Silva-Costa Catarina, Gomes-Silva Joana, Teodoro Inês, Ramirez Mário, Melo-Cristino José
Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, 1649-028 Lisboa, Portugal.
Microorganisms. 2021 May 8;9(5):1016. doi: 10.3390/microorganisms9051016.
Increasing the uptake of the 13-valent pneumococcal conjugate vaccine (PCV13) in children is expected to alter the serotypes causing invasive pneumococcal disease (IPD) in adults due to herd protection. We characterized 2172 cases of adult IPD in 2015-2018 in Portugal after the introduction of PCV13 in the national immunization plan of 2015. Among the 58 detected serotypes, serotypes 8 ( = 413; 19%), 3 ( = 334; 15%), 22F ( = 148; 7%), 14 ( = 138; 6%), and 19A ( = 116; 5%) were the most frequent. Among PCV13 serotypes, 7F and 19A IPD decreased, but serotype 3 IPD remained stable. The non-PCV13 serotypes were a heterogeneous group, with serotypes 23A and 23B enriched among CSF cases; serotype 8 associated with younger patients; and serotypes 22F, 6C, and 31 associated with older patients. The continued increase of serotype 8 IPD was one of the drivers for the increased coverage of the 23-valent pneumococcal polysaccharide vaccine (PPV23; 80% in 2015-2018). Antimicrobial resistance was associated with older age and serotypes 6C, 11A, 14, 15A, 19A, and 19F. Three years after the introduction of PCV13 in the NIP with an uptake of >95%, the proportion of PCV13 serotypes causing IPD in adults stabilized in Portugal. The direct vaccination of adults may be important in preventing IPD in this age group.
由于群体保护作用，预计增加儿童13价肺炎球菌结合疫苗（PCV13）的接种率会改变导致成人侵袭性肺炎球菌病（IPD）的血清型。在2015年葡萄牙国家免疫规划引入PCV13之后，我们对2015 - 2018年期间的2172例成人IPD病例进行了特征分析。在检测出的58种血清型中，血清型8（n = 413；19%）、3（n = 334；15%）、22F（n = 148；7%）、14（n = 138；6%）和19A（n = 116；5%）最为常见。在PCV13血清型中，7F和19A引起的IPD有所减少，但血清型3引起的IPD保持稳定。非PCV13血清型是一个异质性群体，23A和23B血清型在脑脊液病例中富集；血清型8与年轻患者相关；血清型22F、6C和31与老年患者相关。血清型8引起的IPD持续增加是23价肺炎球菌多糖疫苗（PPV23；2015 - 2018年接种率为80%）接种率增加的驱动因素之一。抗菌药物耐药性与老年以及血清型6C、11A、14、15A、19A和19F相关。在国家免疫规划中引入PCV13且接种率>95%三年后，葡萄牙成人中引起IPD的PCV13血清型比例趋于稳定。对成人进行直接疫苗接种对于预防该年龄组的IPD可能很重要。
