease was the most common complication (4/7). We observed no mortality, neurological sequelae or progression to end-stage kidney disease.
Serotype 19A is most commonly associated with pneumococcal HUS, despite the introduction of the 13-valent vaccine. Chronic kidney disease is a significant complication of pneumococcal HUS.
肺炎球菌感染是溶血尿毒综合征（HUS）的主要病因，具有潜在的疫苗预防作用。已有研究数据表明，肺炎球菌感染可导致较高的死亡率和较差的肾脏预后。7 价肺炎球菌结合疫苗（PCV）的使用导致了非疫苗菌株疾病的出现，尤其是 19A 型。本研究旨在描述血清型流行情况和结局，特别是在 13 价 PCV 使用之后。
我们进行了一项回顾性图表研究，使用医院病历资料，在澳大利亚一家三级儿科医院中，确定了 20 年间（1997 年 1 月-2016 年 12 月）HUS 病例。鉴定出相关的肺炎球菌感染，并根据疫苗时代对血清型数据进行分类：疫苗前时代（1997 年 1 月-2004 年 12 月）、PCV7 时代（2005 年 1 月-2011 年 6 月）和 PCV13 时代（2011 年 7 月-2016 年 12 月）。
我们共确定了 66 例 HUS 病例。11 例证实存在肺炎球菌感染，占 PCV7 引入前的 4%（1/26）、PCV7 时代的 20%（3/15）和 PCV13 时代的 28%（7/25）。19A 型是最常见的肺炎球菌血清型（6/11）。接受 PCV7 的 4 例患者均感染了非疫苗血清型。接受 PCV13 的 5 例患者中，有 4 例被归类为疫苗失败。中位随访时间为 14（范围 1-108）个月。慢性肾脏病是最常见的并发症（4/7）。我们未观察到死亡、神经后遗症或进展为终末期肾脏病。
尽管使用了 13 价疫苗，但血清型 19A 与肺炎球菌 HUS 最相关。肺炎球菌 HUS 的一个显著并发症是慢性肾脏病。
