Pneumococcal invasive disease in newborns before and after 7-valent and 13-valent universal pneumococcal vaccination in Uruguay
Pneumococcal invasive disease in newborns before and after 7-valent and 13-valent universal pneumococcal vaccination in Uruguay
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DOI：
10.4067/s0716-10182015000300005
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发表时间：
2015-04-01
期刊：
影响因子：
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通讯作者：
Pírez, María Catalina
中科院分区：
文献类型：
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作者：
Assandri, Elizabeth;Amorín, Belén;Pírez, María Catalina
前言：肺炎链球菌感染在新生儿中并不常见，但发病率和死亡率很高。2008年，7价肺炎球菌结合疫苗（PCV）被引入儿童疫苗接种计划，然后在2010年被13价PCV取代。第一剂在2个月大时给药。通过普遍接种，新生儿有望得到保护。目的：描述2001-2007年（疫苗接种前）、2008年（干预）和2009-2013年（疫苗接种后）在乌拉圭两家医院检测到的肺炎球菌侵袭性感染（PIT）新生儿的临床表现、微生物学和结局。方法：在佩雷拉罗塞尔医院和Paysandu医院进行描述性回顾性研究。所有S.包括从正常无菌流体获得的肺炎链球菌。数据来自临床记录和微生物实验室。对绝对频率、相对频率、比率和相对危险度进行统计学分析。结果如下：25例新生儿入组，诊断为：败血症（n = 13）、脑膜炎（n = 9）、菌血症（n = 1）、肺炎伴脓胸（n = 1）和肺炎（n = 1）。接种疫苗前的PIT发病率为19/25，比率为0.30/1 000，而接种疫苗后的比率为0.04/1 000。相对危险度为5.9。报告了6/20例（30%）死亡病例（脑膜炎n = 3;败血症n = 2;脓胸n = 1）。最常见的血清型为5型和1型（14/25），24/25株菌株对青霉素敏感。讨论：症状与其他病原体引起的感染难以区分。接种疫苗后，PIT病例减少，没有发生死亡。未观察到非疫苗血清型增加。
Introduction: Streptococcus pneumoniae infections are not frequent in neonates, but presents high morbidity and mortality. In 2008, the 7-valent pneumococcal conjugate vaccine (PCV) was introduced in the childhood vaccination schedule and then replaced by 13-valent PCV in 2010. First dose is given at 2 months of age. Protection of neonates is expected with universal vaccination. Objective: To describe the clinical presentation, microbiology and outcome of neonates with pneumococcal invasive infections (PIT) detected in two hospitals in Uruguay in 2001-2007 (pre-vaccination), 2008 (intervention) and 2009-2013 (post-vaccination). Methods: A descriptive, retrospective study was done at Pereira Rossell Hospital and Paysandu Hospital. All isolates of S. pneumoniae obtained from normally sterile fluids were included. Data were obtained from the clinical records and the microbiology laboratory. A statistical analysis with absolute frequencies, relative, rates and relative risk was performed. Results: 25 neonates were enrolled with diagnosis of: sepsis (n = 13), meningitis (n = 9), bacteremia (n = 1), pneumonia with empyema (n = 1) and pneumonia (n = 1). The incidence of PIT in the prevaccination period was 19/25, with a rate of 0.30/1,000 births, compared to post-vaccination rate of 0.04/1,000. The relative risk was 5.9. 6/20 (30%) cases of death were reported (meningitis n = 3; sepsis n = 2; empyema n = 1). Most common serotypes were 5 and 1 (14/25) and 24/25 strains were susceptible to penicillin. Discussion: The symptoms were indistinguishable to infections caused by other pathogens. PIT cases decreased and no deaths occurred in the post-vaccination period. No increase in non-vaccine serotypes was observed.