Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Vaccine. 2019 Aug 23;37(36):5147-5152. doi: 10.1016/j.vaccine.2019.07.073. Epub 2019 Jul 31.
The study aimed to investigate the impact of 13-valent pneumococcal conjugate vaccine (PCV13) immunization on the overall pneumococcal disease in children in Taiwan by surveillance of culture-confirmed pneumococcal disease (CCPD). This study was conducted in a medical center from 2012 to 2016. Clinical isolates of Streptococcus pneumoniae were prospectively collected from pediatric patients. Serotyping, multi-locus sequence typing, and antimicrobial susceptibility testing were performed. A total of 473 patients with CCPD, including 58 with invasive pneumococcal disease (IPD), were identified. The incidence of CCPD per 10,000 admissions decreased from 71.7 in 2012 to 27.0 in 2016. The proportion of additional PCV13 serotypes significantly decreased from 52.0% in 2012 to 21.7% in 2015 but increased slightly to 26.7% because of serotype 19A in 2016 (P < 0.0001). The proportion of non-vaccine serotypes (NVTs) increased significantly from 18.4% in 2012 to 66.7% in 2016, but the increase of the incidence of CCPD caused by NVTs was not considered significant (P = 0.0885). Genotyping identified predominant clones, ST63, ST83, and ST166/338, for major NVTs. The penicillin non-susceptibility of PCV13 serotypes was significantly higher than that of NVTs (P < 0.0001). Surveillance of CCPD appears superior to IPD alone for evaluation of the overall impact of pneumococcal immunization. Serotype replacement occurred quickly after the use of PCV13, while the incidence of NVT infection did not show a significant increase in children over the years. The gradual introduction of PCV13 into national immunization program is effective in reducing overall pneumococcal disease in children.
本研究旨在通过对培养确诊肺炎球菌病（CCPD）的监测，调查 13 价肺炎球菌结合疫苗（PCV13）免疫接种对台湾儿童总体肺炎球菌病的影响。这项研究在一家医疗中心进行，时间为 2012 年至 2016 年。从儿科患者中前瞻性收集肺炎链球菌临床分离株。进行血清分型、多位点序列分型和抗菌药物敏感性试验。共确定了 473 例 CCPD 患者，其中 58 例为侵袭性肺炎球菌病（IPD）。每 10000 例住院患者中 CCPD 的发病率从 2012 年的 71.7 例降至 2016 年的 27.0 例。额外的 PCV13 血清型的比例从 2012 年的 52.0%显著下降至 2015 年的 21.7%，但由于 2016 年血清型 19A 的原因略有上升至 26.7%（P<0.0001）。非疫苗血清型（NVTs）的比例从 2012 年的 18.4%显著增加至 2016 年的 66.7%，但 NVTs 引起的 CCPD 发病率增加并不被认为具有显著意义（P=0.0885）。基因分型确定了主要 NVTs 的主要克隆，ST63、ST83 和 ST166/338。PCV13 血清型的青霉素不敏感性显著高于 NVTs（P<0.0001）。与 IPD 单独监测相比，CCPD 的监测似乎更能评估肺炎球菌免疫接种的总体影响。在使用 PCV13 后，血清型替换迅速发生，而多年来儿童中 NVT 感染的发病率并未显示出显著增加。PCV13 逐渐被纳入国家免疫规划，这有效地降低了儿童总体肺炎球菌病的发病率。
