Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population.
Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population.
复制标题
西澳大利亚原住民中肺炎球菌携带的预测因素以及 13 价肺炎球菌结合疫苗接种的效果。
DOI：
10.1186/s41479-017-0038-x
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Lehmann D
中科院分区：
文献类型：
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作者：
Collins DA;Hoskins A;Snelling T;Senasinghe K;Bowman J;Stemberger NA;Leach AJ;Lehmann D
7价肺炎球菌结合疫苗（PCV 7）于2001年在西澳大利亚州（WA）土著居民中引入，以预防侵袭性肺炎球菌疾病（IPD）。2011年7月，PCV 13取代了PCV 7，覆盖了另外六种肺炎球菌血清型;然而，西澳大利亚州土著人的IPD率仍然很高。上呼吸道肺炎球菌携带可先于IPD，PCV改变血清型分布。为了评估PCV 13引入的影响，确定新出现的血清型，并评估携带的风险因素，收集了2008年8月至2014年11月期间西澳大利亚州土著儿童和成人的鼻咽拭子和人口统计学特征，健康，药物和生活条件的信息。使用选择性培养基培养细菌，并通过Quellung反应对肺炎球菌分离株进行血清分型。危险因素采用多因素Logistic回归分析。收集了1500份PCV 13引入前拭子和1385份PCV 13引入后拭子。在PCV 13后，在66.8%的5岁以下儿童和53.2%的5-14岁儿童中检测到肺炎球菌携带，而PCV 13前的患病率分别为72.2%和49.4%。<5岁儿童中PCV 13-非PCV 7血清型的患病率从PCV 13前的13.5%下降到PCV 13后的5.8%（p < 0.01），5-14岁儿童中从8.4%下降到6.1%（p > 0.05）。PCV后最常见的血清型13为11 A（患病率4.0%）、15 B（3.5%）、16 F（3.5%）和19 F（3.2%）。检测到肺炎球菌携带的风险增加，直到12个月大（比值比[OR] 4.19，95%置信区间[CI] 2.39-7.33），伴有流涕（OR 2.49 [95% CI 2.00-3.09]）、居住在偏远社区（OR 2.21 [95% CI 1.67-2.92]）和家庭拥挤（OR 1.36 [95% CI 1.11-1.67]）。近期抗生素使用与肺炎球菌携带呈负相关（OR 0.48 [95%CI 0.33-0.69]）。血清型19 A（6.0%）、19 F（2.3%）和非分型分离株（1.9%）对青霉素完全耐药。23 F型和新出现的7 B型对复方新诺明、红霉素和四环素的耐药率分别为86.9%、86.9%、82.0%和100.0%、100.0%和93.3%。由于PCV 13取代了PCV 7，PCV 13-非PCV 7血清型的携带在<5岁的儿童中显著减少，这些儿童最有可能接受PCV 13，并且在老年人中程度较小。已知的携带风险因素，包括拥挤和年轻，仍然存在于土著人口中。
The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcal disease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering six additional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratory tract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution. To assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage, nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions from Aboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were cultured using selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed by multivariable logistic regression. One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8% of children <5 years old and 53.2% of 5–14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2% and 49.4%, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased in children <5 years old from 13.5% pre-PCV13 to 5.8% post-PCV13 (p < 0.01), and from 8.4% to 6.1% in children 5–14 years old (p > 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0%), 15B (3.5%), 16F (3.5%), and 19F (3.2%). Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.39–7.33), with nasal discharge (OR 2.49 [95% CI 2.00–3.09]), residence in a remote community (OR 2.21 [95% CI 1.67–2.92]) and household crowding (OR 1.36 [95% CI 1.11–1.67]). Recent antibiotic use was negatively associated with pneumococcal carriage (OR 0.48 [95% CI 0.33–0.69]). Complete resistance to penicillin was present among isolates of serotypes 19A (6.0%), 19F (2.3%) and non-serotypeable isolates (1.9%). Serotype 23F and newly emerged serotype 7B isolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9%, 86.9%, 82.0%, respectively for 23F, 100.0%, 100.0% and 93.3% for 7B). Since PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among children <5 years old, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors for carriage including crowding and young age remain in the Aboriginal population.