BACKGROUND Pneumococcal conjugate vaccine (PCV) implementation has led to a sharp decrease in invasive pneumococcal disease (IPD) due to the reduction in PCV serotypes. We aimed to describe the changes in the spectrum of IPD and its clinical presentations after 13-valent PCV (PCV13) implementation. METHODS This prospective, hospital-based, active surveillance involved 130 pediatric wards and microbiology departments throughout France. We analyzed IPD cases from 2011 to 2016 for which a pneumococcal isolate was sent to the National Reference Center for Pneumococci for serotyping. Clinical data recorded were medical history, vaccination status, type of IPD, clinical features, and short-term evolution. RESULTS Among 1082 IPD cases, we observed a 35.3% decrease (95% confidence interval, 29.2%-41.8%]) and the median age shifted from 38.3 months to 23.7 months (P = .007). The change in IPD type was mostly due to a reduction in bacteremic pneumonia frequency (from 42.1% to 19.1%; P < .001). Among the emerging non-PCV13 types (NVTs), those known to have the highest disease potential (8, 12F, 24F, and 33F) were isolated more frequently in patients without underlying conditions and were able to induce all IPD clinical presentations including bacteremic pneumonia. Conversely, serotypes with lower disease potential (15A, 15BC, 16F, and 23B) were rarely isolated from bacteremic pneumonia cases and were particularly involved in IPD in patients with underlying conditions (35.8%). CONCLUSIONS Besides the decrease in IPD after 7-valent, then 13-valent PCV implementation, the spectrum of the remaining IPD cases showed significant changes, with substantial discrepancies across NVTs implicated in terms of clinical features and underlying conditions.

中文翻译：

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实施13价肺炎球菌接合疫苗后，侵袭性肺炎球菌疾病谱的变化。

背景技术由于降低了PCV血清型，肺炎球菌结合疫苗（PCV）的实施已导致侵袭性肺炎球菌疾病（IPD）的急剧减少。我们旨在描述13价PCV（PCV13）实施后IPD频谱的变化及其临床表现。方法该前瞻性，以医院为基础的主动监视涉及整个法国的130个儿科病房和微生物科。我们分析了2011年至2016年的IPD病例，将其中的肺炎球菌分离株送往国家肺炎球菌参考中心进行血清分型。记录的临床数据包括病史，疫苗接种状况，IPD类型，临床特征和短期演变。结果在1082例IPD病例中，我们观察到年龄下降了35.3％（95％置信区间，29.2％-41.8％），中位年龄从38.3个月转移到23岁。7个月（P = .007）。IPD类型的改变主要是由于细菌性肺炎发生率降低（从42.1％降至19.1％； P <.001）。在新兴的非PCV13型（NVT）中，已知无疾病的患者中更容易分离出已知具有最高疾病潜能的类型（8、12F，24F和33F），并且能够诱发包括细菌性肺炎在内的所有IPD临床表现。相反，具有较低疾病潜力的血清型（15A，15BC，16F和23B）很少从细菌性肺炎病例中分离出来，特别是在具有潜在疾病的患者中参与IPD（35.8％）。结论除了实施7价，然后是13价的PCV实施方案后IPD减少之外，其余IPD病例的范围也发生了显着变化，