英格兰 22F 和 33F 导致的侵袭性肺炎球菌病：两种血清型的故事。
Invasive pneumococcal disease due to 22F and 33F in England: A tail of two serotypes.
机构信息
Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Respiratory and Vaccine Preventable Bacterial Reference Unit, Public Health England, London, UK.
出版信息
Vaccine. 2021 Apr 1;39(14):1997-2004. doi: 10.1016/j.vaccine.2021.02.026. Epub 2021 Mar 11.
BACKGROUND
A 15-valent pneumococcal conjugate vaccine (PCV15) aims to protect against serotype 22F and 33F in addition to the serotypes within the 13-valent PCV (PCV13) which was introduced to the UK childhood immunisation programme in April 2010. Little is known about the specific epidemiology, clinical features or outcomes of invasive pneumococcal disease (IPD) due to these two serotypes.
METHODS
Public Health England (PHE) conducts enhanced IPD surveillance in England. Hospital laboratories routinely submit invasive pneumococcal isolates to PHE for serotyping and enhanced clinical information is collected through questionnaires sent to general practitioners. IPD due to serotypes 22F and 33F diagnosed during 2014/15-2018/19 were compared with IPD due to PCV13 serotypes and remaining serotypes.
RESULTS
In total, 25,415 isolates (93.4%) were serotyped and questionnaires were completed for 22,097 (86.9%) cases. Serotype 22F was responsible for 1,788 (7.0%) and serotype 33F for 893 (3.5%) cases compared to 19.9% (n = 5,047) for PCV13 and 69.6% (n = 17,687) for the remaining serotypes. IPD incidence increased for both serotypes since 2005/06, especially in older adults, but plateaued after PCV13 introduction. Comorbidity prevalence was 68.7% (n = 1,037) for serotype 22F and 67.2% (n = 505) for serotype 33F, with invasive pneumonia being the most common clinical presentation 1,067/1,482; 72.0%, and 514/755; 68.1%, respectively. There were 3,617 deaths within 30 days of disease onset, including 236 (CFR, 15.4%) among 22F, 128 (CFR, 16.5%) among 33F and 21.3% (925/4,350) among PCV13-type IPD cases. When compared with PCV13-type IPD, serotype 22F (aOR 0.58, 95%CI 0.49-0.68, p < 0.001) and 33F (aOR 0.73, 95%CI 0.59-0.91, p = 0.004) were independently associated with lower odds of death. The major circulating sequence types (STs) in 22F (ST 433, ST698) and 33F (ST717, ST100, ST673) were not associated with an increased risk of death compared to the other STs.
CONCLUSIONS
Serotype 22F and 33F-type IPD are associated with a lower risk of death compared to PCV13-type, with those presenting with septicaemia more likely to have a fatal outcome compared to pneumonia. PCV15 has the potential to prevent up to an additional 10% of IPD cases in England.
背景
15 价肺炎球菌结合疫苗（PCV15）旨在预防 22F 和 33F 血清型以及 2010 年 4 月引入英国儿童免疫计划的 13 价 PCV（PCV13）中的血清型。由于这两种血清型，侵袭性肺炎球菌病（IPD）的具体流行病学、临床特征或结果知之甚少。
方法
英国公共卫生署（PHE）在英格兰开展了强化 IPD 监测。医院实验室常规将侵袭性肺炎球菌分离株提交给 PHE 进行血清分型，并通过发送给全科医生的问卷收集增强的临床信息。2014/15 年至 2018/19 年期间诊断的血清型 22F 和 33F 所致 IPD 与 PCV13 血清型和其余血清型所致 IPD 进行了比较。
结果
共有 25415 株（93.4%）进行了血清分型，22097 例（86.9%）完成了问卷调查。血清型 22F 导致 1788 例（7.0%），血清型 33F 导致 893 例（3.5%），而 PCV13 为 19.9%（n=5047），其余血清型为 69.6%（n=17687）。自 2005/06 年以来，这两种血清型的 IPD 发病率均有所上升，尤其是在老年人中，但在 PCV13 推出后趋于平稳。共病患病率为血清型 22F 68.7%（n=1037），血清型 33F 67.2%（n=505），最常见的临床特征是侵袭性肺炎 1037/1482；72.0%和 514/755；68.1%。发病后 30 天内有 3617 人死亡，其中 22F 有 236 人（病死率，15.4%），33F 有 128 人（病死率，16.5%），PCV13 型 IPD 病例中有 21.3%（925/4350）。与 PCV13 型 IPD 相比，血清型 22F（aOR 0.58，95%CI 0.49-0.68，p<0.001）和 33F（aOR 0.73，95%CI 0.59-0.91，p=0.004）与较低的死亡几率独立相关。22F（ST433、ST698）和 33F（ST717、ST100、ST673）中的主要循环序列类型（ST）与死亡风险增加无关。
结论
与 PCV13 型相比，血清型 22F 和 33F 型 IPD 死亡风险较低，与肺炎相比，败血症患者更有可能出现致命后果。PCV15 有可能在英格兰预防多达 10%的 IPD 病例。
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