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首页> 外文期刊>Pneumonia. >Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population
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Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population

机译：西澳大利亚原住民肺炎球菌携带预测因子和13价肺炎球菌结合疫苗接种的效果

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Background 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. Methods 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. Results One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8% of children ?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). Conclusion 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.
机译：背景技术2001年，在澳大利亚西部的西澳原住民中引入了7价肺炎球菌结合疫苗（PCV7），以预防侵袭性肺炎球菌疾病（IPD）。2011年7月，PCV13取代了PCV7，涵盖了另外6种肺炎球菌血清型。然而，西澳原住民的IPD率仍然很高。上呼吸道肺炎球菌携带可以在IPD之前发生，而PCV会改变血清型分布。方法收集2008年8月至2014年11月间西澳州原住民儿童和成年人的PCV13引入的影响，鉴定新出现的血清型并评估携带，鼻咽拭子的危险因素以及人口统计学特征，健康，用药和生活条件的信息。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。通过多因素逻辑回归分析危险因素。结果收集了PCV13导入前的1500个拭子和1385个后的拭子。在66.8％的儿童中检出了肺炎球菌感染（≥0.05）。 PCV13后最常见的血清型为11A（患病率4.0％），15B（3.5％），16F（3.5％）和19F（3.2％）。直到12个月大时，发现肺炎球菌携带的风险增加（几率[OR] 4.19，95％置信区间[CI] 2.39–7.33），并有鼻涕（OR 2.49 [95％CI 2.00–3.09]），居住在偏远社区（OR 2.21 [95％CI 1.11-1.67]）和家庭拥挤（OR 1.36 [95％CI 1.11-1.67]）。最近使用的抗生素与肺炎球菌的运输呈负相关（OR 0.48 [95％CI 0.33-0.69]）。在血清型19A（6.0％），19F（2.3％）和非血清型分离株（1.9％）中存在对青霉素的完全耐药性。血清型23F和新出现的血清型7B分离株显示出对考特莫唑，红霉素和四环素的高耐药率（23F分别为86.9％，86.9％，82.0％，7B分别为100.0％，100.0％和93.3％）。结论自从PCV13取代PCV7以来，在5岁以下的儿童（最有可能接受PCV13的儿童）中，携带PCV13-非PCV7的血清型的携带者明显减少，而老年人的携带程度则较小。原住民人口中已知的拥挤危险因素包括拥挤和年少。

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