在加拿大基于年龄和风险的肺炎球菌疫苗推荐的背景下,本研究提供了2010年至2017年间住院成人肺炎球菌社区获得性肺炎(pCAP)和侵袭性肺炎球菌病(IPD)主动监测的最新数据.
S.使用培养物(血液和痰液)检测肺炎,和尿抗原检测(UAD)。用Quellung进行血清分型,PCR,或使用PCV13和PPV23(非PCV13)特定的UAD。实验室结果,人口统计学,和结果数据按年龄(16-49,50-64和65岁以上)和疾病分类[非细菌性pCAP,菌血症pCAP,和IPD(非CAP)]。
11,129例CAP和216例IPD(非CAP)。对8912例CAP患者进行了肺炎链球菌的实验室检测,确定1264(14.2%)为pCAP。在pCAP病例中,811(64.1%)为非菌血症,455(35.9%)为菌血症。65岁以上的成年人占非细菌性pCAP的54.5%,41.4%的菌血症性pCAP,占IPD病例的48.6%。50-64岁的成年人贡献了30.3%,33.1%,和29.9%,分别。在pCAP中,PCV13血清型在2010年至2014年间下降,原因是7F和19A血清型下降,然后从2015年到2017年稳定,血清型3持续存在。在后来的研究中,非细菌性pCAP占优势,和PPV23(非PCV13)血清型从2015年到2017年增加,血清型为22F,11A,和9N被最频繁地识别。与非pCAP相比,pCAP病例更有可能进入重症监护病房,需要机械通气。这些结果和死亡率在细菌性pCAP和IPD中更常见,与非细菌性pCAP相比。
随着IPD,pCAP监测(菌血症和非菌血症)很重要,因为它们的趋势可能会随着时间的推移而有所不同。由于对PCV13儿童免疫接种的群体保护不足,或在成人中使用PPV23,这项研究支持使用PCV13或更高价结合疫苗进行成人直接免疫,以减少pCAP和IPD的残留负担.
In the context of age- and risk-based pneumococcal vaccine recommendations in Canada, this study presents updated data from active surveillance of pneumococcal community acquired pneumonia (pCAP) and invasive pneumococcal disease (IPD) in hospitalized adults from 2010 to 2017.
S. pneumoniae was detected using culture (blood and sputum), and urine antigen detection (UAD). Serotyping was performed with Quellung, PCR, or using the PCV13- and PPV23 (non-PCV13)-specific UADs. Laboratory results, demographic, and outcome data were categorized by age (16-49, 50-64, and 65 + ) and by disease [non-bacteremic pCAP, bacteremic pCAP, and IPD(non-CAP)].
11,129 CAP cases and 216 cases of IPD (non-CAP) were identified. Laboratory testing for S. pneumoniae was performed in 8912 CAP cases, identifying 1264 (14.2%) as pCAP. Of pCAP cases, 811 (64.1%) were non-bacteremic and 455 (35.9%) were bacteremic. Adults 65 + years represented 54.5% of non-bacteremic pCAP, 41.4% of bacteremic pCAP, and 48.6% of IPD cases. Adults 50-64 years contributed 30.3%, 33.1%, and 29.9%, respectively. In pCAP, PCV13 serotypes declined between 2010 and 2014 due to declines in serotypes 7F and 19A, then plateaued from 2015 to 2017 with persistence of serotype 3. In later study years, non-bacteremic pCAP was predominant, and PPV23 (non-PCV13) serotypes increased from 2015 to 2017, with serotypes 22F, 11A, and 9 N being most frequently identified. Compared to non-pCAP, pCAP cases were more likely to be admitted to intensive care units and require mechanical ventilation. These outcomes and mortality were more common in bacteremic pCAP and IPD, versus non-bacteremic pCAP.
Along with IPD, pCAP surveillance (bacteremic and non-bacteremic) is important as their trends may differ over time. With insufficient herd protection from PCV13 childhood immunization, or use of PPV23 in adults, this study supports direct adult immunization with PCV13 or higher valency conjugate vaccines to reduce the residual burden of pCAP and IPD.