葡萄牙城乡地区儿童使用 13 价肺炎球菌结合疫苗（PCV13）私人用途对肺炎球菌带菌率的影响。
Impact of private use of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal carriage among Portuguese children living in urban and rural regions.
机构信息
Laboratory of Molecular Microbiology of Human Pathogens, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa (ITQB NOVA), Oeiras, Portugal.
Clinical Affiliate, MostMicro Unit, ITQB NOVA, Portugal.
出版信息
Vaccine. 2021 Jul 22;39(32):4524-4533. doi: 10.1016/j.vaccine.2021.06.035. Epub 2021 Jun 25.
In Portugal, the 13-valent pneumococcal conjugate vaccine (PCV13) was commercially available between 2010 and 2015, following a decade of private use of PCV7. We evaluated changes on serotype distribution and antimicrobial susceptibility of pneumococci carried by children living in two regions of Portugal (one urban and one rural). Three epidemiological periods were defined: pre-PCV13 (2009-2010), early-PCV13 (2011-2012), and late-PCV13 (2015-2016). Nasopharyngeal samples (n = 4,232) were obtained from children 0-6 years old attending day-care centers. Private use of PCVs was very high in both regions (>75%). Pneumococcal carriage remained stable and high over time (62.1%, 62.4% and 61.6% (p = 0.909) in the urban region; and 59.8%, 62.8%, 59.5% (p = 0.543) in the rural region). Carriage of PCV7 serotypes remained low (5.3%, 7.8% and 4.3% in the urban region; and 2.5%, 3.7% and 4.8% in the rural region). Carriage of PCV13 serotypes not targeted by PCV7 decreased in both the urban (16.4%, 7.3%, and 1.6%; p < 0.001) and rural regions (13.2%, 7.8%, and 1.9%; p < 0.001). This decline was mostly attributable to serotype 19A (14.1%, 4.4% and 1.3% in the urban region; and 11.1%, 3.6% and 0.8% in the rural region, both p < 0.001). Serotype 3 declined over time in the urban region (10.1%, 4.4%, 0.8%; p < 0.001) and had no obvious trend in the rural region (4.2%, 6.7%, 2.4%; p = 0.505). Serotype 6C decreased in both regions while serotypes 11D, 15A/B/C, 16F, 21, 22F, 23A/B, 24F, 35F, and NT were the most prevalent in the late-PCV13 period. Intermediate resistance to penicillin and non-susceptibility to erythromycin decreased significantly in both regions (19.5%, 13.3%, and 9.3%; and 25.4%, 25.9%, and 13.4%; both p < 0.001, respectively in the urban region; and 12.4%, 11.1%, and 2.8% (p < 0.001); and 15.3%, 14.7%, and 9.2% (p = 0.037), respectively, in the rural region). In conclusion, private use of PCV13 led to significant changes on the pneumococcal population carried by children in Portugal.
在葡萄牙，13 价肺炎球菌结合疫苗（PCV13）于 2010 年至 2015 年在私营部门使用了十年后开始商业化。我们评估了葡萄牙两个地区（一个城市和一个农村）儿童携带的肺炎球菌血清型分布和抗生素敏感性的变化。定义了三个流行病学时期：PCV13 前期（2009-2010 年）、PCV13 早期（2011-2012 年）和 PCV13 后期（2015-2016 年）。从 0-6 岁在日托中心的儿童中获得了鼻咽样本（n=4232）。在两个地区，私人使用 PCV 的比例都非常高（>75%）。肺炎球菌的携带率在时间上保持稳定且较高（城市地区分别为 62.1%、62.4%和 61.6%（p=0.909）；农村地区分别为 59.8%、62.8%和 59.5%（p=0.543））。PCV7 血清型的携带率仍然较低（城市地区分别为 5.3%、7.8%和 4.3%；农村地区分别为 2.5%、3.7%和 4.8%）。PCV13 血清型的携带率在城市（16.4%、7.3%和 1.6%；p<0.001）和农村地区（13.2%、7.8%和 1.9%；p<0.001）均下降。这种下降主要归因于血清型 19A（城市地区分别为 14.1%、4.4%和 1.3%；农村地区分别为 11.1%、3.6%和 0.8%；均 p<0.001）。血清型 3 在城市地区的时间呈下降趋势（10.1%、4.4%、0.8%；p<0.001），在农村地区则无明显趋势（4.2%、6.7%、2.4%；p=0.505）。血清型 6C 在两个地区均减少，而血清型 11D、15A/B/C、16F、21、22F、23A/B、24F、35F 和 NT 在 PCV13 后期最为流行。在两个地区，青霉素中介耐药率和红霉素不敏感性显著下降（城市地区分别为 19.5%、13.3%和 9.3%；农村地区分别为 25.4%、25.9%和 13.4%；均 p<0.001）。在农村地区，青霉素中介耐药率和红霉素不敏感性分别为 12.4%、11.1%和 2.8%（p<0.001）和 15.3%、14.7%和 9.2%（p=0.037）。总之，PCV13 的私人使用导致葡萄牙儿童携带的肺炎球菌种群发生了显著变化。
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