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The constant increase in the level of resistance of Streptococcus pneumoniae to antimicrobial drugs significantly affects the algorithms for the pharmacotherapy of pneumococcal infection, reduces the effectiveness of the therapy and increases the healthcare costs. In this regard, specific vaccine prevention of pneumococcal diseases is a socially significant and economically promising and profitable area.The aim of the study is to analyze the current status of antimicrobial resistance of S. pneumoniae in healthy carriers and patients with non-invasive and invasive pneumococcal infections, as well as specific vaccine prevention of pneumococcal infection.Conclusion. An increase in the number of pneumococcal strains resistant to macrolides and tetracycline has been noted, as well as a trend toward an increase in resistance to beta-lactam antibiotics. Given the spread of resistant strains of S. pneumoniae, a continuous epidemiological surveillance of pneumococcal infection with an assessment of the dynamics of pneumococcal serotype resistance and the effectiveness of vaccination is needed on a global scale.
The constant increase in the level of resistance of Streptococcus pneumoniae to antimicrobial drugs significantly affects the algorithms for the pharmacotherapy of pneumococcal infection, reduces the effectiveness of the therapy and increases the healthcare costs. In this regard, specific vaccine prevention of pneumococcal diseases is a socially significant and economically promising and profitable area.The aim of the study is to analyze the current status of antimicrobial resistance of S. pneumoniae in healthy carriers and patients with non-invasive and invasive pneumococcal infections, as well as specific vaccine prevention of pneumococcal infection.Conclusion. An increase in the number of pneumococcal strains resistant to macrolides and tetracycline has been noted, as well as a trend toward an increase in resistance to beta-lactam antibiotics. Given the spread of resistant strains of S. pneumoniae, a continuous epidemiological surveillance of pneumococcal infection with an assessment of the dynamics of pneumococcal serotype resistance and the effectiveness of vaccination is needed on a global scale.
The aim of the article is the evaluation of the economic damage (ED) because of the absence of pneumococcal vaccination as a leading risk factor for the development of community-acquired pneumonia (CAP) and acute exacerbations of а chronic obstructive pulmonary disease (COPD).Materials and methods. The method of attributive statistics was used for the first time to assess the ED of the vaccination absence as an independent risk factor contributing to the development of CAP and COPD exacerbations in the Astrakhan region for the period of 2015–2019. To do this, at the beginning of the study based on the literature data, a relative risk of COPD complications associated with the absence of pneumococcal vaccination was determined. Using it as a risk factor, prevalence rates (a proportion of non-vaccinated patients with COPD), the population attributable risk (PAR) was calculated. Further, the annual economic damage (ED) from the development of CAP and COPD exacerbations was determined. To assess the cost-effectiveness of the COPD complications prevention, vaccination costs of newly registered patients were calculated and the ratio of these costs to the average annual ED was determined.Results. A decrease in the non-vaccinated patients’ proportion corresponds to the decrease in the total ED from COPD complications: from 13.16 million rubles to 6.06 million rubles during the observation period. The calculations showed that due to the increase in the vaccinated patients’ proportion over a five-year observation period, the ED from the CAP development decreased by 2.1 times, from exacerbations of COPD – by 2.3 times. The vaccination costs of newly diagnosed COPD cases amounted to 0.63 million rubles. Thus, to prevent the annual ED of 3.24 million rubles, the sum for the state to spend, should be 5.2 times as small.Conclusion. A study on the evaluation of the ED due to the risk factor (RF), the pneumococcal vaccination absence, showed that its elimination reduces the risk of acute COPD exacerbations and the development of CAP, as well the ED, as associated with them. Reducing the economic costs of the health care system with significantly lower vaccination costs, makes this preventive measure economically viable.
Relevance. Studying the spread of individual S. pneumoniae serotypes is of special epidemiologic and clinical importance. Sverdlovsk Region with the 20% proportion of community-acquired pneumonia and its proportion among the causes of mortality of up to 70% is of special concern.Aims. Studying the features of the S. pneumoniae serotype landscape in individual socially significant population groups in Sverdlovsk Region in 2020 and 2021.Materials and methods. The work presents the results of testing nasopharyngeal smears collected in two observation groups, namely, that of 159 unvaccinated children aged 0 to 5 with acute respiratory infections (ARI), and that of 392 apparently healthy adults aged 19 to 27. We performed molecular genetic typing for identification of 20 leading S. рneumoniae serotypes/serogroups (1, 2, 3, 4, 5, 14, 16F, 19A, 19F, 23A, 23F, 6ABCD, 7AF, 9AV, 9LN, 11AD, 15AF, 18ABCF, 22AF, 12FAB/44/46, 33AF/37) using multiplex polymerase chain reaction (PCR).Results and discussion. In the individuals of the studied groups of observation, in 27.0% and 28.1% of the cases the study detected the S. pneumoniae in the biological material with circulation of 12 «vaccine» (19F – 2,6%, 6ABCD – 2,6%, 4 – 2,0%, 23F – 2,0%, 9AV – 1,3%, 9LN – 0,6%, 11AD – 1,3%, 18ABCF – 2,0%) and «nonvaccine» (15AF – 0.7%, 16F – 0.6%) serotypes. Nontypable strains with the highest proportion (77.3%) among the immunized adult population were predominant in the structure; in the unvaccinated children, this rate was 53.5%. Among the typable strains in children, 70.0% belonged to the vaccine ones, and most frequently the study identified 19F and 23F serotypes, while serotypes 3 and 12F/A/B/44/46 dominated among the adults.Conclusion. The study of unimmunized pediatric and immunized adult populations of Sverdlovsk Region confirmed a trend toward an increase in the circulation of nontypable S. pneumoniae strains in the Russian Federation, which sets the agenda to improve the monitoring system and optimize molecular genetic techniques for identification of the pathogens and upgrade the present specific and nonspecific preventive remedies, including the current antimicrobial ones and locally-produced vaccine.
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