预测肺炎球菌携带和13价肺炎球菌结合疫苗接种在西澳大利亚土著人口的影响。

IF 8.5 Q1 RESPIRATORY SYSTEM
Pneumonia Pub Date : 2017-09-25 eCollection Date: 2017-01-01 DOI:10.1186/s41479-017-0038-x
Deirdre A Collins, Anke Hoskins, Thomas Snelling, Kalpani Senasinghe, Jacinta Bowman, Natalie A Stemberger, Amanda J Leach, Deborah Lehmann
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引用次数: 22

摘要

背景:7价肺炎球菌结合疫苗(PCV7)于2001年在西澳大利亚(WA)原住民中引入以预防侵袭性肺炎球菌病(IPD)。2011年7月,PCV13取代了PCV7,覆盖了另外六种肺炎球菌血清型;然而,西澳大利亚土著人的IPD率仍然很高。上呼吸道肺炎球菌携带可先于IPD, pcv改变血清型分布。方法:收集2008年8月至2014年11月西澳大利亚地区土著儿童和成人的人口统计学特征、健康、用药和生活条件等信息,评估PCV13引入的影响,确定新出现的血清型,评估携带的危险因素。采用选择性培养基培养细菌,采用Quellung反应对分离的肺炎球菌进行血清分型。采用多变量logistic回归分析危险因素。结果:收集pcv13引入前1500份拭子和引入后1385份拭子。66.8%的儿童检出肺炎球菌携带(p > 0.05)。pcv13后最常见的血清型为11A(患病率4.0%)、15B(患病率3.5%)、16F(患病率3.5%)和19F(患病率3.2%)。发现肺炎球菌携带的风险在12个月前增加(优势比[OR] 4.19, 95%可信区间[CI] 2.39-7.33),有鼻分泌物(优势比[OR] 2.49 [95% CI 2.00-3.09])、居住在偏远社区(优势比[OR] 2.21 [95% CI 1.67-2.92])和家庭拥挤(优势比[OR] 1.36 [95% CI 1.11-1.67])。近期抗生素使用与肺炎球菌携带呈负相关(OR 0.48 [95% CI 0.33-0.69])。血清型19A(6.0%)、血清型19F(2.3%)和非血清型分离株(1.9%)对青霉素完全耐药。23F血清型和新出现的7B血清型菌株对复方新诺明、红霉素和四环素的耐药率分别为86.9%、86.9%、82.0%、100.0%和93.3%。结论:自PCV13取代PCV7后,儿童PCV13-非PCV7血清型携带率明显下降
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population.

Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population.

Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population.

Background: The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcal disease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering six additional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratory tract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution.

Methods: To assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage, nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions from Aboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were cultured using selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed by multivariable logistic regression.

Results: One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8% of children <5 years old and 53.2% of 5-14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2% and 49.4%, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased in children <5 years old from 13.5% pre-PCV13 to 5.8% post-PCV13 (p < 0.01), and from 8.4% to 6.1% in children 5-14 years old (p > 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0%), 15B (3.5%), 16F (3.5%), and 19F (3.2%). Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.39-7.33), with nasal discharge (OR 2.49 [95% CI 2.00-3.09]), residence in a remote community (OR 2.21 [95% CI 1.67-2.92]) and household crowding (OR 1.36 [95% CI 1.11-1.67]). Recent antibiotic use was negatively associated with pneumococcal carriage (OR 0.48 [95% CI 0.33-0.69]). Complete resistance to penicillin was present among isolates of serotypes 19A (6.0%), 19F (2.3%) and non-serotypeable isolates (1.9%). Serotype 23F and newly emerged serotype 7B isolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9%, 86.9%, 82.0%, respectively for 23F, 100.0%, 100.0% and 93.3% for 7B).

Conclusion: Since PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among children <5 years old, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors for carriage including crowding and young age remain in the Aboriginal population.

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Pneumonia
Pneumonia RESPIRATORY SYSTEM-
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