10 价肺炎球菌结合疫苗对莫桑比克小于 5 岁儿童鼻咽携带肺炎链球菌的影响：10 价肺炎球菌结合疫苗引入后 3 年
Effect of 10-Valent Pneumococcal Conjugate Vaccine on Streptococcus pneumoniae Nasopharyngeal Carriage Among Children Less Than 5 Years Old: 3 Years Post-10-Valent Pneumococcal Conjugate Vaccine Introduction in Mozambique.
机构信息
Epidemic Intelligence Service assigned to National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Moçambique.
出版信息
J Pediatric Infect Dis Soc. 2021 Apr 30;10(4):448-456. doi: 10.1093/jpids/piaa132.
BACKGROUND
Mozambique introduced 10-valent pneumococcal conjugate vaccine (PCV10) in 2013 with doses at ages 2, 3, and 4 months and no catch-up or booster dose. We evaluated PCV10 impact on the carriage of vaccine-type (VT), non-VT, and antimicrobial non-susceptible pneumococci 3 years after introduction.
METHODS
We conducted cross-sectional carriage surveys among HIV-infected and HIV-uninfected children aged 6 weeks to 59 months: 1 pre-PCV10 (2012-2013 [Baseline]) and 2 post-PCV10 introductions (2014-2015 [Post1] and 2015-2016 [Post2]). Pneumococci isolated from nasopharyngeal swabs underwent Quellung serotyping and antimicrobial susceptibility testing. Non-susceptible isolates (intermediate or resistant) were defined using Clinical and Laboratory Standards Institute 2018 breakpoints. We used log-binomial regression to estimate changes in the pneumococcal carriage between survey periods. We compared proportions of non-susceptible pneumococci between Baseline and Post2.
RESULTS
We enrolled 720 children at Baseline, 911 at Post1, and 1208 at Post2. Baseline VT carriage was similar for HIV-uninfected (36.0%, 110/306) and HIV-infected children (34.8%, 144/414). VT carriage was 36% (95% confidence interval [CI]: 19%-49%) and 27% (95% CI: 11%-41%) lower in Post1 vs baseline among HIV-uninfected and HIV-infected children, respectively. VT carriage prevalence declined in Post2 vs Post1 for HIV-uninfected but remained stable for HIV-infected children. VT carriage prevalence 3 years after PCV10 introduction was 14.5% in HIV-uninfected and 21.0% in HIV-infected children. Pneumococcal isolates non-susceptible to penicillin declined from 66.0% to 56.2% (P= .0281) among HIV-infected children.
CONCLUSIONS
VT and antimicrobial non-susceptible pneumococci carriage dropped after PCV10 introduction, especially in HIV-uninfected children. However, VT carriage remained common, indicating ongoing VT pneumococci transmission.
背景
莫桑比克于 2013 年引入了 10 价肺炎球菌结合疫苗（PCV10），免疫程序为 2、3 和 4 月龄各接种 1 剂，无补种或加强免疫。我们评估了 PCV10 接种对疫苗血清型（VT）、非 VT 和抗菌药物非敏感性肺炎球菌定植的影响，该评估在疫苗引入 3 年后进行。
方法
我们对感染和未感染 HIV 的 6 周至 59 月龄儿童进行了横断面带菌调查：1 次为 PCV10 引入前（2012-2013 年[基线期]），2 次为 PCV10 引入后（2014-2015 年[Post1]和 2015-2016 年[Post2]）。从鼻咽拭子中分离的肺炎球菌进行胶乳凝集血清分型和抗菌药物敏感性试验。使用临床和实验室标准协会 2018 年的折点定义非敏感性分离株（中介或耐药）。我们使用对数二项式回归估计各研究期间肺炎球菌定植率的变化。我们比较了基线期和 Post2 时非敏感性肺炎球菌的比例。
结果
我们在基线期纳入了 720 名儿童，在 Post1 期纳入了 911 名，在 Post2 期纳入了 1208 名。未感染 HIV 的儿童（36.0%，110/306）和感染 HIV 的儿童（34.8%，144/414）的基线期 VT 携带率相似。未感染 HIV 的儿童和感染 HIV 的儿童的 Post1 期与基线期相比，VT 携带率分别降低了 36%（95%置信区间[CI]：19%-49%）和 27%（95% CI：11%-41%）。Post2 期与 Post1 期相比，未感染 HIV 的儿童的 VT 携带率下降，但感染 HIV 的儿童的 VT 携带率保持稳定。PCV10 引入 3 年后，未感染 HIV 的儿童的 VT 携带率为 14.5%，感染 HIV 的儿童为 21.0%。感染 HIV 的儿童对青霉素的非敏感性肺炎球菌分离株从 66.0%下降到 56.2%（P=.0281）。
结论
PCV10 引入后，VT 和抗菌药物非敏感性肺炎球菌的携带率下降，尤其是在未感染 HIV 的儿童中。然而，VT 携带率仍然较高，表明持续存在 VT 肺炎球菌传播。
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