Changing incidence of invasive pneumococcal disease in infants less than 90 days of age before and after introduction of the 13-valent Pneumococcal Conjugate Vaccine in Blantyre, Malawi: a 14-year hospital based surveillance study
Changing incidence of invasive pneumococcal disease in infants less than 90 days of age before and after introduction of the 13-valent Pneumococcal Conjugate Vaccine in Blantyre, Malawi: a 14-year hospital based surveillance study
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马拉维布兰太尔引入 13 价肺炎球菌结合疫苗前后 90 天以下婴儿侵袭性肺炎球菌疾病发病率的变化：一项为期 14 年的医院监测研究
DOI：
10.1101/2021.08.18.21262215
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Koenraads M
中科院分区：
文献类型：
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作者：
Koenraads M
背景：侵袭性肺炎球菌病（IPD）在小婴儿中并不常见，但与高发病率和死亡率相关。目前缺乏低收入国家婴幼儿IPD负担的准确数据。我们检查了马拉维布兰太尔14年期间< 90天婴儿的IPD负担，并评估了13价肺炎球菌结合疫苗（PCV 13）对该人群中疫苗血清型IPD（VT-IPD）的间接影响。方法：我们对2005年至2018年期间在布兰太尔伊丽莎白女王中心医院住院的< 90天婴儿进行了基于实验室的前瞻性IPD监测，包括PCV 13引入前7年和PCV 13引入后7年。IPD定义为通过血液或脑脊液培养鉴定的肺炎链球菌。结果：在2005年至2018年期间，我们确定了130例培养确诊的90天以下婴儿IPD病例。在引入PCV 13之前，IPD总发病率呈下降趋势。在后PCV 13时代，IPD的平均发病率显著降低。血清型5（27.8%）和1（15.6%）最常见。即使在PCV 13引入后，VT仍然是IPD的主要原因，血清5型占17.4%，血清1型占13.0%的病例在年幼的infants.Conclusion：疫苗血清1型和5型是IPD的主要原因，在新生儿和年幼的婴儿，无论是之前和之后的PCV 13引入。这表明，尽管在这种情况下接种疫苗，但人群中持续存在VT携带的间接保护不完全。需要考虑替代疫苗接种时间表和其他疫苗引入方法来保护这一脆弱人群。背景
Background:Invasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants< 90 days old in Blantyre, Malawi over a 14-year period and evaluated the indirect impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on vaccine-serotype IPD (VT-IPD) in this population.Methods:We conducted laboratory-based prospective IPD surveillance in infants< 90 days of age admitted to Queen Elizabeth Central Hospital in Blantyre between 2005 and 2018, including 7 years pre-PCV13 and 7 years post-PCV13 introduction. IPD was defined as Streptococcus pneumoniae identified by culture from blood or cerebrospinal fluid. Serotypes were determined by multiplex polymerase chain reaction and latex agglutination testing.Results:We identified 130 cases of culture-confirmed IPD in infants< 90 days old between 2005 and 2018. Total IPD incidence was declining before PCV13 introduction. The mean incidence of IPD was significantly lower in the post-PCV13 era. Serotypes 5 (27.8%) and 1 (15.6%) were most prevalent. Even after PCV13 introduction, VTs remained the primary cause of IPD, with serotype 5 accounting for 17.4% and serotype 1 for 13.0% of cases in young infants.Conclusion:Vaccine serotypes 1 and 5 were the main cause of IPD in neonates and young infants, both before and after PCV13 introduction. This suggests incomplete indirect protection with persisting VT carriage across the population despite vaccination in this setting. Alternative vaccine schedules and other vaccine introduction approaches need to be considered to protect this vulnerable population.BACKGROUND