The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Vaccine. 2021 Sep 24;39(40):5757-5761. doi: 10.1016/j.vaccine.2021.08.082. Epub 2021 Sep 1.
Following pneumococcal conjugate vaccines (PCVs) implementation, worldwide, pneumococcal carriage rates remained stable, indicating full replacement of vaccine-serotypes (VT) with non-VT. However, data are scarce regarding PCV impact on pneumococcal carriage rates in healthy vs. sick children. We assessed pneumococcal carriage rates dynamics in healthy and sick children 6-23 months, following PCV introduction.
This is a prospective, population-based surveillance conducted during the years 2009-2017, in southern Israel. Three groups were defined as follows: Children without respiratory infection signs (the healthy/non-respiratory group); Children who had a chest radiography at the hospital (the Hosp-CXR group); and children with community-acquired alveolar pneumonia (CAAP). Rate ratios (RRs; 95% CI) were calculated, comparing between late-13-valent PCV (PCV13) period (2016-2017) and early-PCV period (2009-2010). Rate ratios were adjusted for antibiotic administration, seasonality and ethnicity, and separate calculations were performed for 6-11 and 12-23 month old children.
Overall, 51% of 8627 nasopharyngeal cultures were positive. In 2009-2010 (early-PCV period), the overall carriage rate was 55%; serotypes included in the PCV13 carriage rates were 28%, 31% and 38% in the healthy/non-respiratory, Hosp-CXR, and CAAP groups, respectively. Overall carriage rates in healthy/non-respiratory episodes were stable (~54%) when comparing between 2016 and 17 and 2009-10 (RR = 0.98; 0.84-1.15). In contrast, rates significantly declined for Hosp-CXR (RR = 0.78; 0.63-0.98) and CAAP (RR = 0.65; 0.47-0.89). These trends were driven by ~ 80% VT reductions, coupled with non-VT increase.
Following 7-valent PCV/ PCV13 introduction, pneumococcal carriage rates declined in respiratory diseases, but not in healthy children and children without respiratory infections. These trends suggest that a reduction in pneumococcal carriage rates during respiratory infections indicates a decline in respiratory infections caused by VT, while carriage rates in non-respiratory cases reflect non-VT predominance, that have low disease potential for respiratory disease.
在全球范围内，肺炎球菌结合疫苗（PCV）实施后，肺炎球菌携带率保持稳定，表明疫苗血清型（VT）已完全被非 VT 取代。然而，关于 PCV 对健康和患病儿童肺炎球菌携带率的影响的数据仍然很少。我们评估了在 PCV 引入后，6-23 个月的健康和患病儿童中肺炎球菌携带率的动态变化。
这是一项前瞻性、基于人群的监测研究，于 2009-2017 年在以色列南部进行。将以下三组定义如下：无呼吸道感染迹象的儿童（健康/非呼吸道组）；在医院进行胸部 X 光检查的儿童（Hosp-CXR 组）；以及患有社区获得性肺泡性肺炎（CAAP）的儿童。计算率比（RR；95%CI），比较 13 价结合疫苗（PCV13）后期（2016-2017 年）和早期（2009-2010 年）。RR 调整了抗生素使用、季节性和种族因素，并且分别为 6-11 个月和 12-23 个月的儿童进行了单独的计算。
总体而言，8627 个鼻咽培养物中有 51%为阳性。在 2009-2010 年（早期 PCV 时期），总体携带率为 55%；PCV13 携带的血清型在健康/非呼吸道、Hosp-CXR 和 CAAP 组中分别为 28%、31%和 38%。与 2009-10 年相比，健康/非呼吸道发作的总体携带率保持稳定（54%）（RR=0.98；0.84-1.15）。相比之下，Hosp-CXR（RR=0.78；0.63-0.98）和 CAAP（RR=0.65；0.47-0.89）的比率显著下降。这些趋势是由80%的 VT 减少和非 VT 增加共同驱动的。
在引入 7 价 PCV/PCV13 后，呼吸道疾病中的肺炎球菌携带率下降，但在健康儿童和无呼吸道感染的儿童中并未下降。这些趋势表明，呼吸道感染期间肺炎球菌携带率的降低表明由 VT 引起的呼吸道感染减少，而非呼吸道病例中的携带率反映了非 VT 的优势，非 VT 对呼吸道疾病的潜在疾病风险较低。
