INTRODUCTION Pneumococcal outbreaks are rare but they still occur, particularly in closed settings usually involving vulnerable groups. We undertook a systematic review to identify strategies for controlling pneumococcal outbreaks since the licensure of higher-valent pneumococcal conjugate vaccines (PCVs). METHODS A systematic literature search was performed for pneumococcal outbreaks published since 2010. A cluster was defined as two or more cases of severe pneumococcal disease in a closed setting within 14 days. RESULTS Eleven reports were identified, including seven caused by serotypes in both the 13-valent PCV (PCV13) and the 23-valent polysaccharide vaccine (PPV23); two were due to a PCV13-only serotype (6A) and one each by a PCV13-related serotype (6C) and a non-vaccine serotype (15A). Eight reported infection control measures, including reinforcing hand washing, respiratory hygiene and patient cohorting. PPV23 was used in five outbreaks, while PCV13 and both vaccines were used in one outbreak each. Different antibiotics were used for chemoprophylaxis in eight outbreaks. CONCLUSIONS Most pneumococcal outbreaks are currently caused by vaccine-preventable serotypes, and PPV23 is the preferred vaccine in more than half the outbreaks. Early implementation of infection control measures is important, and antibiotic chemoprophylaxis should be considered for high-risk individuals.

中文翻译：

---

结合疫苗时代在封闭环境中爆发的严重肺炎球菌疾病暴发，2010-2018年：一项系统综述，旨在为英国的国家指南提供依据。

引言肺炎球菌暴发很少见，但仍会发生，特别是在通常涉及弱势群体的封闭环境中。由于获得了更高价的肺炎球菌结合疫苗（PCV）的许可，我们进行了系统的审查，以确定控制肺炎球菌暴发的策略。方法对自2010年以来发表的肺炎球菌暴发进行了系统的文献检索。将一个集群定义为在14天之内于封闭环境中发生的两例或更多例严重肺炎球菌疾病。结果确定了11份报告，其中7份是由13价PCV（PCV13）和23价多糖疫苗（PPV23）的血清型引起的。两种是由于仅PCV13血清型（6A），一种是由于PCV13相关血清型（6C）和非疫苗血清型（15A）。报告了八项感染控制措施，包括加强洗手，呼吸卫生和患者分组。PPV23用于五次暴发，而PCV13和两种疫苗均用于一次暴发。在八次暴发中，使用了不同的抗生素进行化学预防。结论当前大多数肺炎球菌暴发是由疫苗可预防的血清型引起的，PPV23是超过一半暴发中的首选疫苗。尽早实施感染控制措施很重要，对于高危人群应考虑抗生素的化学预防。结论当前大多数肺炎球菌暴发是由疫苗可预防的血清型引起的，PPV23是超过一半暴发中的首选疫苗。尽早实施感染控制措施很重要，对于高危人群应考虑抗生素的化学预防。结论当前大多数肺炎球菌暴发是由疫苗可预防的血清型引起的，PPV23是超过一半暴发中的首选疫苗。尽早实施感染控制措施很重要，对于高危人群应考虑抗生素的化学预防。