Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types
Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types
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DOI：
10.1183/09031936.00080814
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发表时间：
2014-12-01
影响因子：
24.3
通讯作者：
Henriques-Normark, Birgitta
中科院分区：
文献类型：
--
作者：
Browall, Sarah;Backhaus, Erik;Henriques-Normark, Birgitta
肺炎球菌结合疫苗（PCV）已显示出疫苗血清型对侵袭性肺炎球菌疾病的保护作用，但已观察到非疫苗血清型疾病的增加。需要探索类型特异性对临床表现的影响。2096 名成人和 192 名患有侵袭性肺炎球菌疾病的儿童的临床数据与肺炎球菌分子血清型相关。使用来自儿童的 165 个侵袭性菌株和 550 个携带菌株计算了肺炎球菌血清型的侵袭性疾病潜力。与疫苗型菌株相比，非 PCV13 的侵袭性疾病潜力较低。感染非 PCV13 毒株的患者有更多的基础疾病，患肺炎的可能性较小，而且在成人中，死亡率往往较高。此外，感染属于仅表达非 PCV13 胶囊的克隆血清型的肺炎球菌的患者发生败血症和死亡的风险较高。 PCV 疫苗接种可能会导致侵袭性肺炎球菌疾病的减少，但会改变侵袭性肺炎球菌疾病的临床表现。导致成人侵袭性肺炎球菌疾病的遗传谱系通常表达非疫苗血清型，疫苗接种后该血清型可能会扩大，从而增加患有基础疾病的患者的感染风险。
Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored.Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children.The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality.PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.