Evaluation of effectiveness,safety and cost-benefit of the 23– valent pneumococcal capsular polysaccharide vaccine for HIV-Infected patients

IntroductionDue to the lack of understanding of the protective effects and safety of 23-valent pneumococcal polysaccharide vaccine (PPV23) in immune-deficient populations, the vaccination rate of PPV23 among HIV-infected patients is still very low in China. The main objectives of this study were to determine whether the efforts to assess measures for the prevention of pneumococcal pneumonia are still worthwhile, and provide designated vaccination program of HIV-infected persons for government policy based on.Methods60 HIV-infected adults in Lanshan county who had never been vaccinated with any pneumococcal vaccine were enrolled in this study, voluntary vaccination of PPV23 and One-year follow-up after vaccination can be completed.Result76.67% patients (46/60) had serologic response at 12 months after vaccine, CD4 count(≤500 cells/ul or > 500 cells/ul) and Month from diagnosis to first antiviral therapy (≤1 month or > 1 month) were related to antibody responses (p < 0.05).In this study, PPV23 was well tolerated, no adverse reaction was reported.11 Streptococcus pneumoniae pneumonia (9.17%,11/120) occurred in the Unvaccinated group and 1 case(1.67%,1/60)in the vaccination group within one year after vaccination(Fisher's exact probability, P = 0.225). The VE was 81.79%. The per capita benefit was 39.32 dollars, the benefit-cost ratio = 1.19. There are significant statistical differences between the vaccinated group and the non-vaccinated group in outpatient costs (p < 0.05, 95 %CI: 9.29–32.11), Medicine costs (p = 0.017, 95 %CI: 2.47–24.44), and disease related indirect costs (p = 0.038, 95 %CI: 0.93–33.63) within one year of vaccination.ConclusionOur study results showed that PPV23 can be safely and effectively administered to HIV-1 infected individuals and effectively preventing Streptococcal pneumonia. Considering the cost-benefit of vaccination among HIV-infected persons, as it has been reported in our study, it is necessary to promote the widespread use of the vaccine among HIV-infected persons in the future.     

深圳市2起人感染猪链球菌病疫情的流行病学调查

目的查明我市2起人感染猪链球菌病的感染途径和流行特征，为制定预防控制措施提供依据。方法开展流行病学调查，采集脑脊液标本，用血平板进行细菌培养、分离，用PCR鉴定。结果患者手部有外伤且有生猪肉接触史，临床上潜伏期短，病程进展迅速，均为脑膜炎型。患者脑脊液中分离的细菌经生化和PCR检测结果为猪链球菌Ⅱ型。病人经过及时抢救均脱离了危险。结论2起疫情为散发疫情，相互间无流行病学联系。传播途径为接触被猪链球菌污染的生猪肉经破损皮肤而传染。应加强卫生知识宣传和教育，提高肉食品加工人员的自我保护能力，同时要提高医务人员的诊治水平。     

Epidemiology and virulence gene expression of intracellular group A streptococci in tonsils of recurrently infected adults

Intracellularly persistent group A streptococci (GAS, Streptococcus pyogenes) have been associated with recurrent tonsillopharyngitis and antibiotic treatment failure. As a supplementation of the published in vitro data, conventional bacteriology and molecular epidemiology was performed on material from 29 adult patients of a German army hospital with anamnestic signs of recurrent tonsillopharyngitis. Pre-surgery tonsil swabs and the surgically removed tonsils were examined with respect to growth of aerobic bacteria in absence and presence of antibiotics with exclusively extracellular activity. Under such antibiotic selection, Staphylococcus aureus and GAS were cultured from specimens of 13 and 3 patients, respectively. In every material GAS-positive by culture methods, the intracellular location of the penicillin-susceptible GAS isolates was confirmed by immunohistologic examination of tonsillar sections using a GAS-specific IgG antibody. The three intracellular GAS isolates were typed by emm gene sequencing and could be associated to types M6 and M49 (two isolates). The bacteria were serially passaged on sheep blood agar, and semiquantitative mRNA analysis from virulence genes was performed using bacteria of the 4th and 25th passage after isolation. An M-type-specific pattern of virulence gene expression and different gene expression levels in relation to the passage number were observed.     

成都地区肺炎链球菌对抗菌药物的耐药性调查

目的 了解成都地区临床分离的肺炎链球菌的耐药性，为肺炎链球菌感染临床合理应用抗菌药物提供理论依据。方法 二倍琼脂稀释法测定11种抗菌药物对肺炎链球菌的最低抑菌浓度(MIC)。结果 91．94％菌株对青霉素敏感，8．06％中度耐药；88．71％菌株对SMZ／TMP敏感，11．29％中度耐药；肺炎链球菌对头孢呋辛、头孢噻肟、头孢毗肟、氧氟沙星、司帕沙星、美洛培南、万古霉素敏感率为100％；对红霉素、克林霉素耐药率相当高，分别达到62．90％和74．19％。结论 成都地区肺炎链球菌对青霉素耐药率较低，而对大环内酯类和克林霉素类耐药率较高。     

Clinical outcome of invasive infections in children caused by highly penicillin-resistant Streptococcus pneumoniae compared with infections caused by penicillin-susceptible strains

BACKGROUND: In this report based on data from the Institutional Surveillance System during 1994-1998, we document the continuing emergence of drug-resistant Streptococcus pneumoniae strains at the Hospital Infantil de Mexico Federico Gómez in Mexico City. METHODS: We evaluate the clinical course of 49 invasive pneumococcal infection outside the central nervous system (CNS) by a number of factors including the site, severity, and place where the infection was acquired, the underlying health of the patient, and the adequacy of antimicrobial therapy. RESULTS: An underlying illness was present in 21 of 49 (43%) patients, 37 (75%) patients had taken previous antimicrobial therapy, and 25% of the infections were nosocomially acquired. Overall, 25 of 49 (51%) of the pneumococcal strains tested were pencillin-resistant; strains with the highest resistance to penicillin were also resistant to cephalosporins. Twenty-two percent of all strains were considered to be multidrug-resistant. Eleven of 25 penicillin-resistant strains were identified as multidrug-resistant, i.e., to erythromycin, TMP/SMX, and chloramphenicol. Ten serotypes accounted for 88% of the isolates, the most frequent serotypes being 23F, 14, 19V, 6A, and 6B. The overall case-fatality rate was 37% (18 of 49), with most deaths occurring within 3-5 days after antibiotic therapy was initiated. There was no difference in the case fatality rate between children with penicillin-nonsusceptible and penicillin-susceptible pneumococcal infections; instead; case-fatality rate correlated with severity of illness on admission and presence of underlying disease. CONCLUSIONS: Characterizing groups at risk for invasive pneumococcal disease could aid in the development of preventive programs and increase the benefits from wide use of future conjugated vaccines.     

四川省一起伴中毒性休克综合征的人感染猪链球菌2型暴发

目的 调查2005年7月中旬四川省资阳市一家医院报告5例以败血症休克为主要临床表现的聚集性病例的病因。方法 建立了病例主动发现、报告的加强监测系统，根据病例的流行病学暴露史和临床表现进行临床诊断；采集患者标本进行细菌分离培养和生化反应鉴定，应用PCR方法对猪链球菌2型的种属和毒力基因进行检测和序列测定；与当地往年报告的流行性脑脊髓膜炎发病数进行比较。结果 2005年6月10日至8月21日，四川省共报告了68例实验室确诊人感染猪链球菌病例，发病前都有屠宰、洗切、加工等病（死）猪的直接暴露史。其中26例（38％）表现为中毒性休克综合征，15例（58％）死亡。其他病例临床表现为轻型败血症或脑膜炎。分离菌株应用PCR方法检测猪链球菌2型的种属和毒力基因（tuf、16S rRNA、cps2J、mrp、sly、ef）均为阳性。同期还报告了136例有相似暴露史，但缺乏实验室确诊依据的临床诊断病例。结论 证实该起发生在四川省部分农村地区直接暴露于病（死）猪后的疾病为猪链球菌2型感染暴发。推测这种罕见的、表现为高病死率的中毒性休克综合征可能是由于感染某种高致病性菌株循环所致。     

社区呼吸道感染中肺炎链球菌对常用抗菌药物敏感性

目的了解社区获得性呼吸道感染中肺炎链球菌对常用抗菌药物的体外抗菌活性。方法先用做肺炎链球菌鉴定粗筛,后用全自动细菌分析系统的革兰阳性菌鉴定卡和单克隆乳胶试剂做肺炎链球菌的最终鉴定,药物敏感性试验用微量稀释方法测定其最低抑菌浓度。结果在1997-11~1998-04,1999-11~2000-04和2001-11~2002-04 3个阶段共收集肺炎链球菌271株。在这3个阶段,肺炎链球菌分别为83,101,87株;对青霉素不敏感率分别为9.6%,8.9%和16%,对青霉素耐药率分别为1.2%,2%和8%;对大环类脂类抗生素的敏感性分别为28.9%,39.6%和18.4%。肺炎链球菌对克拉霉素显示高水平耐药。阿其霉素和克拉霉素的交叉耐药率可达98.4%。对左氧氟沙星的耐药率分别为1.2%,6.9%和1.2%; 对复方新诺明的耐药率分别为30.1%,62.4%和66.7%;多重耐药的肺炎链球菌分别为2.4%,3.0%和6.9%。在多重耐药的肺炎链球菌中,以阿齐霉素、复方新诺明和青霉素模式为主,占72.7%(8/11),同时有80%(8/10)对青霉素耐药的肺炎链球菌发生多重耐药;肺炎链球菌对万古霉素未见有耐药株。结论对青霉素耐药的肺炎链球菌有逐年上升的趋势,定期进行细菌耐药性的监测,有助于合理应用抗菌药物。     

肺炎链球菌对大环内酯类抗生素耐药机制研究

目的观察耐大环内酯类肺炎链球菌的耐药表型和基因型。方法用琼脂二倍稀释法测定耐大环内酯类肺炎链球菌对11种抗生素的最低抑菌浓度,耐药表型由红霉素和克林霉素双纸片法初步分型,通过PCR扩增耐药基因ermB和mefA进行基因分型,并测定ermB和mefA基因序列。结果　所有23株肺炎链球菌对大环内酯和克林霉素高度耐药,均表现为内在型耐药,没有发现诱导型耐药和M型耐药。ermB基因在23株肺炎链球菌中均检测到,其中5株同时检测到mefA基因,没有发现仅单一mefA基因阳性的菌株,基因型与耐药表型完全一致。所测ermB和mefA基因序列与基因库收录序列高度一致。 结论ermB基因介导的靶位改变可能是重庆地区肺炎链球菌对大环内酯类抗生素的主要耐药机制。     

How cost effective is switching universal vaccination from PCV10 to PCV13? A case study from a developing country

BackgroundChildren immunization with pneumococcal conjugate vaccine (PCV) had profound public health effects across the globe. Colombian adopted PCV10 universal vaccination, but PCV incremental impact need to be revalued. The objective of this analysis was to estimate the cost-effectiveness of switch to PCV13 versus continue PCV10 in Colombian children.MethodsA complete economic analysis was carried-out assessing potential epidemiological and economic impact of switching from PCV10 to PCV13. Epidemiological information on PCV10 impact was obtained from lab-based epidemiological surveillance on pneumococcal isolates at the Colombian National Institute of Health. Economic inputs were extracted from the literature. Incremental PCV13 effectiveness was based in additional serotypes included. Comparisons among alternatives were evaluated with the Incremental Cost-Effectiveness Ratio (ICER) at a willingness to pay of one GDP per capita (USD$ 6631) per Year of Live Saved (YLS). All costs were reported in 2014USD. Deterministic and probabilistic sensitivity analyses were performed, and 95% confidence interval reported.ResultsAfter four years using PCV10 for universal vaccination on children the Colombian health surveillance system showed a relative increment on non PCV10 isolates. To change from PCV10 to PCV13 would avoid 587 (CI95% −49–1008) ambulatory Rx community-acquired pneumoniae (CAP), 1622 (CI95% 591–2343) Inpatient RxCAP, 10 (CI 95% 6–11) pneumococcal meningitis, and 79 (CI95% 76–98) deaths. ICER per YLS was USD$ 2319 (CI95% Dominated – USD$ 4225) for Keep-PCV10 and USD$ 1771 (CI95% USD$ 1285–9884) for Switch-to PCV13. In spite of its cost-effectiveness Keep-PCV10 is an extended dominated alternative and Switch-to PCV13 would be preferred. Results are robust to parameters changes in the sensitivity analyses.ConclusionA national immunization strategy based in Switch-to PCV13 was found to be good value for money and prevent additional burden of pneumococcal disease saving additional treatment costs, when compared with to Keep-PCV10 in Colombia, however additional criteria to decision making must be taken into account.     

An innovative quaternary ammonium methacrylate polymer can provide improved antimicrobial properties for a dental adhesive system

A quaternary ammonium methacrylate polymer (QAMP) with antimicrobial potential was synthesized. The resulting product (QAMP) was characterized by FTIR spectroscopy, NMR spectroscopy, visible spectrophotometry, XRPD and TGA. The in vitro susceptibility tests against Streptococcus mutans of QAMP were investigated prior and after incorporation into a commercial adhesive system (Clearfil? SE Bond). The release of quaternary ammonium compounds from the experimental adhesive system (Clearfil? SE Bond?+?5% QAMP) was performed during 1, 7, 14, 21 and 30 days. Spectroscopic data confirmed that QAMP was successfully obtained. Thermogravimetric analysis indicated that QAMP was heat stable. Prior incorporation into the adhesive system, QAMP revealed an inhibition halo of 18.33?±?0.6?mm. By agar disk diffusion test, Clearfil? SE Bond containing 5% QAMP presented an inhibition halo (16.67?±?1.5?mm) similar to Clearfil? Protect Bond (positive control, 17.00?±?1.7, p?=?0.815) and significantly higher than Clearfil? SE Bond (negative control, 11.00?±?1.0, p?=?0.006). The minimum inhibitory/bactericidal concentrations for Clearfil? SE Bond containing 5% QAMP were 20?μL?mL^?1. The release of quaternary ammonium compounds from the experimental adhesive containing QAMP was very low (5.1%) when compared to Clearfil? Protect Bond that released 47.2% of its quaternary ammonium monomer (MDPB) after 30 days. The QAMP can offer enhanced antimicrobial properties for self-etching adhesive systems.