Manoharan Anand, Jayaraman Ranjith
The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India.
Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Indian J Med Microbiol. 2018 Oct-Dec;36(4):465-474. doi: 10.4103/ijmm.IJMM_18_442.
Streptococcus pneumoniae continues to take a heavy toll on childhood mortality and morbidity across the developing world. An estimated 10.6 million invasive pneumococcal diseases (IPDs) occur every year, with nearly 1 million deaths in children under 5 years of age. Introduction of vaccines in the childhood immunisation programme in developed world has brought down the incidence of the disease considerably. However, childhood immunocompromising illnesses including HIV have increased the risk of IPD several folds. There is also a growing concern on the increasing antibiotic resistance among these invasive strains to penicillin, other beta-lactams and macrolides, making treatment difficult and expensive. It is estimated that about 62% of IPD worldwide is caused by the 10 most common serotypes. Although the ranking of individual pneumococcal serotypes causing serious disease varies among nations, the 7-13 serotypes included in pneumococcal conjugate vaccines (PCVs) may prevent 50%-80% of all paediatric pneumococcal diseases globally. The World Health Organization has recommended the use of PCV-10/13 in the national immunisation programmes (NIPs) of developing countries. Four doses of PCV-13 have been recommended by the US Association of Pediatrics and Centers for Disease Control and Prevention, at intervals of each 2 months for the first 6 months and by the 12 to 15 months after birth. This is expected to reduce the morbidity and mortality associated with IPD and simultaneously decrease colonisation with circulating antibiotic-resistant strains in immunized communities. Nevertheless, continued surveillance of antimicrobial resistance in non-vaccine serotypes is necessary to prevent the resurgence of resistance. Other virulence factors which are not serotype specific also need to be studied to overcome the drawbacks of serotype-specific pneumococcal vaccines. PCV-13 was launched during May 2017 under the NIP of five Indian states with the highest pneumococcal diseases in the country and is expected to be rolled out in the other parts of the country in the coming days.
肺炎链球菌继续在发展中世界对儿童死亡率和发病率造成沉重影响。据估计，每年发生1060万例侵袭性肺炎球菌疾病（IPD），近100万5岁以下儿童死亡。在发达国家的儿童免疫规划中引入疫苗已大幅降低了该疾病的发病率。然而，包括艾滋病毒在内的儿童免疫功能低下疾病使IPD风险增加了数倍。人们还越来越担心这些侵袭性菌株对青霉素、其他β-内酰胺类和大环内酯类抗生素的耐药性不断增加，导致治疗困难且费用高昂。据估计，全球约62%的IPD由10种最常见的血清型引起。尽管各国导致严重疾病的肺炎球菌血清型个体排名有所不同，但肺炎球菌结合疫苗（PCV）中包含的7至13种血清型可预防全球50%至80%的所有儿童肺炎球菌疾病。世界卫生组织已建议在发展中国家的国家免疫规划（NIP）中使用PCV-10/13。美国儿科学会和疾病控制与预防中心建议接种4剂PCV-13，在出生后的前6个月每2个月接种1剂，在12至15个月时接种第4剂。这有望降低与IPD相关的发病率和死亡率，同时减少免疫社区中循环耐药菌株的定植。尽管如此，仍有必要持续监测非疫苗血清型的抗菌耐药性，以防止耐药性的再次出现。还需要研究其他非血清型特异性的毒力因子，以克服血清型特异性肺炎球菌疫苗的缺点。PCV-13于2017年5月在印度肺炎球菌疾病发病率最高的五个邦的国家免疫规划下推出，预计未来几天将在该国其他地区推广。
