比利时婴儿在实施肺炎球菌结合疫苗计划 9 年后鼻咽部肺炎链球菌定植和密度。
Nasopharyngeal s. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme.
机构信息
Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium.
出版信息
Vaccine. 2018 Jan 2;36(1):15-22. doi: 10.1016/j.vaccine.2017.11.052. Epub 2017 Nov 24.
BACKGROUND
In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance.
MATERIALS/METHODS: Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed.
RESULTS
Culture-based (DCC: 462/760; 60.8% - AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 × 10 copies/µl (95%CI = 3.9-9.2 × 10, median = 3.5 × 10); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture-based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively.
CONCLUSION
Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.
背景
在比利时，婴儿肺炎球菌结合疫苗（PCV）计划从 PCV7（2007-2011 年）改为 PCV13（2011-2015 年），再改为 PCV10（2015-2016 年）。2016 年计划转换期间启动了一项为期 3 年的鼻咽携带研究。第 1 年评估的主要目标是获得肺炎球菌携带率、携带密度、血清型分布和抗生素耐药性的基线测量。
材料/方法：对 6-30 个月大的两个婴儿人群进行了研究，他们在采样前 7 天内没有使用抗生素：（1）参加了 85 个随机选择的日托中心（DCC）之一；（2）在经过培训的全科医生和儿科医生处因急性中耳炎就诊。记录了人口统计学和临床特征，并采集了一个鼻咽拭子。培养了肺炎链球菌，对其进行了抗生素耐药性筛查和血清型分型，并进行了针对 LytA 的定量 Taqman 实时 PCR（qRT-PCR）。
结果
基于培养的（DCC：462/760；60.8% - 急性中耳炎：27/39；69.2%）和基于 LytA 的（DCC：603/753；80.1% - 急性中耳炎：32/39；82.1%）携带率很高。LytA 阳性日托样本中的肺炎链球菌 DNA 载量平均为 6.5×10 拷贝/µl（95%CI=3.9-9.2×10，中位数=3.5×10）；DNA 载量与普通感冒的迹象呈正相关，与之前使用抗生素呈负相关。在 DCC 中，13 种肺炎球菌疫苗（PCV）血清型的培养频率为 5.4%，在急性中耳炎中为 7.7%，其中 19F 和 14 最为常见，在两个群体中，血清型 3、6A 和 19A 的频率均低于 0.5%。主要的非 PCV 血清型是 23B 和 23A 在日托中心和 11A 在急性中耳炎婴儿中。在日托中心，青霉素耐药性罕见（<0.5%），对左氧氟沙星无耐药性；分别有 32.7%和 16.9%的分离株对复方磺胺甲噁唑和红霉素耐药。
结论
PCV13 引入疫苗接种计划 4 年后，比利时各地婴儿中 PCV13 血清型携带率很低，青霉素耐药性罕见。在 PCV 计划转换的背景下，需要继续进行监测。
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