Rapid Decrease of 7-Valent Conjugate Vaccine Coverage for Invasive Pneumococcal Diseases in Pediatric Patients in Japan
Rapid Decrease of 7-Valent Conjugate Vaccine Coverage for Invasive Pneumococcal Diseases in Pediatric Patients in Japan
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DOI：
10.1089/mdr.2012.0180
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发表时间：
2013-08-01
影响因子：
2.6
通讯作者：
Ubukata, Kimiko
中科院分区：
文献类型：
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作者：
Chiba, Naoko;Morozumi, Miyuki;Ubukata, Kimiko
在日本，自2010年2月以来，在自愿基础上引入了七价肺炎球菌结合疫苗（PCV 7），并于2010年11月开始为5岁以下儿童提供官方财政支助。PCV 7对儿童侵袭性肺炎球菌疾病（IPD）的影响尚不清楚。日本全国有340家医疗机构积极参与了我们的监测项目。我们在2006年（PCV 7前）从IPD患者中收集了252株菌株，2010年收集了280株菌株（免疫率低于10%），2011年收集了128株菌株（免疫率为50%至60%）。比较不同年份血清型和青霉素耐药基因型的差异。还对这些菌株进行了多位点序列分型。2011年，由于官方宣传，IPD显著下降（p < 0.001）。特别是，疫苗型（VT）菌株引起的脑膜炎和败血症下降（p = 0.033，p < 0.001）。在不到2年的时间里，在非疫苗类型（NVT）中，15A和22F在2011年增加（p = 0.015，p = 0.015）。PCV7的覆盖率从2006年的71.8%下降到2011年的51.6%。VT和NVT菌株均出现序列型差异，并伴随着向gPRSP的进化。VT菌株引起的IPD减少已经完成，但NVT的快速增加引起了对PCV疗效未来下降的担忧7。
In Japan, the heptavalent pneumococcal conjugate vaccine (PCV7) has been introduced on a voluntary basis since February 2010, and official financial support for children under 5 years started in November 2010. The impact of PCV7 on invasive pneumococcal diseases (IPD) in children is unknown. There are 340 medical institutions that actively participated in our surveillance project throughout Japan. We collected 252 strains from patients with IPD in 2006 (pre-PCV7), 280 strains in 2010 (under 10% immunization achieved), and 128 strains in 2011 (50% to 60% immunization). Serotypes and penicillin-resistance genotypes (g) were compared between these years. Multilocus sequence typing was also carried out on these strains. Due to the official promotion, IPD significantly decreased in 2011 (p < 0.001). In particular, meningitis and sepsis caused by vaccine type (VT) strains declined (p = 0.033, p < 0.001). In less than 2 years, among nonvaccine types (NVT), 15A and 22F increased in 2011 (p = 0.015, p = 0.015). Coverage by PCV7 decreased from 71.8% in 2006 to 51.6% in 2011. Sequence-type diversities accompanied by evolution to gPRSP occurred in both VT and NVT strains. Reduction of IPD caused by VT strains was accomplished, but a rapid increase of NVT raises concern about a future decrease in the efficacy of PCV7.