Medicina Preventiva del Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Servicio de Epidemiología de la Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2023 Feb;41(2):92-98. doi: 10.1016/j.eimce.2022.07.001. Epub 2022 Jul 27.
To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage.
We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases.
1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar.
The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage. The presence of clusters due to STnoPCV13 after the date of inclusion of the 13-valent vaccine in the childhood vaccination calendar indicates serotypes replacement. The increase in cases of resistant STnoPCV13 could be related to the replacement of vaccine serotypes in nasopharyngeal colonization, facilitated by the consumption of macrolides still at high levels in MC.
研究耐红霉素肺炎球菌疾病（IPD）病例的时空分布及其与社区大环内酯类药物消费和儿童疫苗接种覆盖率的关系。
我们选择了马德里社区（MC）59 岁以上成年人的 IPD 病例，这些病例是在 2007-2016 年期间报告的。所研究的变量是从疫苗接种信息系统和药物服务中获得的。采用欧盟药敏试验委员会（EUCAST）分类的截断点（最小抑菌红霉素浓度>0.5mg/L）来定义红霉素耐药血清型。我们使用 JointPoint 来估计包含在 13 价疫苗（STPCV13）中的红霉素耐药血清型（STPCV13）和不包含在其中的血清型（STnoPCV13）的发病率趋势。使用泊松模型来评估这些发病率与社区大环内酯类药物消费和疫苗接种覆盖率之间的关系。使用统计扫描来检测病例的时空聚类。
共确定了 1936 例病例，其中 427 例为红霉素耐药血清型。所有耐药血清型病例的发病率均呈下降趋势（AAPC：-5.40%）。在研究期间，红霉素耐药 STPCV13 引起的病例发病率呈下降趋势，年百分比变化（APC）为-13.8%，与儿童疫苗接种覆盖率呈负相关（IRR 0.641），而红霉素耐药 STnoPCV13 引起的病例发病率呈上升趋势（APC：4.5%），与覆盖率无关。在包含 13 价疫苗的儿童疫苗接种日程后，发现了一个由 STnoPCV13 引起的聚类，而由 STPCV13 引起的聚类则没有。
红霉素耐药 STPCV13 引起的 IPD 减少与儿童疫苗接种覆盖率的增加有关。在包含 13 价疫苗的儿童疫苗接种日程后，由于 STnoPCV13 引起的病例聚类的存在表明血清型的替代。耐红霉素耐药 STnoPCV13 病例的增加可能与鼻咽定植中疫苗血清型的替代有关，这得益于 MC 大环内酯类药物仍处于较高水平的消费。
