The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Antimicrob Chemother. 2020 Oct 1;75(10):3038-3045. doi: 10.1093/jac/dkaa263.
In the pre-pneumococcal conjugated vaccines (PCVs) era, serotypes included in the 7/13-valent PCVs (PCV7/PCV13) caused most pneumococcal otitis media (OM) and antibiotic-non-susceptible pneumococcal OM (ANSP-OM) episodes. In southern Israel, sequential PCV7/PCV13 introduction resulted in >90% reduction of vaccine-serotype OM.
We assessed the dynamics of ANSP-OM necessitating middle ear fluid culture following PCV7/PCV13 sequential introduction in young children.
This was a prospective, population-based, active surveillance. All episodes in children <3 years old, during 2004-16, were included. Two subperiods were defined: (i) pre-PCV: 2004-08; and (ii) PCV13: 2014-16. ANSP was defined for the following antibiotics: penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone, trimethoprim/sulfamethoxazole and chloramphenicol. MDR was defined as ANSP for ≥3 classes.
Overall, 2270 pneumococcal OM episodes were identified. Annual overall pneumococcal, PCV13 and non-PCV13 serotype OM incidence declined by 86%, 97% and 33%, respectively, comparing pre-PCV with the PCV13 period. During 2004-08, 95% of ANSP was observed in vaccine serotypes. Incidence of penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone and multidrug ANSP-OM declined by >90% in the PCV13 period. Rates of trimethoprim/sulfamethoxazole and chloramphenicol ANSP-OM declined by 85% and 79%, respectively. The proportions of ANSP of all pneumococcal isolates declined by ∼70% for penicillin, ceftriaxone and erythromycin; 53% for tetracycline; and 55% for MDR, versus no significant reductions observed for chloramphenicol, trimethoprim/sulfamethoxazole and clindamycin.
PCV7/PCV13 sequential introduction resulted in rapid and substantial ANSP-OM reduction, in parallel with the near disappearance of PCV13-serotype OM and no increase in replacement disease.
在肺炎球菌结合疫苗（PCV）问世之前，7/13 价 PCV（PCV7/PCV13）包含的血清型导致了大多数肺炎球菌中耳炎（OM）和抗生素耐药性肺炎球菌 OM（ANSP-OM）的发生。在以色列南部，序贯接种 PCV7/PCV13 疫苗后，疫苗血清型 OM 的发生率降低了 90%以上。
我们评估了 PCV7/PCV13 序贯接种后，儿童中需要进行中耳液培养的 ANSP-OM 的动态变化。
这是一项前瞻性、基于人群的主动监测研究。纳入了 2004 年至 2016 年期间所有 <3 岁儿童的 OM 发作。定义了两个亚时期：（i）PCV 前：2004 年 8 月；（ii）PCV13 期：2014 年 16 月。对以下抗生素的 ANSP 进行了定义：青霉素（MIC≥0.1mg/L 和≥1.0mg/L）、大环内酯类、四环素类、克林霉素、头孢曲松、复方磺胺甲噁唑和氯霉素。多重耐药性（MDR）定义为对≥3 类抗生素耐药。
总体而言，共发现 2270 例肺炎球菌 OM 发作。与 PCV13 时期相比，PCV 前和 PCV13 时期的总体肺炎球菌、PCV13 和非 PCV13 血清型 OM 的年发病率分别下降了 86%、97%和 33%。在 2004 年 8 月，95%的 ANSP 发生在疫苗血清型中。PCV13 时期青霉素（MIC≥0.1mg/L 和≥1.0mg/L）、大环内酯类、四环素类、克林霉素、头孢曲松和多药耐药性 ANSP-OM 的发生率下降了>90%。复方磺胺甲噁唑和氯霉素 ANSP-OM 的发生率分别下降了 85%和 79%。所有肺炎球菌分离株中对青霉素、头孢曲松和红霉素的 ANSP 比例下降了约 70%；对四环素的比例下降了 53%；对 MDR 的比例下降了 55%；而氯霉素、复方磺胺甲噁唑和克林霉素的比例没有明显下降。
PCV7/PCV13 序贯接种导致 ANSP-OM 迅速且显著减少，与 PCV13 血清型 OM 几乎消失以及无替代疾病增加同时发生。
