2008 - 2019年在哥伦比亚波哥大进行的一项多中心研究：10价肺炎球菌结合疫苗引入前后确诊为肺炎球菌肺炎的儿童的流行病学特征及血清型分布
Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008-2019.
作者信息
Gutiérrez-Tobar Iván Felipe, Londoño-Ruiz Juan Pablo, Mariño-Drews Cristina, Beltrán-Higuera Sandra, Camacho-Moreno Germán, Leal-Castro Aura Lucia, Patiño-Niño Jaime Alberto, Álvarez-Olmos Martha Isabel, Barrero-Barreto Rocio, Espinosa Fabio, Suarez María Alejandra, Ramos Nicolás, Moreno-Mejia Vivian Marcela, Marín Alejandra, Sierra Parada Claudia Rocio, Pescador Angela, Montañez Anita
机构信息
Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia.
Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia; Universidad el Bosque, Colombia.
出版信息
Vaccine. 2022 May 3;40(20):2875-2883. doi: 10.1016/j.vaccine.2022.03.022. Epub 2022 Apr 5.
BACKGROUND
Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012.
METHODS
Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination.
RESULTS
A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period.
CONCLUSIONS
PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.
背景
肺炎球菌结合疫苗（PCV）已降低了儿童肺炎的发病率。哥伦比亚于2012年开始大规模接种PCV10。
方法
纳入了10家医院的肺炎球菌肺炎病例。比较了两个时期：PCV10接种前（2008 - 2011年）和PCV10接种后（2014 - 2019年）。目的是比较PCV10接种前后的流行病学和临床特征。
结果
共纳入370例病例。在PCV10接种前时期，1型（15例，11.2%）和14型（33例，24.6%）最为常见，19A 型仅有4例（3%），3型仅有1例（0.7%）。从PCV10接种前时期到接种后时期，1型（6例，3.1%）和14型（1例，7.8%）病例减少，而19A 型（58例，30.2%）、3型（32例，16.7%）和6A 型（7例，3.6%）病例增加（p < 0.001）；复杂性肺炎（CP）显著增加（从13.4%增至31.8%）（p < 0.001）；住院时间从8（5.5 - 15）天增加到12（7 - 22）天（p < 0.……此处原文有误，推测是想表达p < 0.001）；儿科重症监护病房（PICU）收治频率从32.8%增至51.6%（p = 0.001）。在PCV10接种后时期，氨苄西林 - 舒巴坦的使用（从0.7%增至24%）和头孢曲松/克林霉素的使用（从0.7%增至5.7%）增加。经验性抗生素治疗持续时间在PCV10接种前时期为7（4 - 11）天，在PCV10接种后时期增至10（6 - 17）天（p < 0.001）。在PCV10接种后时期，死亡率略有非显著性增加（7.5%对9.9%；p = 0.57）。
结论
PCV10显著降低了1型和14型病例，19A 型、3型和6A型病例增加，这些是主要血清型且病情更严重（例如，入住PICU、CP以及耐药性更强，广谱抗生素使用增加且住院时间延长），随后被纳入PCV13。当前数据支持国家和地区关于用包含19A 型的更高价疫苗（如PCV13）替代PCV10的重要性的证据，目的是减少传播，特别是该血清型的传播。
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