Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany

IntroductionPediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).MethodsIn a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.ResultsS. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1–4.3 years] vs. median 5.6 years [IQR 3.8–8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1.ConclusionFollowing the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.     

新生儿病房铜绿假单胞菌的血清学分型,质粒分析研究

新生儿病房１９８９年１０月～１９９０年１２月、１９９６年３～６月两个时间段分离４０株铜绿假单胞菌，血清学分型率９７．５％，第一时间段以Ｏ１１型最多，占３０．４％，集中在１９９０年６～１０月，第二时间段Ｏ３型占９３．８％，集中在１９９６年３～６月，表明该病房发生两次铜绿假单胞菌医院感染流行。质粒检出率４２．９％，Ｏ１１型菌株质粒谱为８．１、４６．５、１７９．１ｋｂ，并经ＨｉｎｄⅢ酶切进一步证实为同一克隆。对氟哌酸、阿米卡星及头孢他啶的敏感率分别为１００％、９７．３％和９５％。对庆大霉素耐药率明显上升，提示控制铜绿假单胞菌医院感染的重要性。     

A porcine G9 rotavirus strain shares neutralization and VP7 phylogenetic sequence lineage 3 characteristics with contemporary human G9 rotavirus strains

Of five globally important VP7 (G) serotypes (G1-4 and 9) of group A rotaviruses (the single most important etiologic agents of infantile diarrhea worldwide), G9 continues to attract considerable attention because of its unique natural history. Serotype G9 rotavirus was isolated from a child with diarrhea first in the United States in 1983 and subsequently in Japan in 1985. Curiously, soon after their detection, G9 rotaviruses were not detected for about a decade in both countries and then reemerged in both countries in the mid-1990s. Unexpectedly, however, such reemerged G9 strains were distinct genetically and molecularly from those isolated in the 1980s. Thus, the origin of the reemerged G9 viruses remains an enigma. Sequence analysis has demonstrated that the G9 rotavirus VP7 gene belongs to one of at least three phylogenetic lineages: lineage 1 (strains isolated in the 1980s in the United States and Japan), lineage 2 (strains first isolated in 1986 and exclusively in India thus far), and lineage 3 (strains that emerged/reemerged in the mid-1990s). Currently, lineage 3 G9 viruses are the most frequently detected G9 strains globally. We characterized a porcine rotavirus (A2 strain) isolated in the United States that was known to belong to the P[7] genotype but had not been serotyped by neutralization. The A2 strain was found to bear serotype G9 and P9 specificities as well as NSP4 [B] and subgroup I characteristics. By VP7-specific neutralization, the porcine G9 strain was more closely related to lineage 3 viruses than to lineage 1 or 2 viruses. Furthermore, by sequence analysis, the A2 VP7 was shown to belong to lineage 3 G9. These findings raise intriguing questions regarding possible explanations for the emergence of variations among the G9 strains.     

One cross-sectional investigation revealed that non-vaccine serotypes of Streptococcus pneumoniae could be identified more frequently in elderly Chinese people

ObjectiveTo analyze the serotype distribution and drug resistance of Streptococcus pneumoniae isolated from hospitalized patients of all ages in Zhongjiang county, Sichuan province, where the young children have just begun to vaccinate the PCV13 in private sector.MethodsSerotypes were determined for 387 isolates of S. pneumoniae by Quellung reaction. Antibiotic susceptibility was tested with the E-test or disc diffusion method.ResultsThe most common serotypes were type 19F and confirmed for 88 isolates (22.7%), followed by 19A (15.0%), 6B (7.8%), 16F (7.8%), 23F (7.0%) and 15A (4.4%). The coverage rates of PCV13 and PPSV23 were 63.3% and 65.1%. With the increase of age, the proportion of PCV13 types decreased significantly, from 71.3% (<2 years old) to 41.9% (≥60 years old). The intermediate rate and resistance rate of the isolates to oral penicillin were 48.6% and 45.2%, respectively. The resistance rate of erythromycin was high (94.4%). The PCV13 isolates was more resistant to penicillin than the non-PCV13 ones.ConclusionThe PCV13 coverage rate in pediatric isolates was higher than those in adult isolates. The adults, especially the elderly, may be the reservoir of non-PCV13 types. It is necessary to investigate the serotype distribution of S. pneumoniae based on all age population to assess potential epidemics of non-vaccine serotype associated with PCVs administration.     

Dynamic changes in clinical characteristics and serotype distribution of invasive pneumococcal disease among adults in Japan after introduction of the pediatric 13-valent pneumococcal conjugate vaccine in 2013–2019

Nationwide population-based surveillance for invasive pneumococcal disease (IPD) is being conducted in few Asian countries. We aimed to evaluate the clinical characteristics and serotype distribution among Japanese adult patients with IPD after introduction of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. IPD surveillance was conducted among adults between 2013 and 2019, and 1,995 patients were analyzed by time period (early, 2013–2015; middle, 2016–2017; late, 2018–2019). We found that the period of 2018–2019 was independently associated with a lower risk of fatal outcome, compared with the period of 2013–2015. The proportion of those with serotype PCV13-nonPCV7 decreased significantly in patients aged 15–64 years and in those aged ≥ 65 years within 3 years after the introduction of pediatric PCV13. By contrast, the proportion of those with nonvaccine serotype increased significantly in those aged ≥ 65 years, but not in those aged 15–64 years. No significant change was found in the proportion of 23-valent polysaccharide pneumococcal vaccine (PPSV23)-nonPCV13 in both of adults aged 15–64 years and ≥ 65 years. The proportions of PCV15-, PCV20- and PCV24-covered serotypes were 38%, 56% and 58% in adult patients with IPD aged ≥ 65 years during the late period. Our data on the serotype distribution support an indirect effect from pediatric PCV13 use among adults, and afford a basis for estimates of protection against IPD by vaccination with newly developed PCVs in older adults in Japan.     

2017-2019年苏州地区儿童肺炎链球菌血清分型及耐药特征

目的 了解苏州大学附属儿童医院呼吸道感染儿童肺炎链球菌菌株的血清型分布及耐药特征,为制定肺炎链球菌相关疾病的治疗和预防接种策略提供参考.方法 采用乳胶凝集和荚膜肿胀试验对肺炎链球菌菌株进行血清分型,采用E-test法检测菌株对多种抗生素的耐药性.结果 2017年1月-2019年7月共收集3 652株肺炎链球菌,主要来自...     

2004～2009年临床分离肺炎链球菌的血清型/群分布及耐药性监测

目的：了解当前本院临床分离肺炎链球菌的血清型/群分布及耐药趋势,为临床合理使用抗生素提供参考。方法：以2004～2009年临床分离的822株肺炎链球菌为研究对象,采用荚膜肿胀试验进行血清分型/群,E-test检测菌种对青霉素、头孢呋辛、头孢地尼、头孢克罗、红霉素、四环素、左氧氟沙星、万古霉素等8种抗生素的敏感性。结果：2004年青霉素不敏感肺炎链球菌（PNSP）的分离率为49.4%,并呈逐年上升趋势,至2006年PNSP分离率高达67.8%,2009年下降至51.0%。822株肺炎链球菌最常见的型/群是19群,其次是23、6、14、3、其他。PNSP在6种血清型/群中所占的比例在2004～2009年期间无显著性变化（P〉0.05）。肺炎链球菌对其他β内酰胺类抗生素的非敏感趋势类似青霉素,对红霉素、四环素的非敏感率始终在60%以上,其中青霉素耐药肺炎链球菌（PRSP）对红霉素和四环素几乎100%耐药,对左氧氟沙星、万古霉素的非敏感率均〈3%。结论：临床分离肺炎链球菌以19群、23群、6群、14群、3群常见;对β内酰胺类抗生素的非敏感率自2007年呈下降趋势,且对左氧氟沙星、万古霉素始终具有较高的敏感性。     

非嗜肺军团菌的分离培养与血清分型研究

目的对吉林省某集中空调冷却塔出水口的水进行军团菌分离培养及血清学分型。方法用分离培养法检测军团菌,再用乳胶凝集对其进行血清学分型。结果在某集中空调冷却塔出水口的水中成功检测出非嗜肺军团菌(博杰曼军团菌),在吉林省属首次报道。结论利用本方法可以较好地分离培养出冷却塔出水口的水中军团菌及进行血清血分型。     

副溶血性弧菌引起的腹泻流行病学及其病原特征分析

目的:了解2010年-2011年间上海市浦东新区由副溶血性弧菌引起的腹泻病的流行特征及副溶血性弧菌的病原特征。方法:采集监测点医院腹泻病例的肛拭标本,登记病例信息。依据《感染性腹泻诊断标准》WS271-2007进行分离培养、生化鉴定、血清分型;用WHO推荐的K-B纸片法进行药敏试验。结果:2年间共检测腹泻病例样品5590件,检出副溶血性弧菌299株,检出率为4.99%。检出高峰7月-9月份;年龄分布4岁～81岁,男女比例接近1∶1;以临海的东部地区居多。血清分型方面,共分出8个血清群,30个血清型,其中O3:K6型检出186件,占62.21%,为主要血清型;药敏试验发现氨苄西林耐药率达到99.33%以上;对阿莫西林/克拉维酸等4种抗生素则完全敏感。结论:基本摸清了浦东新区腹泻病例副溶血弧菌的流行特点、血清型、耐药性,为疾病的诊治和预防提供科学依据。     

2株不同基因型树鼩呼肠孤病毒的分离和鉴定

目的 从腹泻树鼩的粪便样本中分离和鉴定病毒。方法 树鼩腹泻粪便样本分别接种Vero、LLC-MK2和KMB17细胞,经连续传代,观察记录细胞病变,并对培养上清进行透射电镜检查、病毒RNA-PAGE胶电泳分析、轮状病毒鉴别筛查、S1全长基因片段扩增和生物信息学分析。结果 树鼩腹泻粪便样品在KMB17、Vero 和LLC-MK2细胞上经连续3代次传代后,均能产生细胞病变。进一步经电镜检查、病毒RNA的聚丙烯酰胺凝胶电泳分析和轮状病毒鉴别筛查,推测其为呼肠孤病毒。病毒基因组全长S1基因扩增、序列测定和分析结果表明,KMB17培养上清中获得的病毒与I型原型株T1L同源性最高,核苷酸和氨基酸同源性分别为85%和90%,因此该病毒定义为呼肠孤病毒I型。而LLC-MK2和Vero细胞上清中的病毒S1基因与III型原型株T3D核苷酸和氨基酸同源性分别为85%和92 %,因此为III型病毒。S1基因的遗传进化分析表明,本研究的分离株已经进化适应了树鼩。结论 本研究首次通过3种基质细胞和S1基因片段特异性引物从同一粪便样品中分离和鉴定了2个不同基因型呼肠孤病毒,对今后树鼩和其它宿主呼肠孤病毒的分离鉴定有一定的指导意义。