Institut de Recerca Sant Joan de Deu, Hospital Sant Joan de Deu, Barcelona, Spain.
Departament de Medicina, Universistat Internacional de Catalunya, Barcelona, Spain.
Microbiol Spectr. 2021 Dec 22;9(3):e0115021. doi: 10.1128/Spectrum.01150-21. Epub 2021 Dec 8.
The goal of this study was to investigate the distribution of serotypes and clonal composition of Streptococcus pneumoniae isolates causing invasive pneumococcal disease (IPD) in Catalonia, before and after systematic introduction of PCV13. Pneumococcal strains isolated from normally sterile sites obtained from patients of all ages with IPD received between 2013 and 2019 from 25 health centers of Catalonia were included. Two study periods were defined: presystematic vaccination period (2013 and 2015) and systematic vaccination period (SVP) (2017 to 2019). A total of 2,303 isolates were analyzed. In the SVP, there was a significant decrease in the incidence of IPD cases in children 5 to 17 years old (relative risk [RR] 0.61; 95% confidence interval [CI] 0.38 to 0.99), while there was a significant increase in the incidence of IPD cases in 18- to 64-year-old adults (RR 1.33; 95% CI 1.16 to 1.52) and adults over 65 years old (RR 1.23; 95% CI 1.09 to 1.38). Serotype 8 was the major emerging serotype in all age groups except in 5- to 17-year-old children. In children younger than 5 years old, the main serotypes in SVP were 24F, 15A, and 3, while in adults older than 65 years they were serotypes 3, 8, and 12F. A significant decrease in the proportions of clonal complexes CC156, CC191, and ST306 and an increase in those of CC180, CC53, and CC404 were observed. A steady decrease in the incidence of IPD caused by PCV13 serotypes indicates the importance and impact of systematic vaccination. The increase of non-PCV13 serotypes highlights the need to expand serotype coverage in future vaccines and rethink vaccination programs for older adults. We found that with the incorporation of the PCV13 vaccine, the numbers of IPD cases caused by serotypes included in this vaccine decreased in all of the age groups. Still, there was an unforeseen increase of the serotypes not included in this vaccine causing IPD, especially in the >65-year-old group. Moreover, a significant increase of serotype 3 included in the vaccine has been observed; this event has been reported by other researchers. These facts call for the incorporation of more serotypes in future vaccines and a more thorough surveillance of the dynamics of this microorganism.
本研究旨在探讨肺炎球菌疾病（IPD）在加泰罗尼亚流行之前和之后，PCV13 系统引入前后，血清型和克隆组成的分布。该研究纳入了 2013 年至 2019 年间，来自加泰罗尼亚 25 个卫生中心的所有年龄段 IPD 患者的无菌部位分离出的肺炎链球菌菌株。定义了两个研究期：系统接种前（2013 年和 2015 年）和系统接种期（SVP）（2017 年至 2019 年）。共分析了 2303 株分离株。在 SVP 中，5 至 17 岁儿童的 IPD 病例发生率显著下降（相对风险 [RR] 0.61；95%置信区间 [CI] 0.38 至 0.99），而 18 至 64 岁成人（RR 1.33；95%CI 1.16 至 1.52）和 65 岁以上成人（RR 1.23；95%CI 1.09 至 1.38）的 IPD 病例发生率显著增加。除 5 至 17 岁儿童外，血清型 8 是所有年龄组的主要新兴血清型。在 5 岁以下儿童中，SVP 中的主要血清型为 24F、15A 和 3，而在 65 岁以上成人中，主要血清型为 3、8 和 12F。CC156、CC191 和 ST306 克隆复合物的比例显著下降，CC180、CC53 和 CC404 的比例增加。PCV13 血清型引起的 IPD 发病率持续下降表明系统接种的重要性和影响。非 PCV13 血清型的增加突出表明，未来疫苗需要扩大血清型覆盖范围，并重新考虑老年人的疫苗接种计划。我们发现，随着 PCV13 疫苗的加入，该疫苗包含的血清型引起的 IPD 病例数量在所有年龄段都有所减少。尽管如此，未包含在该疫苗中的血清型引起的 IPD 数量仍出人意料地增加，尤其是在>65 岁的人群中。此外，观察到疫苗中包含的血清型 3 的显著增加；其他研究人员也报告了这一事件。这些事实呼吁在未来疫苗中加入更多的血清型，并更彻底地监测这种微生物的动态。
