Impact of pneumococcal conjugate vaccine on infections caused by antibiotic-resistant Streptococcus pneumoniae
Impact of pneumococcal conjugate vaccine on infections caused by antibiotic-resistant Streptococcus pneumoniae
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DOI：
10.1111/j.1469-0691.2009.02726.x
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发表时间：
2009-04-01
影响因子：
14.2
通讯作者：
Dagan, R.
中科院分区：
文献类型：
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作者：
Dagan, R.
研究表明，接种七价肺炎球菌结合疫苗（PCV7）可导致鼻咽部耐青霉素肺炎链球菌的携带减少，疫苗型肺炎球菌的携带减少，并被非疫苗血清型取代。疫苗可以通过减少抗生素耐药血清型的携带来减少已接种疫苗和未接种疫苗人群的肺炎球菌耐药性，从而保护已接种人群并防止疾病传播给其他人，并通过总体减少抗生素使用来降低抗生素耐药性。然而，PCV7在降低鼻咽部疫苗血清型和耐药血清型水平的同时，也会引起非疫苗肺炎球菌的替代。血清型替代对疾病的影响尚不清楚。佩尔顿等人。在推出 PCV7 免疫计划后不久，对两个社区进行了调查，发现虽然从 2000 年到 2003 年，疫苗血清型的定植率从 22% 下降到 2%，但非疫苗血清型的流行率从 7% 上升到 16%。尽管耐青霉素定植肺炎链球菌分离株最初有所下降，但在引入 PCV7 后两年，青霉素中间分离株有所增加。这一变化主要是由于青霉素中间血清型 19A 的增加造成的。 19A 血清型是唯一不受 PCV7 影响的血清型，该血清型在世界范围内流行，具有临床重要性，并且具有高度多重耐药性。希克斯等人的一项研究。确定血清型 19A 是儿童和老年人侵袭性肺炎球菌疾病 (IPD) 的主要 PCV7 后病因。抗生素耐药血清型 19A 分离株在不接种疫苗的情况下也会导致 IPD 发生率增加；报告显示，广泛使用抗生素的地区有所增加，这凸显了遏制抗生素耐药性战略的重要性。
Studies have shown that vaccination with seven-valent pneumococcal conjugate vaccine (PCV7) results in a decline in nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae, in carriage of vaccine-type pneumococci, and in replacement by non-vaccine serotypes. Vaccines can reduce pneumococcal resistance in vaccinated and unvaccinated populations by reducing the carriage of antibiotic-resistant serotypes, which protects the vaccinated population and prevents spread of disease to others, and by decreasing antibiotic resistance through overall reduction in antibiotic use. However, while reducing the level of vaccine serotypes and drug-resistant serotypes in the nasopharynx, PCV7 also causes non-vaccine pneumococci replacement. The impact of serotype replacement on disease is not clearly understood. Pelton et al. surveyed two communities shortly after the introduction of the PCV7 immunization programme and found that while colonization with vaccine serotypes declined from 22% to 2% from 2000 to 2003, prevalence of non-vaccine serotypes increased from 7% to 16%. Although penicillin-resistant colonizing S. pneumoniae isolates initially declined, penicillin-intermediate isolates increased 2 years following PCV7 introduction. The change was primarily accounted for by an increase in penicillin-intermediate serotype 19A. Serotype 19A is the only serotype not affected by PCV7 that is prevalent worldwide, clinically important, and highly multidrug-resistant. A study by Hicks et al. established serotype 19A as the predominant post-PCV7 cause of invasive pneumococcal disease (IPD) in children and the elderly. An increase in IPD rates caused by antibiotic-resistant serotype 19A isolates can also occur without vaccination; reports indicate increases in regions characterized by extensive antibiotic use, underscoring the importance of strategies to contain antibiotic resistance.