局部振动对家兔血浆内皮素浓度的影响

目的　探讨局部振动对血浆内皮素浓度的影响及其与振动性血管损伤之间的关系。方法　将家兔随机分为A组 (接振强度 4.90m/s2 )、B组 (接振强度 15 .31m/s2 )、C组 (接振强度 2 6 .2 6m/s2 )和 1个对照组 ,分别于不同接振时间测定各组家兔血浆内皮素浓度。结果　接振后 10、2 0、30d ,A组的血浆内皮素浓度分别为 (4 5 .71± 3.6 2 )pg/ml、(5 1.97± 4.46 )pg/ml、(5 5 .37± 5 .5 3)pg/ml;B组分别为 (5 2 .5 6± 8.0 0 )pg/ml、(6 3.2 4± 6 .73)pg/ml、(72 .98± 9.2 4)pg/ml;C组分别为 (6 4.77± 5 .0 8)pg/ml、(83.6 4± 9.36 )pg/ml、(82 .5 6± 6 .41)pg/ml。随接振时间的延长和接振剂量的增大 ,血浆内皮素浓度有升高的趋势 ,振动试验后 ,各试验组血浆内皮素浓度均高于对照组 ,差异有显著性 (P <0 .0 5 ,P <0 .0 1)。结论　局部振动可致家兔血浆内皮素浓度增高 ,这种增高与振动性血管损伤有一定联系     

IgA肾病患者血浆肾上腺髓质素的检测及意义

目的　探讨IgA肾病患者血浆肾上腺髓质素 (ADM)水平及其临床意义。方法　检测 3 5例IgA肾病患者及 2 2例正常人血浆ADM水平 ,分析患者血浆ADM与尿蛋白的关系。结果　IgA肾病患者血浆ADM水平为 (2 4 2± 3 8)pg/ml显著高于正常对照组 (10 9± 0 8)pg/ml(P <0 0 1) ;蛋白尿大于 1g/ 2 4h组血浆ADM(3 2 1± 4 7)pg/ml显著高于少量或无蛋白尿组 (18 1± 2 5 )pg/ml(P <0 0 5 )。结论　ADM参与了IgA肾病患者病理生理过程 ,合并明显蛋白尿的IgA肾病患者血浆ADM升高 ,可能为代偿性的保护作用。     

山莨菪碱对大鼠热应激的影响

目的　探讨预先静脉注射山莨菪碱有无预防大鼠中暑性内毒素血症的作用。方法　实验动物随机分为两组 ,置于 38℃～ 40℃、5 0 %～ 6 0 %相对湿度的热环境中 ,用四道生理记录仪、半导体温度计测平均动脉压和直肠温度 ,并测热应激的生存时间和生存率 ,在严格无菌和去热源的条件下 ,采集门静脉血和颈动脉血 ,用显示基质偶氮法测血浆内毒素含量。结果　热应激过程中 ,实验组和对照组动物肛温持续增加 ,2h后分别达 (4 2 .7± 0 .6 )℃和 (4 3.1± 0 .5 )℃ ,两组比较 ,差异无显著性(P >0 .0 5 ) ,死亡前肛温高达 (4 4.6± 0 .2 )℃和 (4 4.2± 0 .3)℃ ,差异有显著性 (P <0 .0 1)。实验前门静脉血内毒素含量分别为 (4 5 .7± 5 .2 ) pg/ml和 (4 2 .6± 5 .4) pg/ml,外周血内毒素含量分别为 (14.8± 4.5 ) pg/ml和 (13.9± 7.2 )pg/ml,差异均无显著性 (P >0 .0 5 ) ;2h后门静脉血分别增至 (12 2 .2±16 .7)pg/ml和 (15 0 .4± 2 2 .1) pg/ml,而外周血增至 (32 .3± 7.8) pg/ml和 (4 9.7± 10 .2 )pg/ml,明显高于实验前 ,差异有显著性 (P <0 .0 1) ,而且两组之间比较 ,差异也有显著性 (P <0 .0 1)。两组动物心率变化趋势基本相同 ,都是先升后降 ,但实验前后心率变化的差异无显著性 (P >0 .0 5 ) ;实验前两组动     

溃疡性结肠炎患者外周血单个核细胞IL-13mRNA表达的研究

目的探讨溃疡性结肠炎(UC)患者外周血单个核细胞(PBMCs)白介13(IL-13)mRNA表达与血清C反应蛋白(C-RP)的关系。方法对21例溃疡性结肠炎(UC)活动期患者、10例缓解期患者及20例健康人,采用RT-PCR法和图像分析半定量法检测PBMCs中IL-13mRNA的表达水平及血清C反应蛋白(CRP)浓度。结果活动期UC患者IL-13mRNA的表达水平(6.45±1.23)明显低于缓解期UC患者(14.72±2.12)和健康人(15.17±2.38)(t=2.13,2.24,P<0.05),而缓解期UC患者与健康人比较无明显降低(t=1.63,P>0.05)。活动期UC患者IL-13mRNA的表达水平(6.45±1.23)与血清C-RP浓度(8.36±3.16mg/L)呈负相关(r=-0.589,P<0.05)。结论活动期UC患者PBMCs中IL-13mRNA表达水平显著降低,炎症活动程度与IL-13基因转录降低有关。     

脐血多种细胞因子表达水平及其临床意义

目的 :探讨新生儿脐血中白细胞介素 - 2 (IL - 2 )、可溶性白细胞介素 - 2受体 (s IL - 2 R)、膜白细胞介素 - 2受体 (m IL - 2 R)、白细胞介素 - 6 (IL - 6 )和可溶性细胞间粘附分子 - 1(s ICAM- 1)的表达水平及其临床意义。方法 :以 EL ISA法检测新生儿脐血中 IL - 2、s IL - 2 R、m IL - 2 R、IL - 6和 s ICAM- 1含量 ,以 Ficoll- Hypaque常规分离产妇外周血单个核细胞 (PBMC)和脐血单个核细胞 (CBMC) ,用生物素 -链霉亲和素 (BSA)系统检测 m IL - 2 R表达水平。结果 :产妇外周血血清中 IL - 2、s IL - 2 R、m IL - 2 R、IL - 6和 s ICAM - 1含量分别为 (9.6 7± 4 .2 6 ) pg/ m l、(2 4 6 .5 0± 97.30 ) pg/ ml、 (3.73±1.0 3) %、(6 .6 7± 1.4 2 ) pg/ ml和 (5 6 0 .70± 136 .5 0 ) ng/ m l。新生儿脐血中 IL - 2、s IL - 2 R、m IL - 2 R、IL - 6和 s ICAM- 1含量分别为 (13.4 7± 3.4 0 ) pg/ ml、(15 5 .0 0± 83.5 0 ) pg/ m l、(1.30± 0 .4 5 ) %、(12 .87± 3.15 ) pg/ m l和 (32 1.2 0± 10 2 .2 0 ) ng/ ml。脐血 IL - 2、s IL - 2 R、m IL - 2 R、IL - 6、s ICAM- 1含量与产妇外周血相比 ,差异均有显著性 (P<0 .0 1)。结论 :脐血虽含有较丰富的天然造血细胞因子 ,但总体细胞因子水平     

小鼠IL-18基因注射对小鼠免疫功能的影响

目的　观察肌肉注射IL 18重组体对机体免疫功能的影响。方法　将表达小鼠IL 18的重组体pcDNA3 18经肌肉注射到小鼠 ,三周后观察小鼠脾脏细胞的NK活性和血清中IFN γ和IL 4水平。结果　注射pcDNA3 18质粒的小鼠脾细胞NK细胞活性 (3 9 46± 7 5 8% )明显高于对照组和空白组 (分别为 2 9 0 2±3 45 %和 3 0 13± 3 3 6% ) (p <0 0 5 )。实验组、对照组和空白组血清中IFN γ水平分别为 170 0 0± 40 5 3 pg/ml、 111 80± 5 9 2 3 pg/ml和 112 2 0± 41 45 pg/ml,IL 4水平分别为 42 2 0± 17 91pg/ml、 3 6 60± 2 3 44 pg/ml和 44 80± 14 41pg/ml,实验组IFN γ水平明显高于对照组和空白组 (p <0 0 5 ) ,而IL 4水平无显著变化(p >0 0 5 )。表明实验组TH1细胞免疫功能显著增强。 结论　肌肉注射小鼠IL 18重组体能增强机体的细胞免疫功能 ,为IL 18用于抗感染和肿瘤基因治疗提供了实验依据。     

外周血内毒素与内外科重症患者死亡率的关系

目的对内毒素检测方法及内外科重症患者外周血内毒素水平与患者死亡率的预测进行研究.方法用稀释加热处理后的健康人血浆代替无热原水,稀释健康人和患者的血浆标本.用APACHEⅡ评分系统,大于7分者为观察对象,48例急诊内外科重症患者进入本研究.患者均于就诊6 h内取血作生化检验,用Vacutainer无热原试管加取1.5 ml全血,进行血浆分离,保存于-30℃冰箱2周内检测.临床观察2周,记录有无死亡.数据用标准统计软件Statview SE作统计分析,P＜0.05时有显著意义.结果内毒素升高的患者(10 pg/m1左右时),其测量误差可达20%.50例健康人内毒素浓度为(3.9±0.7)pg/ml.48例重症患者APACHEⅡ评分范围为7～30分,外周血内毒素浓度为(11.4±2.7)pg/ml,明显高于正常人(P=0.0001).当周围血内毒素值分为三组(6.0～9.9pg/ml,10.0～14.9pg/ml,15.0～20.0pg/ml)时,观察到死亡率分别为0、30.0%、75.0%,两者有明显相关性(r=0.99,P=0.04).当APACHE II评分也分为三组(7～14分,15～19分,20～30分)时,患者死亡率分别为0、54.5%、66.7%,两者亦相关(r=0.88,P=0.31).结论重症患者早期外周血内毒素的水平与疾病死亡率明显相关,观察早期外周血内毒素的水平对预测患者的预后有一定临床意义.     

细胞因子TNF-α及CD95对强直性脊柱炎影响的研究

目的　探讨强直性脊柱炎与 TNF- α及 CD95之间的关系。方法　检测 2 2例早期病例和 16例中晚期病例以及 16例健康人血清中 TNF- α和 CD95含量。结果　早期病例组分别为 7.5 8± 1.5 7pg/ ml和5 .2 9± 1.92 ng/ ml;中晚期病例组 TNF- α和 CD95分别为 16 4 .5 1± 95 .4 2 pg/ m l和 4 .5 2± 1.6 2 ng/ m l;健康对照组分别为 5 .82± 1.91pg/ ml和 3.87± 0 .72 ng/ ml。早期病例组与健康对照组无明显差异 ,早期病例组与中晚期病例组的 TNF- α含量有显著性差异 (t=2 .12 4 ,P<0 .0 5 )。结论　 TNF- α浓度增高可能与患病程度和患病部位某些细胞凋亡 (PCD)受到抑制有密切关系 ,也可能是机体在阻止病程进展中维持机体平衡的一种反应。     

狼疮性肾炎患者血清三参数水平变化及意义

目的　探讨白细胞介素 -6(IL -6)、白细胞介素 -8(IL -8)、白细胞介素 -13 (IL -13 )在狼疮性肾炎 (LN)患者中的变化及临床意义。方法　采用酶联免疫吸附法 (ELISA)检测 5 6例LN患者血清IL -6、IL -8、IL -13含量。结果　活动期LN患者血清IL -6、IL -8、IL -13含量显著高于非活动期组与正常对照组 (P <0 0 1) ,非活动期组LN患者血清IL -6、IL -8、IL -13含量与正常对照组比较无显著性差异 (P >0 0 5 ) ,活动期组LN患者血清IL -6、IL -8、IL -13的含量与抗双链DNA滴度、血沉呈显著正相关(P <0 0 1,P <0 0 5 ) ,而与补体C3 、补体C4则呈显著负相关 (P <0 0 1)。结论　IL -6、IL -8、IL -13可能参与了LN的发病过程 ,可作为LN患者狼疮活跃的临床参考指标 ,对于指导治疗及改善预后有重要意义。     

阿托伐他汀对急性冠状动脉综合征患者巨噬细胞集落刺激因子的影响

目的　探讨阿托伐他汀对正常血脂的急性冠状动脉综合征 (ACS)患者巨噬细胞集落刺激因子 (MCSF)的影响。方法　 86例未经调脂治疗具有正常胆固醇的ACS患者 ,随机分为阿托伐他汀治疗组和对照组 ,前者给予阿托伐他汀 2 0mg/d ,对照组未予调脂治疗。分别测定治疗前及治疗 4周后的血MCSF及血脂各项指标 ,比较其变化。结果　阿托伐他汀治疗组MCSF水平治疗后 ( 80 1.13± 2 18.85)pg/ml较治疗前 ( 92 4.65± 2 79.3 2 )pg/ml及对照组 ( 973 .0 0± 2 92 .66) pg/ml均显著降低 (与治疗组治疗前对比 ,P <0 .0 5;与对照组治疗后对比 ,P <0 .0 1)。结论　阿托伐他汀治疗 4周时 ,可显著降低ACS患者血浆MCSF水平     

白细胞介素13在系膜增生性肾小球肾炎患者血浆及肾组织的表达

目的 探讨系膜增生性肾小球肾炎(MsPGN)患者血浆及肾组织白细胞介素13(IL—13)的表达，进一步了解MsPGN的分子病理机制，为临床治疗探索新的途径。方法 应用酶联免疫吸附试验(ELISA)和免疫组化ABC技术检测30例MsPGN患者血浆IL—13水平及其在肾组织的表达、定位和分布。结果 MsPGN患者血浆IL—13水平较正常对照组明显增高，以IgAN增高明显MsPGN患者肾小球及肾小管间质区IL—13表达较正常对照组增高，而以肾小管间质区表达更强，non-Iga MsPGN与IgAN相比，肾小管间质区IL—13表达无明显差异。结论 IL—13可能参与了MsPGN分子病理机制。     

2002年云南非脊灰病毒测序定型和ECHO13病毒基因特征分析

目的对云南省2002年急性弛缓性麻痹(acute flaccid paralysis,AFP)病例中非脊灰病毒(non-polio,NPV)的带毒情况及埃柯病毒13型(echovirus 13,E13)的基因特征进行描述。方法按Obster等介绍的方法,对2002年云南省脊灰实验室分离到的21株NPV进行基因测序定型。结果 2002年云南省共报告267例AFP病例,共采集到<15岁AFP病例的合格粪便标本257份,257份便标本中共检测到NPV43株(带毒率为16.7%),其中脊髓灰质炎病毒(poliovirus,PV)22株(阳性率8.6%),均为疫苗株,未发现脊灰野病毒;检测到非脊灰病毒(NPV)21株(阳性率8.2%)。21株EV中,12株为人类肠道病毒B组(HEV-B,11个血清型,其中3株为E13),3株为人类肠道病毒C组(HEV-C,1个血清型),未分离到HEV-A和HEV-D组病毒。结论 2002年云南省AFP病例中非脊灰病毒携带率不高。对3株常见的E13进行基因进化分析,表明E13病毒存在基因多样性特点(即存在不同的基因型)。     

Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine in adults 18–49 years of age,naive to 23-valent pneumococcal polysaccharide vaccine

BackgroundBased on the success of vaccination with pneumococcal conjugate vaccines (PCVs) in children, recent studies have focused on PCVs in adults. Data from a randomized, double-blind study comparing the immunogenicity, tolerability, and safety of the 13-valent PCV (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in PPSV23-naive adults 60–64 years of age have been published. The same study also included a cohort of adults aged 18–49 years that received open-label PCV13. The purpose of this cohort was to examine the immunogenicity, safety, and tolerability of PCV13 in adult subjects 18–49 years of age compared with adults 60–64 years of age for whom PCV13 is approved.MethodsAdults naive to PPSV23 were grouped by age into 2 cohorts: 18–49 years (n = 899; further stratified by age into 3 subgroups 18–29, 30–39, and 40–49 years) and 60–64 years (n = 417). All subjects received 1 dose of PCV13. In both age groups, immunogenicity was assessed by antipneumococcal opsonophagocytic activity (OPA) geometric mean titers (GMTs) and IgG geometric mean concentrations (GMCs) 1 month after vaccination. Safety and tolerability were evaluated.ResultsIn adults aged 18–49 years, OPA GMTs and IgG GMCs were noninferior for all 13 serotypes and statistically significantly higher for all except 1 serotype (OPA GMT) and 5 serotypes (IgG GMCs) compared with adults 60–64 years. Immune responses were highest in the youngest age subgroup (18–29 years). Local reactions and systemic events were more common in adults 18–49 years compared with 60–64 years and were self-limited.ConclusionImmune responses to PCV13 are robust in adults ≥18 years of age, with highest responses observed in the youngest subgroup. Based on its safety and immunologic profile, PCV13 may serve an important therapeutic role in younger adults, particularly those with underlying medical conditions who have an increased risk of serious pneumococcal infections.     

Post-licensure surveillance of 13-valent pneumococcal conjugate vaccine (PCV13) in adults aged ⩾19 years old in the United States,Vaccine Adverse Event Reporting System (VAERS), June 1, 2012–December 31, 2015

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) was first recommended for use in adults aged ⩾19 years with immunocompromising conditions in June 2012. On August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of PCV13 among adults aged ⩾65 years.MethodsWe assessed adverse events (AEs) reports following PCV13 in adults aged ⩾19 years reported to the Vaccine Adverse Event Reporting System (VAERS) from June 2012 to December 2015. VAERS is a national spontaneous reporting system for monitoring AEs following vaccination. Our assessment included automated data analysis, clinical review of all serious reports and reports of special interest. We conducted empirical Bayesian data mining to assess for disproportionate reporting.ResultsVAERS received 2976 US PCV13 adult reports; 2103 (71%) of these reports were from PCV13 administered alone. Fourteen percent were in persons aged 19–64 years and 86% were in persons aged ⩾65 years. Injection site erythema (28%), injection site pain (24%) and fever (22%) were the most frequent AEs among persons aged 19–64 years; injection site erythema (30%), erythema (20%) and injection site swelling (18%) were the most frequent among persons aged ⩾65 years who were given the vaccine alone. The most frequently reported AEs among non-death serious reports were injection site reactions and general malaise among persons 19–64 years old; injection site reactions, general malaise and Guillain-Barré syndrome among those ⩾65 years (Table 2). Data mining did not detect disproportional reporting for any unexpected AE.ConclusionsThe results of this study were consistent with safety data from pre-licensure studies of PCV13. We did not detect any new or unexpected AEs.     

益肾化湿颗粒辅助治疗慢性肾小球肾炎的效果研究

目的 探究慢性肾小球肾炎患者应用益肾化湿颗粒辅助治疗的临床疗效。方法 选择2017年3月1日—2019年3月1日在河南科技大学第一附属医院接受治疗的慢性肾小球肾炎患者120例作为临床研究对象,随机投掷硬币法分组。对照组60例患者应用氯沙坦钾片治疗,观察组60例患者应用氯沙坦钾片与益肾化湿颗粒联合治疗,比较所有患者治疗后的临床疗效以及对血清中白细胞诱素-1(LKN－1)、肿瘤坏死因子α(TNF－α)和白细胞介素13(IL－13)水平的影响情况。结果 经治疗后,观察组患者的治疗总有效率为96.67%,高于对照组患者的73.33%(P<0.05);观察组患者的尿红细胞为(4.09±1.01)个/HP、24 h尿蛋白定量为(0.79±0.35)g/L、血尿素氮(BUN)为(9.11±2.65)mmol/L以及血肌酐(Scr)为(119.44±48.99)umol/L,均低于对照组患者水平(P<0.05):尿红细胞(6.20±1.98)个/HP、24 h尿蛋白定量(1.25±0.39)g/L、血尿素氮(BUN)(10.60±3.18)mmol/L以及血肌酐(Scr)(137.01±55.43)umol/L;观察组患者血清中IL-13水平为(12.08±2.24)ng/L、TNF-α为(13.57±4.34)ng/L、LKN－1为(70.43±33.88)pmol/L,均低于对照组患者水平,差异均具有统计学意义(P<0.05)。结论 应用益肾化湿颗粒治疗慢性肾小球肾炎患者,可有效消除炎症,改善肾功能,提高临床治疗效果,值得推广应用。     

Rethinking number-needed-to-vaccinate for pneumococcal conjugate vaccines in older adults: Current and future implications

BackgroundNumber-needed-to-vaccinate (NNV) is increasingly used to inform decisions about vaccine use, but it is not calculated uniformly across studies. This study compared two methodologies for calculating NNV with 13-valent pneumococcal conjugate vaccine (PCV13) to prevent one case of community-acquired pneumonia (CAP) among US adults aged ≥65 years: (i) using one-year absolute rate differences as was originally performed by the Centers for Disease Control and Prevention (CDC) and (ii) using absolute risk reduction over 5 years.MethodsWe constructed a hypothetical fixed cohort of 200,000 adults aged ≥65 years equally separated into PCV13-vaccinated and PCV13-unvaccinated groups. We incorporated the same conservative assumptions used by CDC in 2014 regarding annual incidence of hospitalized (1375 per 100,000) and outpatient (2010 per 100,000) CAP, the initial (2014) proportion of adult PCV13-type CAP (10%), and PCV13 efficacy against vaccine-type CAP (45%). To model PCV13 impact over time, we assumed annual mortality was 5% for both groups, the percentage of adult PCV13-type CAP declined annually due to pediatric herd effects, and PCV13 efficacy did not wane over 5 years.ResultsAmong adults aged ≥65 years, NNV with PCV13 to prevent one hospitalized and one outpatient case of CAP as originally calculated by CDC in 2014 were 1620 and 1110, respectively. Accounting for 5-year cumulative effects, NNV with PCV13 to prevent one hospitalized and one outpatient case of CAP over 5 years were 576 and 394, respectively. These revised NNV estimates are roughly one third of initial estimates in which cumulative effects were ignored. NNV to prevent any CAP (inpatient or outpatient) over 5 years with one PCV13 dose was 234.ConclusionAccounting for cumulative preventive effects of PCV13 vaccination over time is critical. Failing to do so, even when using conservative disease burden parameters, can grossly underestimate the public health impact of adult PCV13 use.     

基于13C-methacetin呼气试验检测肝硬化肝储备功能

肝硬化是一种以肝组织弥漫性纤维、假小叶和再生结节形成为特征的慢性肝病.但现在有的生化检查并不能准确、全面地反应抽血取样时的肝功能.为此,重点研究13C-methacetin呼吸试验(13C-MBT)判定肝硬化患者储备功能作用,并与常规肝功能检查及Child-pugh肝功能分级进行比较,为及时、准确地反映检查当日的肝脏功...     

Competitive bidding in Medicare Advantage: Effect of benchmark changes on plan bids

Bidding has been proposed to replace or complement the administered prices that Medicare pays to hospitals and health plans. In 2006, the Medicare Advantage program implemented a competitive bidding system to determine plan payments. In perfectly competitive models, plans bid their costs and thus bids are insensitive to the benchmark. Under many other models of competition, bids respond to changes in the benchmark. We conceptualize the bidding system and use an instrumental variable approach to study the effect of benchmark changes on bids. We use 2006–2010 plan payment data from the Centers for Medicare and Medicaid Services, published county benchmarks, actual realized fee-for-service costs, and Medicare Advantage enrollment. We find that a $1 increase in the benchmark leads to about a $0.53 increase in bids, suggesting that plans in the Medicare Advantage market have meaningful market power.     

Using genomics to examine the persistence of Streptococcus pneumoniae serotype 19A in Ireland and the emergence of a sub-clade associated with vaccine failures

BackgroundStreptococcus pneumoniae serotype 19A remains a significant cause of invasive pneumococcal disease (IPD) in Ireland despite the successful introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 which reduced the overall incidence of IPD in children.MethodsInvasive Streptococcus pneumoniae serotype 19A isolates from the Irish reference laboratory between 2007–08 and 2017–18 were analysed using whole genome sequencing (WGS) to investigate the persistence of this vaccine-preventable serotype. We compared the entire national 19A collection to other international collections using a standardised nomenclature of Global Pneumococcal Sequencing Clusters (GPSC).ResultsExpansion of GPSCs and clonal complexes (CCs) may have been associated with vaccine introduction and antimicrobial prescribing policies. A sub-clade of GPSC1-CC320 (n = 25) unique to Ireland, included five of the ten vaccine failures/breakthrough cases identified (p = 0.0086). This sub-clade was not observed in a global GPSC1-CC320 collection. All isolates within the sub-clade (n = 25) contained a galE gene variant rarely observed in a global pneumococcal collection (n = 37/13454, p < 0.001) nor within GPSC1-CC320 (n = 19/227) (p < 0.001). The sub-clade was estimated to have emerged at the start of the PCV-vaccine era (ancestral origin 2000, range 1995–2004) and expanded in Ireland, with most isolated after PCV13 introduction (n = 24/25).ConclusionsThe identification of a sub-clade/variant of serotype 19A highlights the benefit of using WGS to analyse genotypes associated with persistence of a preventable serotype of S. pneumoniae. Particularly as this sub-clade identified was more likely to be associated with IPD in vaccinated children than other 19A genotypes. It is possible that changes to the galE gene, which is involved in capsule production but outside of the capsular polysaccharide biosynthesis locus, may affect bacterial persistence within the population. Discrete changes associated with vaccine-serotype persistence should be further investigated and may inform vaccine strategies.