Dullius Cynthia Rocha, Zani Luciana, Chatkin José Miguel
. Programa de Pós-Graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.
. Programa de Pós-Graduação em Pneumologia, Hospital São Lucas, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.
J Bras Pneumol. 2018 Sep-Oct;44(5):361-366. doi: 10.1590/S1806-37562017000000056. Epub 2018 Jun 25.
To evaluate Streptococcus pneumoniae serotypes isolated from an inpatient population at a tertiary care hospital, in order to determine the theoretical coverage of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPV23).
This was a cross-sectional study involving 118 inpatients at the Hospital São Lucas, in the city of Porto Alegre, Brazil, whose cultures of blood, cerebrospinal fluid, or other sterile body fluid specimens, collected between January 2005 and December 2016, yielded pneumococcal isolates. The theoretical vaccine coverage was studied in relation to the serotypes identified in the sample and their relationship with those contained in the pneumococcal vaccines available in Brazil.
The majority of the population was male (n = 66; 55.9%), with a median age of 57 years (interquartile range: 33-72 years). The most common manifestation was pneumonia, and the pneumococcus was most commonly isolated from blood cultures. More than one fourth of the study population had some degree of immunosuppression (n = 34; 28.8%). Of the total sample, 39 patients (33.1%) died. There were no significant associations between mortality and comorbidity type, ICU admission, or need for mechanical ventilation. The theoretical vaccine coverage of PPV23 alone and PCV13 plus PPV23 was 31.4% and 50.8%, respectively.
If the patients in this sample had been previously vaccinated with PCV13 plus PPV23, theoretically, 50.8% of the cases of invasive pneumococcal disease that required hospital admission could potentially have been prevented. Invasive pneumococcal disease should be prevented by vaccination not only of children and the elderly but also of adults in their economically productive years, so as to reduce the socioeconomic costs, morbidity, and mortality still associated with the disease, especially in underdeveloped countries.
评估从一家三级护理医院的住院患者中分离出的肺炎链球菌血清型，以确定13价肺炎球菌结合疫苗（PCV13）和23价肺炎球菌多糖疫苗（PPV23）的理论覆盖率。
这是一项横断面研究，涉及巴西阿雷格里港圣卢卡斯医院的118名住院患者，他们在2005年1月至2016年12月期间采集的血液、脑脊液或其他无菌体液标本培养物中分离出了肺炎球菌菌株。根据样本中鉴定出的血清型及其与巴西可用肺炎球菌疫苗中所含血清型的关系，研究了理论疫苗覆盖率。
大多数患者为男性（n = 66；55.9%），中位年龄为57岁（四分位间距：33 - 72岁）。最常见的表现是肺炎，肺炎球菌最常从血培养中分离出来。超过四分之一的研究人群有一定程度的免疫抑制（n = 34；28.8%）。在总样本中，39名患者（33.1%）死亡。死亡率与合并症类型、入住重症监护病房或是否需要机械通气之间无显著关联。单独使用PPV23以及PCV13加PPV23的理论疫苗覆盖率分别为31.4%和50.8%。
如果该样本中的患者先前接种了PCV13加PPV23，理论上，50.8%需要住院治疗的侵袭性肺炎球菌病病例可能会得到预防。侵袭性肺炎球菌病不仅应通过对儿童和老年人接种疫苗来预防，还应通过对经济生产年龄段的成年人接种疫苗来预防，以降低与该疾病相关的社会经济成本、发病率和死亡率，特别是在欠发达国家。
