Targeting pneumococcal vaccination to high-risk groups: a feasibility study in one general practice

The Department of Health recommends pneumococcal vaccination opportunistically or when immunising against influenza. This was a study in one general practice to assess the feasibility of targeting patients for pneumococcal vaccination in primary care. We also examined the rate of uptake of pneumococcal vaccine in identified risk groups after one year of a pneumococcal vaccination programme. A self-administered questionnaire was given to patients attending for influenza vaccine between September and December 1996. A total of 551/747 (73.8%) patients returned completed questionnaires. Few patients receiving influenza vaccination (133/509, 26%) were aware of pneumococcal vaccine. Only 55/108 (51%) of those given influenza vaccination were in a clinical risk group for pneumococcal vaccine. Attitudes towards vaccination were more positive and intention to take up pneumococcal vaccination significantly greater in high-risk patients compared to those who were not in a risk group. A targeted vaccination campaign directed at high-risk patients, both opportunistically and those attending for influenza vaccination over one year, resulted in the following proportions of patients in at-risk groups being vaccinated: coronary disease 144/312 (46%), diabetes 79/132 (60%), splenectomy 2/2 (100%), chronic obstructive airways disease and asthma 135/700 (19%), and chronic renal failure 5/9 (56%). Most doses of pneumococcal vaccine (336/463; 73%) were delivered to patients in high-risk groups. We conclude that a well-organised pneumococcal vaccination campaign can improve coverage of at-risk patients in general practice. Programmes to increase patient awareness of the vaccine, improved availability of vaccine, and practice guidelines, would help to target the vaccine to at-risk patients. Patients with chronic lung disease and asthma were particularly difficult to define and target in this study. A review of the UK guidelines, aligning those for pneumococcal and influenza vaccination and including patients over 65 years, would improve the logistics of vaccine delivery.     

Invasive pneumococcal disease in Indigenous people in north Queensland, 1999-2004

OBJECTIVE: To describe the epidemiology of invasive pneumococcal disease (IPD), and the impact of pneumococcal vaccines on IPD, in Indigenous people in north Queensland. SETTING: North Queensland, 1999-2004; there are about 53 750 Indigenous people in the region, including nearly 6900 children < 5 years and nearly 5650 adults > or = 50 years. MAIN OUTCOME MEASURES: Incidences of IPD in Indigenous children and in Indigenous adults compared between the 3 years before and after the introduction of a 7-valent pneumococcal conjugate vaccine (7vPCV) (1999-2001 versus 2002-2004). RESULTS: Estimated annual incidence of IPD in Indigenous children < 5 years of age declined from 170 to 78 cases per 100 000 in the 3 years following the introduction of 7vPCV in 2001. The annual incidence of vaccine-preventable IPD in Indigenous adults had declined by 86% since a 23-valent pneumococcal polysaccharide vaccine (23vPPV) was introduced to the region in 1996, to 15 cases per 100 000 (95% CI, 8-25) in 2002-2004. CONCLUSION: Although there was a rapid decline in IPD in young Indigenous children, it is unlikely that the incidence will fall much further with the current 7-valent vaccine. There was a suggestion that vaccinating Indigenous children indirectly protected those aged 5-14 years and Indigenous adults > or =15 years of age. Incidence of IPD in Indigenous adults in 2002-2004 was the lowest on record in the region.     

Invasive pneumococcal disease in children in Ireland—the anticipated benefit of conjugate pneumococcal vaccination

Background   Streptococcus pneumoniae is an important cause of childhood illness. Recently a safe and effective 7-valent conjugate pneumococcal vaccine for children has been licensed in the EU. Aims  To calculate the incidence of invasive pneumococcal disease (IPD) in children in Ireland, to estimate the burden of disease and to anticipate the protective effect of the conjugate vaccine. Methods  Retrospective review of data from children with IPD. Results  Ninety-six cases of IPD in 95 children including two related deaths were identified. All childhood IPD incidence was estimated at 10.6/100,000. We anticipate that the 7-valent conjugate vaccine could prevent up to 90% of sepsis and up to 82.5% of meningitis cases. Conclusions  IPD is an important cause of mortality and morbidity in children in Ireland. Routine use of conjugate pneumococcal vaccine would have a significant impact on pneumococcal disease, especially in vaccinated children but also in unvaccinated children and older adults. Prior to publication, data from this study was made available to the Health Protection Surveillance Centre (HSPC) in Ireland. These data contributed to the decision by the National Immunisation Advisory Committee to recommend the introduction of an universal childhood pneumococcal vaccination programme. This is currently expected to commence in September 2008.     

Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995-1998: Opportunities for prevention in the conjugate vaccine era

CONTEXT: Pneumococcal polysaccharide vaccine is recommended for elderly persons and adults with certain chronic illnesses. Additionally, a recently licensed pneumococcal 7-valent conjugate vaccine has been recommended for use in young children and could dramatically change the epidemiology of pneumococcal disease. OBJECTIVES: To assess pneumococcal disease burden in the United States, estimate the potential impact of new vaccines, and identify gaps in vaccine recommendations. DESIGN AND SETTING: Analysis of data from the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, an active, population-based system in 9 states. PATIENTS: A total of 15 860 cases of invasive pneumococcal disease occurring between January 1, 1995, and December 31, 1998. MAIN OUTCOME MEASURES: Age- and race-specific pneumoccocal disease incidence rates per 100 000 persons, case-fatality rates, and vaccine preventability. RESULTS: In 1998, overall incidence was 23.2 cases per 100 000, corresponding to an estimated 62 840 cases in the United States. Incidence was highest among children younger than 2 years (166.9) and adults aged 65 years or older (59.7). Incidence among blacks was 2.6 times higher than among whites (95% confidence interval [CI], 2.4-2.8). Overall, 28.6% of case-patients were at least 65 years old and 85.9% of cases in this age group were due to serotypes included in the 23-valent polysaccharide vaccine; 19.3% of case-patients were younger than 2 years and 82.2% of cases in this age group were due to serotypes included in the 7-valent conjugate vaccine. Among patients aged 2 to 64 years, 50.6% had a vaccine indication as defined by the Advisory Committee on Immunization Practices (ACIP). The case-fatality rate among patients aged 18 to 64 years with an ACIP indication was 12.1% compared with 5.4% for those without an indication (relative risk, 2.2; 95% CI, 1.7-2.9). CONCLUSIONS: Young children, elderly persons, and black persons of all ages are disproportionately affected by invasive pneumococcal disease. Current ACIP recommendations do not address a subset of persons aged 18 to 64 years but do include those at highest risk for death from invasive pneumococcal disease.     

Influenza and pneumococcal vaccination: patient perceptions

The efficacy of the influenza vaccine in reducing mortality and hospital admissions is established, particularly in the elderly. However, up to 50% of those at risk do not receive the vaccine. These patients are also at risk from pneumococcal infection and there is considerable overlap between the target group for each vaccine. This study sought to identify at risk individuals from consecutive admissions to an acute geriatric unit and to gain an insight into their perceptions with regard to vaccination. The awareness of each vaccine was recorded, together with the vaccination history. Seventy four per cent of the final cohort had heard of the influenza vaccine, while only 13% had heard of the pneumococcal vaccine. Fifty per cent perceived themselves to be at risk from influenza and its complications and 87% of the cohort believed it to be a serious infection. Influenza vaccine was judged to confer good protection by 72% of the sample and yet up to 50% believed that the vaccine can make the recipient ill. Influenza is perceived as a serious infection by patients and yet many do not believe themselves to be at particular risk. Although influenza vaccination is believed to confer protection, the decision whether, or not, to accept the vaccine is coloured by many factors, including popular myths and anecdotal information from friends and relatives. The uptake of influenza vaccine is suboptimal and the awareness of the pneumococcal vaccine certainly in the elderly is poor. The need for a comprehensive nationwide education campaign promoting both influenza and pneumococcal vaccine is highlighted.     

肺炎链球菌疫苗候选抗原PspA异家族亚类间交叉反应评价

目的：观察肺炎链球菌DNA疫苗候选抗原肺炎链球菌表面蛋白A（PspA）在临床肺炎链球菌自然感染情况下家族分布及异家族亚类间抗原抗体交叉反应情况,探索肺炎链球菌PspA核酸疫苗的抗原组成形式。方法：采集我院42例临床侵入性肺炎链球菌感染菌株,及患者恢复期（第21±3天）的血清样本,同期确诊为非感染性疾病患者36例血清样本为对照组,细菌基因组特异性PCR及测序比对鉴定PspA家族分布,酶联免疫吸附法（ELISA）检测患者血清PspA抗体与PspA蛋白6种亚类抗原的交叉反应情况。结果：42株肺炎链球菌中以PspA家族Faml-Clade2（31.0％）和Fam2-Clade3（47.6％）的菌株为优势分布,所有侵入性肺炎链球菌感染患者血清中针对PspA-Faml特异性抗体水平高于针对PspA-Fam2的特异性抗体水平,血清PspA抗体与PspA蛋白6种亚类抗原的交叉反应发现异家族各亚类间交叉反应弱,但同家族亚类间显著交叉反应以Faml-Cladel和Fam2-Clade3为优势。结论：肺炎链球菌PspA核酸疫苗靶抗原的组成时应同时包括产生高保护性抗体效价和强交叉反应的Faml及Fam2的优势Clade亚类成分才能有效针对广泛的临床致病肺炎链球菌菌株感染的保护。     

Use of a low-literacy patient education tool to enhance pneumococcal vaccination rates. A randomized controlled trial.

CONTEXT: Pneumococcal immunization rates for elderly and high-risk patients are only one third to one half the target rate of 60% established by the US Public Health Service. Limited or marginal literacy, which affects nearly 100 million Americans, especially the elderly, may contribute to these low rates of immunization. OBJECTIVE: To determine whether the use of a simple, low-literacy educational tool enhances patient-physician dialogue about pneumococcal vaccination and increases rates of immunization. DESIGN: A randomized controlled trial conducted between May and June of 1998. SETTING: Ambulatory care clinic of a 900-bed public teaching hospital serving a predominantly indigent, low-literate, African American, inner-city population. PARTICIPANTS: Of 433 patients who presented for routine primary care, had vaccine indications (age > or =65 years or chronic disease), and had not been previously vaccinated, 221 were randomly assigned to the intervention group and 212 to the control group. Of the total patient population (mean age, 63 years), 280 (64.7%) had less than a high school education, 401 (92.6%) were African American, and 300 (69.3%) were female. INTERVENTION: One-page, low-literacy (below fifth-grade level) educational handout encouraging patients to "ask your doctor about the pneumonia shot" vs a control group (1 -page, low-literacy educational handout conveying information about nutrition). MAIN OUTCOME MEASURES: Vaccination rates (documented by chart audit) of patients who received pneumococcal vaccination and rates of patients who self-reported having discussed vaccination with their physicians. RESULTS: Patients in the intervention group were 4 times more likely to have discussed the pneumococcal vaccine with their physicians than patients in the control group (87/221 [39.4%] vs 21/212 [9.9%]; relative risk [RR], 3.97 [95% confidence interval [CI], 2.71-5.83]), and were more than 5 times as likely to have received the pneumococcal vaccine than the control group (44/221 [19.9%] vs 8/212 [3.8%]; RR, 5.28 [95% CI, 2.80-9.93]). In a multivariate analysis controlling for race, sex, education, insurance status, age, level of physician training, health status, and vaccine indication, only assignment to the intervention group was statistically significantly related to the probability of being immunized or discussing the issue with their physicians (P<.001 for both trends). CONCLUSIONS: A simple, low-literacy educational tool increased pneumococcal vaccination rates and patient-physician discussions about the vaccine in an elderly, low-literate, indigent, minority population.     

Invasive pneumococcal disease in an Alaska native population, 1980 through 1986

From 1980 through 1986, one hundred fourteen Alaska Native patients from the Yukon-Kuskokwim Delta had community-acquired invasive pneumococcal disease confirmed by isolates of Streptococcus pneumoniae from normally sterile body sites. The annual bacteremia rates per 100,000 persons were 105 cases for all ages, 1195 cases for infants under 2 years of age, and 130 cases for adults over 59 years of age. These were six to 34 times higher than rates reported for other US populations. The most common underlying conditions in infants diagnosed before 24 months of age were previously diagnosed anemia and pneumonia, while alcoholism and anemia were most common in adults. The case-fatality rate for infants under 2 years of age was 3.2%, and the case-fatality rate for adults over 59 years of age was 30%. Serotyping of more than half the isolates identified 96% of these isolates to be present in the currently available pneumococcal polysaccharide vaccine. The pneumococcal disease rates reported herein are likely to be underestimates since most diseases that occur in this region are treated at the village level without laboratory confirmation.     

23价肺炎球菌多糖疫苗接种对稳定期COPD患者的影响

目的评价23价肺炎球菌多糖疫苗（PPSV-23）接种在稳定期慢性阻塞性肺病（COPD）的作用。方法将100例稳定期COPD患者随机分成干预组和对照组,干预组患者于接种后随访1周观察不良反应。注射疫苗2年内观察病情急性发作、肺部感染、住院次数、死亡率和不良反应,并与对照组进行对比。结果干预组急性发作次数、肺部感染、住院次数、病死率均低于对照组。接种后不良反应多为局部反应,经热敷或休息1～3d可缓解。结论 PPSV-23可以减少稳定期COPD患者急性发作率、肺部感染率、住院率、死亡率。     

慢性阻塞性肺病患者接种23价肺炎球菌多糖疫苗的成本-效益分析

目的：了解23价肺炎球菌多糖疫苗对慢性阻塞性肺病（COPD）患者的预防保护效果及因此带来的经济效益.方法：从2007年10月以来曾在我院呼吸内科就诊,有完整病历资料的COPD患者资料库中,随机筛取240人入选为研究对象,随机分成疫苗组及对照组各120人.收集基线情况及通过对两组患者两年的急性发作情况、住院情况及治疗费用的跟踪随访,并对比分析两组数据.结果：疫苗组无论在COPD急性发作次数、发作持续天数、住院次数、平均住院天数及治疗成本上均显著低于对照组.疫苗组比对照组减少总治愈成本167385.18元,接种疫苗后效益成本比达到7.08,接种疫苗后净效益达到143742.18元.结论：23价肺炎球菌多糖疫苗能有效预防COPD的发作及肺部感染的严重程度和治愈时间,并显著降低COPD所致的治疗成本.     

Invasive pneumococcal disease in Indigenous people in north Queensland: an update, 2005-2007

OBJECTIVE: To examine trends in invasive pneumococcal disease (IPD) in Indigenous people in north Queensland following the introduction of the 7-valent pneumococcal conjugate vaccine (7vPCV). DESIGN: Trends in IPD were compared over three 3-year periods: before the introduction of 7vPCV for Indigenous children (1999-2001), and two consecutive periods after its introduction (2002-2004 and 2005-2007). MAIN OUTCOME MEASURES: Incidences of IPD in Indigenous children and adults in 1999-2001 and 2005-2007; trends in IPD caused by 7vPCV and non-7vPCV serotypes; and trends in indirect protective effects and emergence of non-7vPCV serotype IPD. RESULTS: From 1999-2001 to 2005-2007, there was a 60% decline in IPD, with the virtual elimination of 7vPCV serotype IPD in young (< 5 years) Indigenous children. There is no evidence yet of an increase in non-7vPCV serotype IPD in these children. Although the annual incidence of IPD in Indigenous adults remained virtually unchanged, there was a 75% decline in 7vPCV serotype IPD in these adults (chi2(trend) = 11.65, P < 0.001). However, the incidence of IPD caused by non-7vPCV serotypes more than tripled in adults (chi2(trend) = 7.58, P = 0.006). Serotype 1 IPD has been prominent over the 9 years, but there is no evidence of a recent increase in serotype 19A IPD. CONCLUSIONS: Vaccinating Indigenous children with 7vPCV has protected Indigenous adults in north Queensland through an indirect "herd immunity" effect. However, this benefit has been offset by a recent increase in non-7vPCV IPD in Indigenous adults. Newer pneumococcal conjugate vaccines could prevent, both directly and indirectly, a considerable amount of the persisting IPD in Indigenous people in the region.     

The pneumococcal vaccine. Immunization at a crossroad.

A new polyvalent pneumococcal vaccine (Pneumovax) was released in February 1978. In an effort to chronicle the dissemination of the vaccine to high-risk patients, we prospectively followed up a single clinic population and conducted a telephone survey of three neighborhood health centers, two private practices, and a university hematology clinic. Three months after notification of the vaccine arrival, physicians in the prospectively chronicled clinic had immunized six of 12 patients with sickle cell disease, five of 80 patients with chronic obstructive pulmonary disease, three of 225 patients with diabetes, and three of 45 patients older than 80 years. Immunization policy in the other clinics surveyed varied greatly. As an attempt to curb low-prevalence, high-severity illness in a small target population, the pneumococcal vaccine presents a new set of problems in the systematic implementation of an immunization.     

Pneumococcal bacteremia in Hawaii: initial findings of a pneumococcal disease prevention project

The Hawaii Department of Health (DOH) recently established a pneumococcal disease initiative to determine the scope of serious pneumococcal disease in residents of Hawaii and to investigate methods of increasing vaccine utilization in the State. The initial phase of the project involved a review of pneumococcal bacteremia at all 38 microbiology laboratories in Hawaii during 1986 and 1987. Two hundred twenty-two residents with bacteremia were identified. Eighty-six percent of adults had pneumonia as the primary source of bacteremia. In children greater than 5 years old, pneumonia was present in 24%, otitis media in 35%, and meningitis in 11%. Bacteremia with no apparent focus of infection was found in 30% of children. The overall annual incidence of pneumococcal bacteremia was 9/10(5) population. Rates were highest in children greater than 2 years old (103/10(5] and persons greater than or equal to 65 years old (22/10(5]. These are similar to rates reported from other populations in the United States during the 1970s and early 1980s, but are less than those detected in 2 more recent population-based studies. The overall case-fatality rate in our study was relatively low (16%); however, 35% of persons greater than or equal to 65 years old died. A record of previous pneumococcal vaccination was found in the medical records of only 2 (1%) patients. Our study confirms that pneumococcal bacteremia causes significant morbidity and mortality among elderly residents of Hawaii and suggests that vaccine coverage is very low among this high-risk population. Phase 2 of the initiative included surveys of Hawaii physicians and the public to ascertain attitudes toward pneumococcal immunization.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevention of pneumococcal infection in children with homozygous sickle cell disease

The efficacy of prophylactic penicillin and of 14 valent pneumococcal vaccine in preventing pneumococcal infection in homozygous sickle cell (SS) disease was investigated in 242 children aged 6 months to 3 years at entry. In the first five years of the trial there were 11 pneumococcal infections in the pneumococcal vaccine treated group, 10 by serotypes present in the vaccine. Type 23 accounted for five of these, and there was evidence of higher infection rates in those given the vaccine before age 1. No pneumococcal isolations occurred in the penicillin group while receiving penicillin, although four isolations occurred within one year of stopping penicillin. Probably the most effective prophylaxis against pneumococcal infection requires penicillin beyond the age of 3. The age at which pneumococcal vaccine should be given must await further data on antibody response and clinical efficacy in these patients.     

慢性阻塞性肺疾病患者接种肺炎球菌疫苗疗效的Meta分析

目的 系统评价慢性阻塞性肺疾病患者接种肺炎球菌疫苗的疗效情况,为防治慢性阻塞性肺疾病提供循证依据。 方法 检索Cochrane图书馆、Pubmed、维普数据库(VIP)、中国期刊全文数据库(CNKI)与万方数据库中关于慢性阻塞性肺疾病患者接种肺炎球菌疫苗疗效的随机对照研究文献。由2名研究人员对纳入的研究文献进行资料提取,提取内容包括研究地点、随访年限、干预措施、结局指标(急性发作次数、住院天数、发作间隔时间),采用Cochrane协作网偏倚风险评价标准对纳入的文献进行质量评价。运用RevMan 5.3软件对资料进行Meta分析,采用标准化均数差为合并统计量,采用95%可信区间进行合并统计量的假设检验,采用χ2检验进行异质性检验。 结果 共纳入9篇研究文献,均为中文文献。根据3项结局指标异质性检验结果(P<0.050),均采用随机效应模型进行Meta分析,结果显示,接种肺炎球菌疫苗的慢性阻塞性肺疾病患者的急性发作次数[SMD=-5.070,95%CI(-8.900,-1.230),P=0.010]和住院天数[SMD=-2.560,95%CI(-3.620,-1.500),P<0.001]较未接种肺炎球菌疫苗患者低,差异具有统计学意义。其发作间隔时间较未接种肺炎球菌疫苗患者长[SMD=1.040,95%CI(0.850,1.230),P<0.001],差异具有统计学意义。 结论 接种肺炎球菌疫苗可有效降低慢性阻塞性肺疾病患者急性发作次数、平均住院天数,延长发作间隔时间,建议慢性阻塞性肺疾病患者接种肺炎球菌疫苗。      

Efficacy of pneumococcal vaccine in severe chronic obstructive pulmonary disease.

Although pneumococcal vaccine has been recommended for patients with chronic obstructive pulmonary disease (COPD), its efficacy in this population has not been shown. A double-blind randomized controlled trial of 14-valent pneumococcal vaccine was carried out in 189 men and women aged 40 to 89 years with a clinical diagnosis of COPD and a forced expiratory volume in 1 second of less than 1.5 L. Of the 189, 92 received the vaccine and 97 received saline placebo. In a randomly chosen subsample of those who received the vaccine the mean titres of specific IgG antibody to selected pneumococcal polysaccharide serotypes increased two- to threefold by 4 weeks after vaccination. Over a 2-year period the rates of death, hospital admissions and emergency visits and the mean length of hospital stay were not significantly different in the two groups. Although a protective effect of 14-valent pneumococcal vaccine could not be shown, the small size of the sample and the relatively low follow-up rates preclude firm conclusions about efficacy from these data alone. The elevated antibody levels before vaccination in some of the patients, suggesting prior infection with Diplococcus pneumoniae, may partly explain the findings.     

Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine

Context  A conjugate vaccine targeting 7 pneumococcal serotypes was licensed for young children in 2000. In contrast to the 23-valent polysaccharide vaccine used in adults, the 7-valent conjugate vaccine affects pneumococcal carriage and transmission. Early after its introduction, incidence of invasive pneumococcal disease declined among older adults, a group at high risk for pneumococcal disease. Objective  To determine among adults aged 50 years or older whether incidence of invasive pneumococcal disease, disease characteristics, or the spectrum of patients acquiring these illnesses have changed over the 4 years since pneumococcal conjugate vaccine licensure. Design, Setting, and Population  Population-based surveillance of invasive pneumococcal disease in 8 US geographic areas (total population, 18 813 000), 1998-2003. Main Outcome Measures  Incidence of invasive pneumococcal disease by pneumococcal serotype and other characteristics; frequency among case patients of comorbid conditions and other factors influencing mortality. Results  Incidence of invasive pneumococcal disease among adults aged 50 years or older declined 28% (95% confidence interval [CI], –31% to –24%), from 40.8 cases/100 000 in 1998-1999 to 29.4 in 2002-2003. Among those aged 65 years or older, the 2002-2003 rate (41.7 cases/100 000) was lower than the Healthy People 2010 goal (42 cases/100 000). Among adults aged 50 years or older, incidence of disease caused by the 7 conjugate vaccine serotypes declined 55% (95% CI, –58% to –51%) from 22.4 to 10.2 cases/100 000. In contrast, disease caused by any of the 16 serotypes only in polysaccharide vaccine did not change, and disease caused by serotypes not in either vaccine increased somewhat, from 6.0 to 6.8 cases/100 000 (13%; 95% CI, 1% to 27%). Between 1998-1999 and 2002-2003, the proportion of case-patients with human immunodeficiency virus infection increased from 1.7% (47/2737) to 5.6% (124/2231) (P<.001), and those with any comorbid condition that is an indication for pneumococcal polysaccharide vaccination increased from 62.3% (1842/2955) to 72.0% (1721/2390) (P<.001). Conclusions  Our findings indicate that use of conjugate vaccine in children has substantially benefited older adults. However, persons with certain comorbid conditions may benefit less than healthier persons from the indirect effects of the new vaccine.      

Risk of pneumococcal infections in renal transplant patients.

Because of the recent licensing of pneumococcal vaccine, the risk of pneumococcal infections on a renal transplant service was determined. The overall risk of infection was 7% (14 of 197 patients) over a six-year period, or 1% per year. In patients with functioning allografts, this represented a risk of 28 infections per 1,000 patient-years of follow-up. Clinically, the major presentations of pneumococcal infection were pneumonia in the patient who was rejecting his kidney and pneumococcemia of sudden onset that was often fatal. Five of the pneumococci isolated from bacteremic patients were typed; three of the isolates were types that are in the vaccine. The frequency and seriousness of pneumococcal infections in renal transplant patients suggest that pneumococcal vaccine should be given to these patients, probably before transplantation.     

肺炎链球菌临床感染疾病谱

肺炎链球菌是威胁人类健康的重要病原菌。全年龄段人群都可能感染该菌,尤其是5岁以下儿童和65岁以上老年人,以及存在基础疾病者。临床感染类型包括中耳炎等非侵袭性感染和菌血症等侵袭性肺炎链球菌感染(IPD)。除了常见的菌血症性肺炎、脓胸和化脓性脑膜炎以外,肺炎链球菌还可以引起很多其他类型IPD感染,曾有学者总结肺炎链球菌引起的少见侵袭性感染的病例报告,结果发现2 064个病例,分别属于95种临床类型。近年来文献又报道了一些新的表现类型或以前未曾报告的基础疾病。肺炎链球菌可侵犯全身各个系统的组织器官,临床感染类型多样,且不同的感染类型可能同时或先后发生。文献报道的多数少见IPD类型都未查及国内病例报告,提示国内临床实践中对病原学检测重视不足,或对肺炎链球菌临床感染类型可能囿于已经明确的诊断,忽视了同时存在的其他感染,也可能对肺炎链球菌能否引起相应感染还缺乏认识。本文就文献报道的肺炎链球菌临床感染类型进行了全面总结,尤其是IPD病例报告,重点介绍了近年来国外报告较多的眼内炎、泪囊脓肿、心包炎、溶血尿毒综合征、急性坏死性筋膜炎、奥地利综合征与噬血细胞综合征等疾病。以期临床能够重视肺炎链球菌感染,尤其是IPD的诊断和治疗,开展相关研究,将来为我国肺炎链球菌感染的防治提供系统全面的证据。