Poolman Jan T
Bacterial Vaccine Discovery & Early Development, Janssen, Leiden, Netherlands.
NPJ Vaccines. 2020 Sep 11;5:84. doi: 10.1038/s41541-020-00232-0. eCollection 2020.
A crisis in bacterial infections looms as ageing populations, increasing rates of bacteraemia and healthcare-associated infections converge with increasing antimicrobial resistance and a paucity of new antimicrobial classes. New initiatives are needed to develop bacterial vaccines for older adults in whom immune senescence plays a critical role. Novel vaccines require an expanded repertoire to prevent mucosal diseases such as pneumonia, skin and soft tissue infections and urinary tract infections that are major causes of morbidity and mortality in the elderly, and key drivers of antimicrobial resistance. This review considers the challenges inherent to the prevention of bacterial diseases, particularly mucosal infections caused by major priority bacterial pathogens against which current vaccines are sub-optimal. It has become clear that prevention of many lung, urinary tract and skin infections requires more than circulating antibodies. Induction of Th1/Th17 cellular responses with tissue-resident memory (Trm) cells homing to mucosal tissues may be a pre-requisite for success.
随着老龄化人口增加、菌血症发病率上升、医疗保健相关感染增多，以及抗菌药物耐药性不断增加和新型抗菌药物种类匮乏，细菌感染危机迫在眉睫。需要采取新举措来开发针对老年人的细菌疫苗，因为免疫衰老在老年人中起着关键作用。新型疫苗需要扩大其预防范围，以预防诸如肺炎、皮肤和软组织感染以及尿路感染等黏膜疾病，这些疾病是老年人发病和死亡的主要原因，也是抗菌药物耐药性的关键驱动因素。本综述探讨了预防细菌疾病，特别是由主要重点细菌病原体引起的黏膜感染所固有的挑战，而目前的疫苗对这些病原体的预防效果并不理想。显然，预防许多肺部、泌尿系统和皮肤感染需要的不仅仅是循环抗体。诱导Th1/Th17细胞反应并使组织驻留记忆（Trm）细胞归巢至黏膜组织可能是成功的先决条件。
