Pneumococcal Vaccines – How Many Serotypes are Enough
复旦大学上海医学院内科学精品课程
呼吸系统试题A1 型题(1-110)A1 型题(1-110)1.肺泡的最主要功能是（记忆,易）A.湿化空气B.净化空气C.气体传导通道D.气体交换场所E.滤清空气2.误吸入呼吸道的异物容易进入右侧支气管的主要原因(应用,易)A.右主支气管比左主支气管长B.右主支气管比左主支气管短C.右主支气管与气管的夹角比左主支气管小D.右主支气管与气管的夹角比左主支气管大且管径略粗E.右主支气管起始部比左主支气管高答案:D3.Where are the lung abscess more commonly noted ?(记忆，中)A.Middle lobe of the right lungB.Lingular segment of the left lungC.Anterior segment of the left lung upper lobeD.Anterior segment of the right lung upper lobeE.Posterior segment of the upper l obe and basilar segment of the lower lobe4.合格的痰液培养标本筛选要求是（应用，易）A.痰液涂片每低倍镜视野上皮细胞>10 个，白细胞>25 个B.痰液涂片每低倍镜视野上皮细胞>15 个，白细胞<25 个C.痰液涂片每低倍镜视野上皮细胞<10 个，白细胞>25 个D.痰液涂片每低倍镜视野上皮细胞<10 个，白细胞<25 个E.痰液涂片每低倍镜视野上皮细胞<25 个，白细胞>10 个5.急性上呼吸道感染由病毒引起的约占：（应用，中）A.10-20%B.30-40%C.50-60%D.70-80%E.90-100%6.急性病毒性咽炎伴有明显发热咽痛提示:（记忆，中）A.肠病毒感染B.流感病毒感染C. 腺病毒感染D.呼吸道合胞病毒感染E. 链球菌感染7.Which of the following symptoms are associated with acute tracheobronchitis? （理解，易）A.chest painB.cyanosisC.sneezing2D.nose running waterE.coughing and expectoration8.病毒感染时外周血象表现为：（记忆，易）A.白细胞计数升高B.中性粒细胞比例升高C.核左移D.白细胞计数正常或降低、淋巴细胞比例增高E.淋巴细胞比例降低9.下面哪项检查结果不属于慢性阻塞性肺病的特征：（记忆，中）A.X 线检查：两肺纹理粗乱及可见网状，斑片状，条索状阴影B.呼吸功能检查：MEFV曲线在75%与50%肺活量时明显降低C.呼吸功能检查：第一秒用力呼气量占用力肺活量的比值〈70%D.X 线检查：肺纹理呈卷发状E.最大通气量低于预计值的80%10.关于COPD 氧疗以下哪项不正确？(记忆，中)A.给予氧疗，使氧分压>60mmHgB.COPD 氧疗应低流量C.缓解期COPD患者PaO2<55mmHg 可长期养疗D.COPD 患者氧疗应当高流量吸入E.长期氧疗可改善COPD伴慢性呼吸衰竭患者的生存时间11.Which of the following is not associated with the characteristic of COPD?（记忆，难）A.FEV 1/FVC<60%B.RV/TLC>40%C.FEV1/FVC<50%D. RV/TLC<20%E.MVV<80% predicted value12.下面哪种疾病是慢性肺源性心脏病的最常见原发病(记忆，易)A.支气管哮喘B.胸廓畸形C.肺结核D.慢性支气管炎并发阻塞性肺气肿E.支气管扩张*13.慢性肺源性心脏病急性加重期患者应慎用（理解，难）A.镇静剂B.祛痰剂C.解痉平喘药D.呼吸兴奋剂E.抗感染药物14.慢性肺源性心脏病右心衰竭时，首选的治疗措施为（应用，中）A.用利尿剂降低心脏前负荷B.用洋地黄药物增加心脏泵功能C.用血管扩张剂，降低右心前后负荷D.氧疗，控制呼吸道感染，改善呼吸功能，纠正缺氧及二氧化碳潴留E.气管插管机械通气15.下列哪项不是肺栓塞溶栓治疗的禁忌症？（记忆，难）A.一周内发生过脑溢血B.陈旧性十二指肠球部溃疡3C.活动性胃溃疡D.10 天内有外科手术史E.亚急性细菌性心内膜炎16.下列关于肺栓塞的病理生理学变化的描述哪一种说法不正确？（记忆，易）A.肺栓塞引起生理死腔增大B.通气/血流比值失调C.肺血管网减少导致肺毛细血管阻力增加引起肺动脉高压D.动脉血二氧化碳分压增加E.肺栓塞可导致急性右心衰竭17.下列关于肺栓塞的特点，那种描述是不正确的？（记忆，易）A.绝大多数肺栓塞患者存在该病的易发因素B.最常见的血栓来自下肢及盆腔静脉C.肺栓塞双侧多于单侧D.好发于左肺上叶E.慢性肺栓塞主要是反复发生的较小范围的肺栓塞*18.治疗外源性过敏性哮喘用抗原脱敏疗法，其免疫学基础是？（理解，难）A.增加IgAB.减少IgEC.增加IgGD.增加IgME.抑制骨髓嗜酸粒细胞生成*19.下列关于支气管哮喘的临床特征的描述哪一项最恰当？（理解，难）A.局限性吸气性干啰音B.反复发作的弥漫性呼气性干啰音C.反复发作的吸气性干啰音D.弥漫性吸气性干啰音E.反复发作的局限性呼气性干啰音20.治疗慢性反复发作的支气管哮喘，下列哪项措施不常规使用？(理解，易)A.避免接触过敏原B.脱敏治疗C.糖皮质激素气雾剂吸入D.注射长效糖皮质激素E.色甘酸二钠吸入21．支气管哮喘与变态反应性肺炎的不同点主要为？（理解，易）A.血嗜酸粒细胞增高B.有无过敏史C.咳嗽气喘D.肺部哮鸣音E.胸部平片显示肺部炎性阴影22.呼吸衰竭分类的依据，下列哪项不正确？（记忆，易）A.根据病理生理B.根据原发病急性或慢性C.根据原发病部位D.根据有无二氧化碳潴留E.根据有无低痒血症23.诊断呼吸衰竭，下列哪项最有意义？（理解，中）A.发绀4B.低血压、心动过速C.PaO 2 50mmHg ，PaCO2 75mmHgD.瞳孔缩小E.烦躁不安*24.关于慢性呼吸衰竭的叙述，下列哪项正确？（理解，中）A.缺氧和二氧化碳潴留同时存在B.肯定有精神神经症状C.肝肾功能损害是不可逆的D.平时无心肺疾患E.有代偿期和失代偿期之分25.急性呼吸衰竭与慢性呼吸衰竭的鉴别，下列哪项是正确的？（记忆，易）A.有无呼吸困难B.有无紫绀C.有无肺水肿D.起病缓急E.有无缺氧及二氧化碳潴留26.支气管扩张大咯血的原因是：（记忆，易）A.支气管壁破坏B.病灶部位毛细血管通透性增高C.动脉终末支扩张形成动脉瘤D.慢性溃疡侵蚀肺小血管E.感染所致粘膜充血27.左下叶和舌叶支气管扩张往往同时存在的原因是：（记忆，中）A.两者支气管开口相邻，下叶感染累及舌叶B.左下叶支气管引流差易感染C.舌叶支气管受心脏压迫影响引流D.支气管扩张可发生在多个肺叶E.左舌叶支气管细长不易引流28.引起支气管扩张的主要原因是：（记忆，易）A.先天性发育缺陷B.支气管—肺脏的感染和支气管阻塞C.支气管外部纤维的牵拉D.遗传因素E.过敏体质29.下列哪种情况不宜做支气管碘油造影？（理解，中）A.病变广泛累及双侧肺B.反复大咯血C.病变位于左下肺反复感染，不易控制D.术前为明确支气管扩张部位和范围E.病变局限于右下肺30.下列哪项不符合ARDS 的病理生理？（记忆，易）A.肺间质水肿B.肺泡萎陷C.肺内分流增加D.肺毛细血管通透性增加E.肺顺应性增加531.慢性肺心病呼吸衰竭患者缺氧和二氧化碳潴留可出现一系列血液循环系统异常，下列哪项不属于呼吸衰竭引起的？（记忆，易）A.血压增高B.心电图肢导联低电压C.心律紊乱D.肺动脉高压和右心衰竭E.心率增快32.关于慢性呼吸衰竭患者建立人工气道的目的，下列哪项是错误的？（理解，中）A.有利于气道分泌物的清除B.有利于保持气道的通畅C.有利于吸出误吸的胃内容物D.有利于防止下呼吸道感染E.便于与呼吸机连接33.The most common pathogen of phneumonia is（记忆，易）A.bacteriaB.virusC.fungiD.mycoplasmE.chlamydia34.The most common complication of pneumococcal pneumonia is （记忆，易）A.pleural effusionB.empyemaC.infectious shockD.myocarditisE.pneumothorax35.有助于军团菌肺炎早期诊断的检查是（记忆，中）A.尿抗原测定B.血常规C.X 线检查D.血培养E.血清抗体36.治疗军团菌肺炎的首选药为（记忆，易）A.红霉素B.庆大霉素C.妥布霉素D.克林霉素E.头孢噻肟钠37.支原体肺炎最突出症状为（记忆，易）A.咳嗽B.咽痛C.头痛D.肌痛E.发热38．最有利于支原体肺炎早期诊断的检查是（记忆，易）A.痰标本检测支原体抗原B.痰培养C.血培养6D.X 线检查E.血常规39.诊断肺脓肿最有价值的症状是（记忆，易）A.高热B.咳嗽C.气急D.胸痛E.咳大量脓臭痰40.急性肺脓肿停用抗生素的指征（理解，易）A.体温正常B.咳嗽消失C.肺部咳痰体征正常D.血象正常E.胸部X 线示病灶消失或仅有纤维条索影41.最易引起脓气胸的肺炎是（记忆，易）A.金黄色葡萄球菌肺炎B.支原体肺炎C.病毒性肺炎D.肺炎球菌肺炎E.肺炎杆菌肺炎42.男性，40 岁，醉酒后出现发热、咳脓痰1 周，胸片示右下肺背段浸润阴影。
史上最长的英语单词
史上最长的英语单词在英语中，“史上最长的英语单词”是一个令人兴奋的话题。
许多人都想知道什么是史上最长的英语单词，甚至还想知道这个单词的含义。
尽管没有人能确定究竟有多长的英语单词，但不可否认的是，史上最长的英语单词是“pneumonoultramicroscopicsilicovolcanoconiosis”。
这个45个音节的单词拥有最多的字母，达到179个。
其次位的是“floccinaucinihilipilification”，其拥有29个音节和171个字母，比第一个略短一点。
虽然它们看起来都极其复杂，但每个单词都有其历史渊源和意义。
因此，让我们从这两个单词开始，看一看它们到底是什么意思。
“Pneumonoultramicroscopicsilicovolcanoconiosis”是一种“危险的粉尘性肺病”。
这种疾病通常是在工作场所中接触火山灰等粉尘性物质后发病的。
病因的本质是，人们接触的烟尘会深入大气中，并进入人体后导致肺部疾病，最终破坏肺部的组织和功能。
“Floccinaucinihilipilification”的意思是“小看、藐视或认为无价值”。
这个单词有四个部分，分别表示“细毛、小颗粒、小物体”和“小看”。
它用来指人们小看他人或某件事物，认为它们没有任何价值、不值得注意。
史上最长的英语单词都是拉丁语，带有深远的历史意义。
令人惊讶的是，这些单词并不受到一般考试的关注，许多人也可能从来没有听说过它们。
然而，光凭它们的名字就可以给人以巨大的冲击力，让人们深思它们所涉及的知识和历史。
当然，史上最长的英语单词只是一种玩笑，但它们也证明了英语的复杂性，以及我们语言学者们为它添砖加瓦所做出的贡献。
在学习这两个单词以及它们涉及的英语单词时，我们有机会接触和感受英语的美好。
理解史上最长的英语单词不仅可以增加我们的语言水平，还有助于每个人对英语的热爱之情的深入。
36个字母单词
36个字母单词每个英文单词都是由字母组成的，而且有的单词的长度可以非常长。
在英语中，最长的单词之一是由36个字母组成的。
这样的单词不仅在拼写上具有挑战性，而且在日常使用中也相当罕见。
接下来，我们将探讨一些关于36个字母单词的有趣知识和例子。
首先，我们要提到的是世界上最长的单词——“pneumonoultramicroscopicsilicovolcanoconiosis”，共有36个字母。
这个单词是用来描述一种肺部疾病，它是由各种不同的矿物质尘埃引起的。
想象一下，这个单词的拼写是一项很大的挑战，即使是英语母语者也可能会被难住。
其次，36个字母单词的存在让我们对英语中字母的多样性有了更深的认识。
这些单词的长度是由它们所描述的事物或概念的复杂性决定的。
在科学、医学和技术领域，这些长单词通常用来描述复杂的过程、疾病和技术术语。
这样的单词在日常生活中很少见，但在考试、字谜游戏和挑战中却经常出现。
掌握这些单词的拼写和含义可以提高我们的语言技能和思维能力。
而且，对于喜欢挑战自己的人来说，尝试拼写和记忆这些长单词也是一种乐趣。
最后，我们要注意的是，拼写和使用这些长单词并不是学习英语的必要要求。
在日常交流中，我们更多地使用简洁、生动和容易理解的词汇。
然而，了解这些长单词的存在和意义可以帮助我们更好地理解和掌握英语语言的多样性和复杂性。
总的来说，36个字母单词是英语语言中的一种特殊现象，它们描述了复杂的概念和现象。
我们可以通过学习和掌握这些单词的拼写和含义来提高我们的语言技能，并欣赏英语语言的多样性。
但在日常生活中，我们更多地使用简洁、生动和通俗的词汇进行交流。
让我们在学习英语的过程中保持好奇心，享受语言的美妙之处。
疫苗知识问答
疫苗知识问答作者：赵晨辉来源：《英语世界》2020年第09期Vaccines are one of our most effective health interventions， but are often misunderstood. In this Q&A， we explain what they are， how they work and why they are important.What is a vaccine？We’re protected from infectious disease by our immune system， which destroys disease-causing germs—also known as pathogens—when they invade the body. If our immune system isn’t quick or strong enough to prevent pathogens taking hold， then we get ill.We use vaccines to stop this from happening. A vaccine provides a controlled exposure to a pathogen， training and strengthening the immune system so it can fight that disease quickly and effectively in future. By imitating an infection， the vaccine protects us against the real thing.Why are vaccines important？They protect us from dangerous diseases. In some regions or populations， dangerous diseases are constantly present （endemic）. Examples include hepatitis B， cholera and polio. So long as these diseases are around， we need vaccines to bolster1 our immune systems and protect us from harm.They protect children and the elderly. Our immune systems are strongest in adulthood，meaning that young children and the elderly are particularly susceptible2 to dangerous infections. By strengthening our immune systems early and late on in life， vaccines bypass this risk.They protect the vulnerable. If enough of a population is vaccinated，infections can’t spread from person to person， which means that everyone has a high level of protection—even those who don’t have immunity. This is known as herd protection （or herd immunity）. It’s important because not everyone can be directly protected with vaccines—some people are unresponsive to them or have allergies or health conditions that prevent them from taking them.They can help us control epidemics. In a world of denser cities， increased international travel， migration and ecological change， the ability of emerging infectious diseases （such as Ebola） to spread and cause devastation is increasing. Vaccines can be a key tool in managing this threat—but only if we have them ready for diseases when they appear.They can help limit drug resistance. Medicine relies on being able to treat infectious diseases with antimicrobial3 drugs， such as antibiotics， but overuse and misuse of these drugs is leading to infections becoming resistant to them. By preventing infections that would require drug treatments，vaccines reduce the opportunity for drug resistance to develop.They are our most effective health intervention. Vaccines prevent an estimated 2–3 million deaths worldwide every year. But， a further 1.5 million lives could be saved annually with better global vaccine coverage.How does a vaccine work？Our immune system fights disease by distinguishing between things that belong in our bodies and things that don’t， destroying the latter. Unwanted foreign substances are identified by markers on their surface called antigens.A vaccine works by exposing the immune system to the antigens from a pathogen， something such as a virus or bacterium that causes a certain disease. When your immune cells encounter these antigens， they mount a response. One cell type—B cells—start making antibodies， which bind to the foreign substance， disable it and mark it for destruction. Other immune cells， known as T cells， attack and destroy cells of the body that have been infected by the pathogen.At the same time， the body also produces long-lived types of white blood cell—called memory T cells and memory B cells—that remember the antigens that have just been encountered. If your immune system comes across the same antigens again， these memory cells allow you to mount a strong response against that specific pathogen very quickly， so you are much less likely to get ill.Who decides who should be vaccinated？Countries set their own vaccine policies， and so these vary around the world， with some countries choosing to make certain vaccines mandatory4.Slovenia， for example， requires that all children are vaccinated against nine key diseases before they start school. Exemption is allowed only for medical reasons，and parents that don’t comply are fined.On the other hand， a number of other European countries， as well as Australia and Canada，have no mandatory vaccinations. Here， parents or （if old enough） individuals themselves decide.However， the governments of such countries may offer incentives to make sure that vaccination levels remain high. In Australia， for example， parents receive certain child benefits from the government only if their child has had all of its routine vaccinations.Why don’t we have a vaccine for every infectious disease？For some diseases，it’s a question of difficulty.HIV， for instance， can insert itself into the genetic material of your cells and hide there undetected. Other viruses， like dengue， have multiple strains5， which makes it very difficult to create a vaccine that covers them all. With other pathogens， the problem is mutation： continual morphing means that the immune system essentially encounters a new threat every single time，making past exposure count for nothing. This is why the common cold is so problematic.They are our most effective health intervention. Vaccines prevent an estimated 2–3 million deaths worldwide every year. But， a further 1.5 million lives could be saved annually with better global vaccine coverage.How does a vaccine work？Our immune system fights disease by distinguishing between things that belong in our bodies and things that don’t， destroying the latter. Unwanted foreign substances are identified by markers on their surface called antigens.A vaccine works by exposing the immune system to the antigens from a pathogen， something such as a virus or bacterium that causes a certain disease. When your immune cells encounter these antigens， they mount a response. One cell type—B cells—start making antibodies， which bind to the foreign substance， disable it and mark it for destruction. Other immune cells， known as T cells， attack and destroy cells of the body that have been infected by the pathogen.At the same time， the body also produces long-lived types of white blood cell—called memory T cells and memory B cells—that remember the antigens that have just been encountered. If your immune system comes across the same antigens again， these memory cells allow you to mount a strong response against that specific pathogen very quickly， so you are much less likely to get ill.Who decides who should be vaccinated？Countries set their own vaccine policies， and so these vary around the world， with some countries choosing to make certain vaccines mandatory4.Slovenia， for example， requires that all children are vaccinated against nine key diseases before they start school. Exemption is allowed only for medical reasons，and parents that don’t comply are fined.On the other hand， a number of other European countries， as well as Australia and Canada，have no mandatory vaccinations. Here， parents or （if old enough） individuals themselves decide.However， the governments of such countries may offer incentives to make sure that vaccination levels remain high. In Australia， for example， parents receive certain child benefits from the government only if their child has had all of its routine vaccinations.Why don’t we have a vac cine for every infectious disease？For some diseases，it’s a question of difficulty.HIV， for instance， can insert itself into the genetic material of your cells and hide there undetected. Other viruses， like dengue， have multiple strains5， which makes it very difficult to create a vaccine that covers them all. With other pathogens， the problem is mutation： continual morphing means that the immune system essentially encounters a new threat every single time，making past exposure count for nothing. This is why the common cold is so problematic.They are our most effective health intervention. Vaccines prevent an estimated 2–3 million deaths worldwide every year. But， a further 1.5 million lives could be saved annually with better global vaccine coverage.How does a vaccine work？Our immune system fights disease by distinguishing between things that belong in our bodies and things that don’t， destroying the latter. Unwanted foreign substances are identified by markers on their surface called antigens.A vaccine works by exposing the immune system to the antigens from a pathogen， something such as a virus or bacterium that causes a certain disease. When your immune cells encounter these antigens， they mount a response. One cell type—B cells—start making antibodies， which bind to the foreign substance， disable it and mark it for destruction. Other immune cells， known as T cells， attack and destroy cells of the body that have been infected by the pathogen.At the same time， the body also produces long-lived types of white blood cell—called memory T cells and memory B cells—that remember the antigens that have just been encountered. If your immune system comes across the same antigens again， these memory cells allow you to mount a strong response against that specific pathogen very quickly， so you are much less likely to get ill.Who decides who should be vaccinated？Countries set their own vaccine policies， and so these vary around the world， with some countries choosing to make certain vaccines mandatory4.Slovenia， for example， requires that all children are vaccinated against nine key diseases before they start school. Exemption is allowed only for medical reasons， and parents that don’t comply are fined.On the other hand， a number of other European countries， as well as Australia and Canada，have no mandatory vaccinations. Here， parents or （if old enough） individuals themselves decide.However， the governments of such countries may offer incentives to make sure that vaccination levels remain high. In Australia， for example， parents receive certain child benefits from the government only if their child has had all of its routine vaccinations.Why don’t we ha ve a vaccine for every infectious disease？For some diseases，it’s a question of difficulty.HIV， for instance， can insert itself into the genetic material of your cells and hide there undetected. Other viruses， like dengue， have multiple strains5， which makes it very difficult to create a vaccine that covers them all. With other pathogens， the problem is mutation： continual morphing means that the immune system essentially encounters a new threat every single time，making past exposure count for nothing. This is why the common cold is so problematic.。
型肺炎症英文作文
型肺炎症英文作文英文：Pneumonia is an inflammation of the lungs that can be caused by various factors such as bacteria, viruses, or fungi. There are different types of pneumonia, but the most common one is community-acquired pneumonia (CAP), which is acquired outside of hospitals or healthcare facilities.One of the most common symptoms of pneumonia is coughing, which can produce phlegm or mucus. Other symptoms include fever, chills, chest pain, and shortness of breath. The severity of pneumonia can vary, and it can be life-threatening for certain groups of people, such as infants, elderly, and those with weakened immune systems.Prevention of pneumonia can be achieved through vaccination, good hygiene practices, and avoiding close contact with people who are sick. Treatment of pneumonia depends on the cause and severity of the illness, but itoften involves antibiotics, rest, and supportive care.As a medical assistant, I have seen many patients with pneumonia. One of the most memorable cases was an elderly woman who had developed pneumonia after a cold. She had a history of smoking and chronic obstructive pulmonarydisease (COPD), which made her more susceptible to respiratory infections. She was hospitalized and treatedwith antibiotics and oxygen therapy. With proper care, she was able to recover and was discharged from the hospital.中文：肺炎是肺部的一种炎症，可以由细菌、病毒或真菌等多种因素引起。
护理专业英语
Unit 1 Development of Nursing 护理学的发展一、单选题：Choose the best answer from A,B,C and D according to the text.1. Which one of the following statements is right? (A)A.Nursing before 19th century was developed slowlyB.Nursing before 19th century was developed rapidlyC.Nursing before 19th century was developed smoothlyD.Nursing before 19th century was developed with ease2. Which one of the following statements is right? (B）A。
Florence Nightingale was born in 1825B。
Florence Nightingale was born in a wealthy familyC。
Florence Nightingale was born in GermanyD。
Florence Nightingale was not well—educated3。
How did Nurses’ Day come into being? (A)A.It came from the Birthday of Florence NightingaleB.It came from the Death date of Florence NightingaleC.It came from the date of outbreak of Crimean WarD.It could not be verified4。
肺炎链球菌新型疫苗研发进展
•综述•肺炎链球菌新型疫苗研发进展邓谢淑婷1刘兴隆1周璇1袁竹1孙滋蔚1吴海燕2#(1.四川大学华西临床医学院#.四川大学华西基础医学与法医学院药理教研室，四川成都610041)R e s e a r c h d e v e l o p m e n t o f n e w v a c c i n e s f o r Streptococcus pneumoniaeD e n g xie S hu-tin g1J i u X i n g-lo n g1，Z h o u X u a n1，Y u a n Z h u1，Sun Z i-w e i1，W u H a i-yan2A(1. W est China College of Medicine , Sichuan University；2. Department of Pharmacology ,W est China School of Basic sciences&Forensic Medicine ,Sichuan University , Sichuan Chengdu 610041)摘要肺炎链球菌％S tre/>to c o cc M s, Spn)是近年来人们所重视的超级细菌之一■，于1881年首次由美国陆军医师乔治.斯特恩伯格和法国化学家路易斯.巴斯德尔从患者痰液中分离获得。
作为一种有荚膜的革兰阳性双球菌，肺炎链球菌是引起脓毒症、肺炎、脑膜炎、鼻窦炎的主要病原体。
现有针对S p n感染的肺炎球菌多糖疫苗（Pneumococcal polysaccharide vaccine,PPV)和肺炎链球菌结合疫苗（Pneumococcal conjugate vaccine，PCV),但具有生产成本高、血清覆盖率有限等局限性。
近年来疫苗的研发方向开始逐步转向改变疫苗的有效成分的方向，并因此出现了以蛋白质疫苗、全细胞疫苗、D N A疫苗为代表的新型肺炎球菌疫苗。
2021医学考研复试：呼吸内科[SC长难句翻译文]
SCI长难句呼吸内科第一章—社区获得性肺炎Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated.Although it can be caused by a wide variety of micro-organisms, the pneumococcus,atypicals,Staphylococcus aureus and certain Gram-negative rods are the usual pathogens encountered.Antimicrobial therapy should be started as soon as possible particularly in those requiring admission to hospita.社区获得性肺炎仍然具有很高的发病率和死亡率，且经常被误诊和不恰当地治疗。
虽然它可以由多种微生物引起，但涉及的常见病原体有肺炎球菌、非典型球菌、金黄色葡萄球菌和某些革兰氏阴性杆菌。
特别是（对于）那些需要住院的患者，抗菌治疗应尽快开始。
知识点总结：1pneum(o)-前缀，肺2pneumonia n.肺炎3pneumococcus n.肺炎球菌4atypical adj.非典型的5Staphylococcus aureus n.金黄色葡萄球菌6Gram-negative rods n.革兰氏阴性杆菌7pathogen n.病原体8antimicrobial adj.抗菌的Mandell munity-acquired pneumonia:An overview.Postgrad Med.2015 Aug;127(6):607-15.SCI长难句呼吸内科第二章—肺脓肿A lung abscess is an infectious pulmonary disease characterised by the presence of a pus-filled cavity within the lung parenchyma.The content of an abscess often drains into the airways spontaneously,leading to an air-fluid level visible on chest X-rays and CT scans. Primary lung abscesses occur in patients who are prone to aspiration or in otherwise healthy individuals;secondary lung abscesses typically develop in association with a stenosing lung neoplasm or a systemic disease that compromises immune defences,such as AIDS,or after organ transplantation.肺脓肿是一种感染性肺部疾病，其特征是肺实质内有充满脓的空洞。
卡氏肺孢子虫肺炎(Pneumocystis
卡氏肺孢子虫肺炎(Pneumocystis carnii Pneumonia, PCP)机会性感染（opportunistic infections，OIs）的定义：当人体的免疫功能下降时，原本已经寄生在人体中的一些非致病性微生物可以造成的疾病，或者是对致病微生物的易感性增加而发生感染。
机会性感染的病原体：细菌、霉菌、寄生虫、病毒常见的OIs我院AIDS并发症的部位分析艾滋病的肺部并发症概况◆卡氏肺孢子虫单细胞微生物，属于真菌类。
全球分布，生活在哺乳类动物和人的肺中。
正常成人有4％～8％带有肺孢子虫，但无临床症状。
◆卡氏肺孢子虫肺炎(PCP)AIDS病人中最重要的机会性感染之一。
约50％左右的AIDS病人会出现。
卡氏肺孢子虫的发现1909年Chagas和Carinii就首次从感染克氏、路氏锥虫的豚鼠肺组织和大鼠肺组织中发现肺孢子虫，数年后，Delano 夫妇进一步证实它是一种新的病原体，并为纪念学者Carinii而将其命名为卡氏肺孢子虫(Pneumocystis carinii)。
卡氏肺孢子虫肺炎的命名到了1952年，V anek和Jirovec报道了欧洲的孤儿院，因营养不良而造成的流行性间质性浆细胞性肺炎，其病原体为肺孢子虫。
并首次从人类肺炎患者尸解的肺组织中分离到该病原体，并将该病命名为卡氏肺孢子虫肺炎(Pneumocystis carinii pneumonia，PCP)。
P.C.特点“虫体”通常寄生在肺泡内，成簇黏附于肺泡上皮上。
主要有三种形态：胞囊、滋养体、胞囊前期。
增殖方式: 大滋养体可通过二分裂法或像酵母菌一样出芽增殖；亦可通过两个大滋养体细胞交配，进行有性生殖。
过去大部分学者倾向于将该病原体归为原虫，其主要依据：(1)有类似原生动物的简单生活史。
(2)组织培养可见其生活周期有包囊和滋养体这两种虫体形态。
(3)滋养体具有类似原虫伪足结构及其活动方式。
(4)广谱抗真菌药物两性霉素B治疗无效。
illness练习题
一、词汇理解1. What is the medical condition called when a person hasa fever, cough, and sore throat?2. The patient was diagnosed with a(n) ________ due to the persistent pain in their abdomen.3. She took antibiotics to treat her ________ infection.4. The doctor prescribed a ________ to relieve the symptoms of the illness.二、句子翻译1. The patient was admitted to the hospital with severe symptoms.2. The doctor advised the patient to rest and drink plenty of fluids.3. The illness is highly contagious and can be transmitted through respiratory droplets.4. The patient's immune system was weakened, making them more susceptible to infections.5. The illness has no known cure, but there are treatments available to manage the symptoms.三、阅读理解1. Read the following passage and answer the questions:What are the main symptoms of the illness?What treatment options are mentioned in the passage?2. Read the following passage and answer the questions:The passage explains the importance of hand hygiene in preventing the spread of infectious diseases.Why is hand hygiene crucial in preventing the spread of illnesses?四、完形填空1. The patient's ________ (1) was elevated, indicating an infection. The doctor ordered a ________ (2) to confirm the diagnosis.2. The ________ (3) of the illness is unknown, but it is believed to be caused a virus.3. The patient was ________ (4) with a ________ (5) to help manage the symptoms.五、选择题1. Which of the following is a symptom of the flu?a) A runny noseb) A coughc) Diarrhead) A headachea) Wearing a maskb) Washing hands frequentlyc) Avoiding crowded placesd) Taking antibioticsa) Rest and hydrationb) Overthecounter pain relieversc) Antibioticsd) Vitamin C六、简答题1. Describe the main symptoms of the flu.2. Explain the importance of hand hygiene in preventing the spread of infectious diseases.4. How can you distinguish between a viral and a bacterial infection?七、匹配题a. COVID19fever, cough, loss of taste or smellb. Influenzasore throat, body aches, fatiguec. Food poisoningdiarrhea, vomiting, stomach crampsd. Allergiessneezing, runny nose, itchy eyesa. Diabetesheart disease, kidney failure, nerve damageb. Asthmarespiratory infections, chronic cough, difficulty breathingc. Hypertensionheart attack, stroke, kidney diseased. Cancerfatigue, weight loss, pain八、填空题1. The prefix "hyper" is often used to describe a condition that is ________ (over) normal.2. A(n) ________ (vaccine) is a biological preparation that stimulates an immune response.3. The term "morbidity" refers to the state of being________ (sick).4. A ________ (pandemic) is an epidemic that affects a large number of people across multiple countries or continents.5. ________ (Preventive) measures are actions taken to reduce the risk of developing an illness.九、判断题1. All illnesses can be cured with medication.2. It is possible to have immunity to a disease without having been vaccinated.3. Handwashing is only necessary when you are sick.4. All antibiotics are effective against viral infections.5. A fever is always a sign of a serious illness.十、选择题1. Which of the following is a symptom of mononucleosis?a) Joint painb) Diarrheac) Severe headached) Loss of appetite2. Which disease is characterized the "five Fs"?a) Chickenpoxb) Measlesc) Mumpsd) Rubella3. What is the primary mode of transmission for HIV?a) Airborne dropletsb) Contaminated waterc) Direct contact with blood or bodily fluidsd) Insect bites十一、简答题2. Describe the process of vaccination and how it works.3. What are the signs and symptoms of appendicitis?4. How can you prevent the spread of hepatitis A?5. What are the potential longterm effects of diabetes?十二、名词解释1. What is meant the term "pathogen"?2. Define "immunity" in the context of disease prevention.3. Explain the concept of "herd immunity."4. What is the difference between "incubation period" and "incidence rate"?5. Describe the role of the "antigenantibody reaction" in the immune response.十三、选择题1. Which of the following is a symptom of dengue fever?a) High feverb) Severe headachec) Joint paind) All of the above2. Which disease is caused the mumps virus?a) Measlesb) Mumpsc) Chickenpoxd) Rubella3. What is the primary cause of meningitis?a) Influenzab) Streptococcus pneumoniaec) Herpes simplex virusd) Varicellazoster virus十四、填空题1. The ________ (CDC) is the leading national public health organization in the United States.2. ________ (HIV) is the virus that causes DS.3. ________ (Hepatitis B) is a viral infection that affects the liver.4. ________ (Epidemic) refers to an increase in the number of cases of a disease in a specific area.5. ________ (Infection) is the invasion and multiplication of pathogenic microorganisms in the body.十五、判断题1. It is possible to have a negative reaction to a vaccine.2. All vaccines are created using live viruses.3. A fever is a sign that the body is fighting off an infection.4. Antibiotics are effective against both bacterial and viral infections.5. Hand sanitizers can be used as a substitute for handwashing.十六、简答题1. What are the primary methods of disease prevention?2. Explain the difference between acute and chronic diseases.3. Describe the role of the immune system in protecting the body against pathogens.5. How can you prevent the transmission of hepatitis C?十七、选择题1. Which disease is often referred to as the "king of diseases"?a) HIV/DSb) Cancerc) Diabetesd) Heart disease2. Which disease is characterized periodic outbreaks?a) Poliob) Smallpoxc) Chickenpoxd) Mumpsa) Bacteriab) Virusesc) Parasitesd) All of the above十八、填空题1. ________ (Immunization) is the process of making someone immune to a disease.2. ________ (Vaccinology) is the study of vaccines and their effects on the immune system.3. ________ (Pandemic) refers to a global outbreak of a disease.4. ________ (Quarantine) is the isolation of a person or group to prevent the spread of an infectious disease.5. ________ (Epidemiology) is the study of how diseases occur and spread in populations.十九、名词解释1. What is the difference between a pathogen and a symbiont?2. Define "hereditary disease" and provide an example.3. Explain the concept of "immunogenicity."5. Describe the term "biosecurity" and its importance.二十、选择题1. Which of the following is a symptom of meningococcal meningitis?a) Stiff neckb) Confusionc) Severe headached) All of the above2. Which disease is caused the EpsteinBarr virus?a) Chickenpoxb) HIV/DSc) Mononucleosisd) Hepatitis B3. What is the primary mode of transmission for hepatitis E?a) Airborneb) Sexual contactc) Contaminated waterd) Direct contact with blood二十一、填空题1. ________ (Inoculation) is the process of introducing a weakened or killed form of a pathogen into the body to stimulate an immune response.2. ________ (Morbidity rate) is the number of new cases of a disease in a population over a specific period.3. ________ (Epidemiological triangle) is a model that illustrates the relationship between the host, the agent, and the environment in the spread of disease.4. ________ (Antiviral) drugs are used to treat viral infections.5. ________ (Pneumococcal) pneumonia is a serious bacterial infection that affects the lungs.二十二、判断题1. It is impossible to develop immunity to a diseaseafter being infected with it.2. Vaccines can provide lifelong immunity to diseases.3. All antibiotics are safe for longterm use.4. Hand hygiene is only necessary in healthcare settings.5. A vaccine can prevent the spread of a disease even if you have already been infected with it.二十三、简答题1. What are the different types of vaccines and how do they work?2. Describe the role of antibiotics in treating bacterial infections.3. What are the factors that contribute to the emergence of new infectious diseases?4. How can you prevent the transmission of respiratory infections?5. What are the signs and symptoms of sepsis?二十四、选择题1. Which disease is caused the West Nile virus?a) Malariab) Dengue feverc) West Nile virusd) Zika virus2. Which disease is characterized the "exanthem" (rash)?a) Measlesb) Rubellac) Chickenpoxd) Smallpox3. What is the primary mode of transmission for tuberculosis?a) Airborneb) Food and waterc) Sexual contactd) Direct contact with blood二十五、填空题1. ________ (Antibiotic resistance) is the ability of bacteria to resist the effects of antibiotics.2. ________ (Influenza) is a viral infection that affects the respiratory system.3. ________ (Vaccinepreventable diseases) are illnesses that can be prevented vaccination.4. ________ (Hygiene hypothesis) suggests that early childhood exposure to certain pathogens can enhance immune function.5. ________ (Global health) is the field of study that focuses on health issues that affect people worldwide.答案一、词汇理解1. flu2. abdominal3. bacterial4. medication5. pandemic二、句子翻译1. The patient was admitted to the hospital with severe symptoms.2. The doctor advised the patient to rest and drink plenty of fluids.3. The illness is highly contagious and can be transmitted through respiratory droplets.4. The patient's immune system was weakened, making them more susceptible to infections.5. The illness has no known cure, but there are treatments available to manage the symptoms.三、阅读理解1. The main symptoms of the illness are fever, cough, and sore throat.Treatment options mentioned include rest, hydration, and possibly antiviral medication.2. Hand hygiene is crucial in preventing the spread of infectious diseases because it removes pathogens from the hands before they can be transferred to others.Common practices include washing hands with soap and water for at least 20 seconds and using hand sanitizers when soap and water are not available.四、完形填空1. The patient's ________ (1) was elevated, indicating an infection. The doctor ordered a ________ (2) to confirm the diagnosis.1. white blood cell count2. blood test2. The ________ (3) of the illness is unknown, but it is believed to be caused a virus.3. origin3. The patient was ________ (4) with a ________ (5) to help manage the symptoms.4. prescribed5. medication五、选择题1. b) A cough2. b) Washing hands frequently3. c) Antibiotics六、简答题2. Vaccination stimulates an immune response introducinga harmless form of a pathogen into the body, which primes the immune system to recognize and fight the actual pathogen if encountered in the future.3. The signs and symptoms of appendicitis include abdominal pain, fever, loss of appetite, nausea, and vomiting.4. To prevent the spread of hepatitis A, practice good hygiene, such as handwashing, and avoid consuming contaminated food or water.5. The potential longterm effects of diabetes include cardiovascular disease, kidney damage, nerve damage, eye problems, and increased risk of infections.（此处省略后续题目的答案，格式同上。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
Pneumococcal Vaccines–How Many Serotypes are Enough? Aaradhana Singh1&A.K.Dutta2Received:14May2017/Accepted:31July2017/Published online:9September2017#Dr.K C Chaudhuri Foundation2017Abstract Streptococcus pneumoniae causes meningitis, pneumonia,septicemia,arthritis,sinusitis and otitis media specially in children and over65y age groups.It contributes significantly to under-five mortality and morbidity worldwide as well as in e of pneumococcal vaccine seems to be the most effective measure to decrease the disease burden and reduction of under-five mortality.Many countries have al-ready included Pneumococcal Conjugate Vaccines(PCV)in their National Immunization Programmes(NIP).Government of India has announced recently to include PCV13in NIP in a phased manner.Superiority of a vaccine over the other de-pends upon serotype coverage,vaccine efficacy,cost effec-tiveness and safety profile.These facts will be discussed for the vaccines available in India.Further research is warranted to know the disease burden and develop vaccines to have more serotype coverage.Keywords Invasive pneumococcal disease(IPD). Pneumococcal conjugate vaccine(PCV).National immunization programme(NIP)IntroductionPneumococcal infections include serious diseases such as pneumonia,meningitis,septicemia and osteoarthritis as well as milder diseases such as otitis media and sinusitis.The caus-ative agent,Streptococcus pneumoniae,colonizes the naso-pharynx and is transmitted by respiratory droplets. Streptococcus pneumoniae is among the most important etio-logical agents of bacterial pneumonia,meningitis and sepsis in children.Invasive pneumococcal disease(IPD)is associated with isolation of pneumococci from sterile body sites such as in meningitis and septic arthritis.Pneumonia is often caused by aspiration of pneumococci from the nasopharynx.When associated with bacteremia,pneumonia is classified as IPD. Children<2y of age are affected the most.S.pneumoniae is responsible for15–50%of all episodes of community ac-quired pneumonia,30–50%of all cases of acute otitis media and a significant proportion of bacterial meningitis and bac-teremia[1–3].Pneumonia is by far the most common cause of pneumococcal death worldwide[4].A recent United Nations Children’s Fund(UNICEF)publication estimated that 410,000children under age five years die of pneumonia each year in India,and a recent data shows that an estimated25%of all child deaths in India are due to pneumonia[5].Case fatality rates for IPD are as high as20%for septicemia and50%for meningitis in developing countries.Long term neurologic se-quelae are found in as high as58%of cases of meningitis survivors.Pneumococcal disease is a serious global problem with an estimated14.5million episodes of invasive pneumo-coccal disease(IPD)and approximately500,000deaths each year in children under five years of age,almost all from low-and middle-income countries as per the reports of Centers for Disease Control and Prevention(CDC)[6].Pneumococcal disease has such a high disease burden, mortality and morbidity that WHO in2007recommended to include Pneumococcal Conjugate Vaccines(PCV)in the National Immunization Program(NIP)of any country with under-five mortality rate(MR)of>50/1000live births or ab-solute child deaths of>50,000per year.With under-five MR*Aaradhana Singhdraaradhanasingh@1Department of Pediatrics,University College of Medical Sciences and Guru Tegh Bahadur Hospital,New Delhi,India2Department of Pediatrics,School of Medical Sciences and Research, Sharda University,Greater Noida,Uttar Pradesh,Indiaof72/1000live births and nearly2million under-five deaths per year,India merits to include PCV in NIP with high priority. The Union Health Ministry has approved the introduction of pneumococcal vaccines in Himachal Pradesh along with four other states under the Universal Immunization Programme (UIP).The pneumonia vaccines will be introduced in a planned manner from2017in Himachal Pradesh,Bihar, Uttar Pradesh,Rajasthan,Haryana and Madhya Pradesh. India is not able to develop any indigenous vaccine against pneumonia but GA VI has promised to offer present PCV13 vaccine at a cost of0.15–0.3USD/dose for inclusion in the national immunization schedule.Pneumococcal SerotypesS.pneumoniae is a Gram-positive encapsulated cocci. Currently,more than90immunologically distinct capsular serotypes have been described which possess distinct epide-miological properties[7].Some serotypes are associated only with nasopharyngeal(NP)carriage and rarely cause invasive disease.Less than20serotypes cause>90%of IPD worldwide [8].Table1shows the studies on prevalent pneumococcal strains in India and Asian countries.Pneumococcal VaccinesV arious pneumococcal vaccines have been developed which contain different serotypes as it is not possible to incorporate all serotypes in a single vaccine.Two broad categories of pneu-mococcal vaccines are:Pneumococcal Polysaccharide V accine (PPSV23)and Pneumococcal Conjugate V accine(PCV). 1.Pneumococcal Polysaccharide V accine(PPSV23)–23valentpolysaccharide vaccine is available since2009and contains 1,2,3,4,5,6B,7F,8,9N,9V,10A,11A,12F,14,15B,17F,18C,19-A,19F,20,22F,23F,and33F.PPSV23,being a polysaccharidevaccine is not used for routine immunization in children due to poor immunogenicity in children<2y of age.So,it is used for special conditions and in elderly.2.Pneumococcal Conjugate Vaccine–PCVs were devel-oped primarily to address the problem of low immunoge-nicity of the polysaccharide vaccine in children below the age of two years who are at high risk for pneumococcal disease.Conjugation of the pneumococcal polysaccharide of varying number of serotypes has been done with CRM197protein,protein D of non-capsulated Hib (Hemophilus influenzae type b vaccine),DT (Diphtheria,Tetanus vaccine)and TT(Tetanus toxoid vaccine)and finally Meningococcal Outer Member Protein(OMP).Three pneumococcal conjugate vaccines are:PCV7(not available after introduction of PCV13), PCV10,and PCV13.PCV7contains polysaccharide antigen of serotypes4,6B,9V,14,18C,19F and23F linked to CRM197.Inadequate coverage of serotypes by PCV7has led to the formulation of PCV10that provides additional protection against1,5and7F,carrier being non-typeable Haemophilus influenza protein D.PCV13 protects against1,5,7F,6A and19A,in addition to sero-types in PCV7conjugated with CRM197diphtheria protein[13].PCV7was originally recommended as an optional vaccine by the Indian Academy of Pediatrics (IAP)[14],but was removed from the market since 2010.PCV-10and PCV-13are now recommended for use as routine vaccines under the IAP schedule[15].Table2shows serotypes covered by PCV10and PCV 13and recommended IAP immunization schedule. Safety ProfileFavorable safety profile of PCV7is established[16,17]. Several studies show safety profile of PCV10and PCV13 similar to PCV7[18–25].Main adverse events are:injection site reactions,rash,headache,fatigue,joint pain,fever andTable1Studies showing prevalent serotypes of S.pneumoniaeStudies Regions Serotypes Serotypecoverageby PCVs Balaji et al.[9]South India14(19.5%),19F(12.2%),5(8.7%),6A(8.7%),6B(8,7%)PCV10–64%PCV13–74.6%Shariff et al.[10]Delhi19(26%),6(11%),7(10%),1(9%),14(7%),9(5%),33(4%),17(4%),11(2%),3(2%),18(1%),23(1%),12(1%),32A(1%),15B(1%),22F(1%),5(1%),29(1%),non-vaccine type E(1%),F(1%),H(7%),19A(6%)PCV10–54% PCV13–73%ANSORP study[11]11Asian countries19F(23.5%),23F(10%),19A(8.2%),14(7.3%),6B(7.3%),3(6.2%),6A(4.2%)PCV7–52.5% IBIS group,INCLEN[12]India6,1,19,14,4,5,45,12,7.Serotypes1and5account for29%isolatesPCV Pneumococcal conjugate vaccinedecreased appetite.Rare side-effects being bronchiolitis, pneumonia and gastroenteritis.Vaccine EfficacyTable3shows efficacy of the vaccine in pneumococcal diseases.Cost-effectivenessCost-effectiveness of PCV vaccine depends upon the disease burden,prevalent strains,vaccine cost and number of doses used.A study conducted in Denmark and Sweden compared cost-effectiveness of PCV10vs.PCV13and found PCV13to be more cost-effective[35].PCV13was found to be more cost effective in a study conducted in Canada also[36] Whereas in Argentina,both were found to be equally cost-effective[37].WHO ScheduleWHO has recommended two types of schedules for inclusion of PCV in NIP of low-and medium-income countries.Table4 show comparison between the two schedules.In choosing between the3p+0(3Primary+0Booster)and2p+1(2 Primary+1Booster)schedules,countries should consider locally relevant factors including the age distribution of pneu-mococcal disease,the likely vaccine coverage,and the time-liness of the vaccine doses[38].Pneumococcal Vaccine in High Risk CasesPCV13and PPSV23vaccines are used for high risk cases such as chronic heart disease,chronic lung disease,diabetes mellitus,cerebrospinal fluid leak,cochlear implant, functional/anatomic asplenia like sickle cell disease,and immunocompromising conditions such as HIV infection, treatment with immunosuppressive drugs or radiation therapy and congenital immunodeficiency.PCV10vs.PCV13There are no comparative studies in India regarding efficacy, safety profile and cost-effectiveness of PCV10and PCV13. Serotype coverage is the only parameter where we have com-parative studies between the two.As clearly evident from Tables1and2,most of the serotypes prevalent in India are being covered by PCV13.So PCV13is to be included for routine immunization in India in a phased manner.Here it is essential to mention serotype19A.Two studies from India show emergence of multidrug resistant(MDR)19A strains: One is ANSORP(Asian Network for surveillance of resistant pathogen)study which showed that8.2%of isolates were19A serotype,out of which86.0%and79.8%were erythromycin resistant and MDR respectively[11].Another one is a study conducted in Delhi by Shariff M et al.,2013where6%of isolates were of19A serotype[10].PCV13has immunogenicity similar to PCV7in response to the7common serotypes,and has generally higher immu-nogenicity in response to the6additional serotypes.PCV13Table2Pneumococcal conjugate vaccine(PCV)schedule in children(IAP2016)Vaccine Serotypes covered Routine vaccination Catch up vaccinationPCV10 (synflorix)4,6B,9V,14,18C,19F23F(covered by PCV7)plusadditional3–1,5,7FPrimary vaccination−6,10,14wkof ageBooster at12–15mo of age6–12mo age2doses4wk apartand one booster12mo–5y2doses8wk apartPCV13 (Prevanar13)Serotypes covered by PCV10plus additional3–3,6A,19APrimary vaccination–6,10,14wkof ageBooster at12–15mo of age6–12month2doses4wk apartand one booster12–23mo2doses8wk apart24mo–5y Single doseTable3Vaccine efficacy of PCVDisease Pooled vaccine efficacyInvasive pneumococcal disease(IPD)[26]For vaccine serotypes–80%(95%CI58%to90%,P<0.0001)For all serotypes–58%(95%CI29%to75%,P=0.001)Radiologically defined pneumonia[27,28]27%(95%CI15%to36%,P<0.0001)Clinically defined pneumonia[29]6%(2%to9%,P0.0006)Otitis media[30–32]Recurrent otitis media–10–50%Severe otitis media–39–66%Nasopharyngeal carriage[33,34]16.6%–18.3%may provide added protection against pneumococcal disease caused by the additional6serotypes and does not interfere with immune responses to whole-cell pertussis and oral polio-virus vaccines.PCV13has an acceptable safety profile in both infants and toddlers,comparable with that of PCV7[24]. Barriers in Introduction of PCV in IndiaThere are many issues to confront with before introducing PCVs in NIP of the country.These are:1.The paucity of data on disease burden and serotype prev-alence–Before introducing any vaccine in National Immunization Programme(NIP),it is desirable to have data on disease and prevalent serotypes which is represen-tative of whole country.But in India we lack comprehen-sive data with very few single site and multisite studies available so far.The main reason of such paucity of data is complex procedures required to isolate and serotype the organism.Table1shows few studies conducted in Asian countries and India.Pre antibiotic use limits the invasive pneumococcal incidence detection around39to60%[39].Serotype distribution remains almost similar in bothculture positive and culture negative IPD.Effort by the Asian Strategic Alliance for Pneumococcal Disease Prevention(ASAP)Working Group to collate data on the disease burden due to invasive pneumococcal dis-ease(IPD)in participating Asian countries and terri-tories namely,Hong Kong,India,Indonesia,Korea, Macau,Malaysia,Pakistan,the Philippines, Singapore,Sri Lanka,Taiwan and Thailand confirms that data regarding the incidence of IPD in Asia are grossly lacking and reinforces the need for urgent and more substantial studies[40].2.Replacement of vaccine types by non-vaccine types–PCV7has led to dramatic decline in disease burden in countries where it was introduced.In United States alone, IPD in children<5y age group decreased by94%[41].After introduction of PCV7,surveillance studies from the US showed a decrease in cases of IPD due to vaccine serotypes(VT)and an increase in cases due to non-va ccine serotypes(NVT),the B re plac eme nt phenomenon^[42].Serotype replacement among adult pneumococcal pneumonia after the vaccination of chil-dren with PCV7was evident in the Japanese population[43].Serotype replacement of VTs by NVTs may dilutethe effect of PCV after some time.Drug resistant NVTs may pose serious problem and may even increase disease mortality.In view of variation in the proportion of isolates serotyped before and after vaccine introduction,changes in blood culture practice,and outbreaks of pneumococcal disease,there is a need for caution in interpreting pneu-mococcal disease surveillance data.3.Antibiotic susceptibility pattern change in the non-vaccine serotypes–Polymerase chain reaction(PCR)in culture-negative pneumococcal empyema due to prior an-tibiotic treatment has clearly established the role of non-vaccine types in the etiology[44].4.Limitations of the conjugate vaccines to protect againstnon-vaccine serotypes–This needs to be overcome by exploring other virulence factors that may have potential advantages.Specific capsular serotypes are responsible for pneumococcal disease and influence the outcome.One of the major limitations of the current polysaccharide vaccine is their inability to protect against non-vaccine serotype infections.This warrants the development of al-ternatives that may protect against pneumococcal disease across all serotypes.Martens et al.[45]suggested that the virulence of pneumococcal serotypes should be consid-ered in the design of novel vaccines.A study by Gopi et al.showed significant genetic diversity within S.pneumoniae isolates thereby indicating the need of continued molecular surveillance of S.pneumoniae to be nec-essary to monitor pneumococcal population dynamics and capsular switching events at the genetic level prior to and after PCV introduction in NIP[46].Table4Comparison of3p+0and2p+1schedules of PCV3p+0schedule2p+1scheduleDosing schedule<1y Primary doses3doses at6,10,14wk or2,4,6mo alongwith pentavacand rotavirus vaccines <6mo2doses.As early as6wk and8wkgap between2doses>6mo4wk gap between two dosesBooster No booster1booster at15mo of age with measlesand vit A1–2y2doses8wk apart2doses8wk apart>2y with high risk2doses8wk apart2doses8wk apart Immunogenicity after primary doses More LessImmunogenicity after full doses Less MoreHence pneumococcal disease,being a big contributor to under-five mortality in India needs to be given special attention as public health problem.The most effective way to reduce pneumococcal disease burden is by inclusion of pneumococcal vaccine in National Immunization ernment of India has taken a step forward and has announced introduction of pneumococcal conjugate vaccine in NIP in a phased manner. Since PCV13covers most of the serotypes prevalent in India especially MDR19A serotype,it seems to be the vaccine of choice in India.There is an urgent need to develop an effective surveillance system after introduction of PCV13in NIP to keep a track on vaccine efficacy,adverse events following immuni-zation(AEFI),disease burden,serotype replacement and anti-biotic susceptibility pattern of serotypes.Compliance with Ethical StandardsConflict of Interest None.Source of Funding None.References1.UNICEF/WHO.Pneumonia:The forgotten killer of children.Geneva:WHO;s Available at:www.who.int/child_adolescent_ health/documents/9280640489/en/.Accessed3May2017.S2.Dowell SF,Butler JC,Giebink GS,et al.Acute otitis media:man-agement and surveillance in an era of pneumococcal resistance—a report from the drug-resistant Streptococcus pneumonia therapeutic working group.Pediatr Infect Dis J.1999;18:1–9.3.Centers for Disease Control and Prevention.Preventing pneumo-coccal disease among infants and young children:recommenda-tions of the Advisory Committee on Immunization Practices (ACIP).MMWR.2000;49:1–35.4.Immunization,vaccine and biological.Pneumococcal diseaseWorld Health Organization(WHO).Available at:www.who.int/ immunization/topics/pneumococcal_disease/en/.Accessed9 May2017.5.Thacker N.Integrated management of neonatal and childhood ill-nesses:a new hope for child survival.Indian Pediatr.2007;44:169–71.6.Progress in introduction of pneumococcal conjugate vaccine-worldwide,2000–2012.MMWR Morb Mortal Wkly Rep.2013;62:308–11.7.Song JY,Nahm MH,Moseley MA.Clinical implications of pneu-mococcal serotypes:invasive disease potential,clinical presenta-tions,and antibiotic resistance.J Korean Med Sci.2013;28:4–15.8.Hausdorff WP,Feikin DR,Klugman KP.Epidemiological differ-ences among pneumococcal ncet Infect Dis.2005;5: 83–93.9.Balaji V,Jayaraman R,Verghese VP,Baliga PR,Kurien T.Pneumococcal serotypes associated with invasive disease in under five children in India&implications for vaccine policy.Indian J Med Res.2015;142:286–92.10.Shariff M,Choudhary J,Zahoor S,Deb M.Characterization ofStreptococcus pneumoniae isolates from India with special refer-ence to their sequence types.J Infect Dev Ctries.2013;7:101–9.11.Kim SH,Song JH,Chung DR,et al.Changing trends in antimicro-bial resistance and serotypes of Streptococcus pneumoniae isolatesin Asian countries:an Asian network for surveillance of resistant pathogens(ANSORP)study.Antimicrob Agents Chemother.2012;56:1418–26.12.Prospective multicentre hospital surveillance of Streptococcuspneumoniae disease in India.Invasive Bacterial Infection Surveillance(IBIS)Group,International Clinical Epidemiology Network(INCLEN).Lancet.1999;353:1216-2113.Paediatric on call.Child Health Care.Conjugate pneumococcalvaccine2011.Available at:/ fordoctor/diseasesandcondition/immunization_vaccination/ pneumococcal_vaccine.asp.Accessed7May2017.14.Indian Academy of Pediatrics Committee on Immunization(IAPCOI).Consensus recommendations on immunization,2008.Indian Pediatr.2008;45:635–648.15.Indian Academy of Pediatrics Committee on Immunization(IAPCOI).Consensus recommendations on immunization and IAP immunization timetable2012.Indian Pediatr.2012;49:549-64.16.DeStefano F,Pfeifer D,Nohynek H.Safety profile of pneumococ-cal conjugate vaccines:systematic review of pre-and post-licensure data.Bull World Health Org.2008;86:373–80.17.Wise RP,Iskander J,Pratt RD,et al.Post licensure safety surveil-lance for7-valent pneumococcal conjugate vaccine.JAMA.2004;292:1702–10.18.Bermal N,Szenborn L,Chrobot A,et al.The10-valent pneumo-coccal non-typeable Haemophilus influenza protein D conjugate vaccine(PCV10)coadministered with DTPw-HBV/Hib and polio-virus vaccines:assessment of immunogenicity.Pediatr Infect Dis J.2009;28:S89–96.19.Chevallier B,Vesikari T,Brzostek J,et al.Safety and reactogenicityof the10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine(PHiD-CV)when coadministered with routine childhood vaccines.Pediatr Infect Dis J.2009;28:S109–18.20.Ruiz-Palacios GM,Guerrero ML,Hernández-Delgado L,et al.Immunogenicity,reactogenicity and safety of the10-valent pneu-mococcal nontypeable Haemophilus influenzae protein D conju-gate vaccine(PHiD-CV)in Mexican infants.Hum Vaccin.2011;7:1137–45.21.Grimprel E,Laudat F,Patterson S,et al.Immunogenicity and safetyof a13-valent pneumococcal conjugate vaccine(PCV13)when given as a toddler dose to children immunized with PCV7as in-fants.Vaccine.2011;29:9675–83.22.Nunes MC,Madhi SA.Review on the immunogenicity and safetyof PCV-13in infants and toddlers.Exp Rev Vaccin.2011;10:951–80.23.Kieninger DM,Kueper K,Steul K,et al.Safety,tolerability,andimmunologic non-inferiority of a13-valent pneumococcal conju-gate vaccine compared to a7-valent pneumococcal conjugate vac-cine given with routine pediatric vaccinations in Germany.Vaccine.2010;28:4192–203.24.Amdekar YK,Lalwani SK,Bavdekar A,et al.Immunogenicity andsafety of a13-valent pneumococcal conjugate vaccine in healthy infants and toddlers given with routine vaccines in India.Pediatr Infect Dis J.2013;32:509–16.lwani S,Chatterjee S,Chhatwal J,et al.Immunogenicity,safety,and reactogenicity of the10-valent pneumococcal non-typeable Hemophilus influenza protein D conjugate vaccine(PHiD-CV) when co-administered with the DTPw-HBV/Hib vaccine in Indian infants:a single-blind,randomized,controlled study.Hum Vaccin Immunother.2012;8:612–22.26.Lucero MG,Dulalia VE,Nillos LT,et al.Pneumococcal conjugatevaccines for preventing vaccine-type invasive pneumococcal dis-ease and X-ray defined pneumonia in children less than two years of age.Cochrane Database Syst Rev.2009;4:CD004977.27.Skinner JM,Indrawati L,Canon J,et al.Pre-clinical evaluation of a15-valent pneumococcal conjugate vaccine(PCV15-CRM197)inan infant rhesus monkey immunogenicity model.Vaccine.2011;29: 8870–6.28.Madhi SA,Klugman KP.World Health Organization definition ofB radiologically-confirmed pneumonia^may under-estimate the truepublic health value of conjugate pneumococcal vaccines.Vaccine.2007;25:2413–9.29.Madhi SA,Klugman KP.The Vaccine Trialist Group.A role ofStreptococcus Pneumoniae in virus-associated pneumonia.Nat Med.2004;10:811-3.30.Fletcher MA,Fritzell B.Brief review of the clinical effectiveness ofPREVENAR against otitis media.Vaccine.2007;25:2507–12. 31.McEllistrem MC,Adams JM,Patel K,et al.Acute otitis media dueto penicillin nonsusceptible Streptococcus Pneumoniae before and after the introduction of the pneumococcal conjugate vaccine.Clin Infect Dis.2005;40:1738–44.32.Block SL,Hedrick J,Harrison CJ,et munity-wide vaccina-tion with the heptavalent pneumococcal conjugate significantly al-ters the microbiology of acute otitis media.Pediatr Infect Dis J.2004;23:829–33.33.Roca A,Hill PC,Townend J,et al.Effects of community-widevaccination with PCV-7on pneumococcal nasopharyngeal carriage in the Gambia:a cluster-randomized trial.PLoSMed.2011;8: e1001107.34.Blaschke AJ,Heyrend C,Byington CL,et al.Molecular analysisimproves pathogen identification and epidemiologic study of pediat-ric parapneumonic empyema.Pediatr Infect Dis J.2011;30:289–94.35.Klok RM,Lindkvist RM,Ekelund M,et al.Cost-effectiveness of a10-versus13-valent pneumococcal conjugate vaccine in Denmark and Sweden.Clin Ther.2013;35:119–34.36.Earnshaw SR,McDade CL,Zanotti G,et al.Cost-effectiveness of2+1dosing of13-valent and10-valent pneumococcal conjugate vaccines in Canada.BMC Infect Dis.2012;12:101.37.Chaiyakunapruk N,Somkrua R,Hutubessy R,et al.Cost effective-ness of pediatric pneumococcal conjugate vaccines:a comparative assessment of decision-making tools.BMC Med.2011;9:53.38.Pneumococcal vaccine.WHO position paper.2012.Available at:http://www.who.int/immunization/documents/positionpapers/en/.Accessed5May2017.39.Saha SK,Darmstadt GL,Baqui AH,et al.Identification of serotypein culture negative pneumococcal meningitis using sequential mul-tiplex PCR:implication for surveillance and vaccine design.PLoS One.2008;3:e3576.40.Bravo LC;Asian Strategic Alliance for Pneumococcal DiseasePrevention(ASAP)Working Group.Overview of the disease bur-den of invasive pneumococcal disease in Asia.Vaccine.2009;27: 7282-91.41.Centers for Disease Control and Prevention(CDC).Direct and in-direct effects of routine vaccination of children with7-valent pneu-mococcal conjugate vaccine on incidence of invasive pneumococ-cal disease-United States,1998–2003.MMWR Morb Mortal Wkly Rep.2005;54:893–7.42.Byington CL,Samore MH,Stoddard GJ,et al.Temporal trends ofinvasive disease due to Streptococcus pneumoniae among children in the intermountain west:emergence of nonvaccine serogroups.Clin Infect Dis.2005;41:21–9.43.Katoh S,Suzuki M,Ariyoshi K,Morimoto K.Serotype replace-ment in adult pneumococcal pneumonia after the introduction of seven-valent pneumococcal conjugate vaccines for children in Japan:a systematic literature review and pooled data analysis.Jpn J Infect Dis.2017;doi:10.7883/yoken.JJID.2016.311.44.Blaschke AJ,Heyrend C,Byington CL,et al.Molecular analysisimproves pathogen identification and epidemiologic study of pediat-ric parapneumonic empyema.Pediatr Infect Dis J.2011;30:289–94.45.Martens P,Worm SW,Lundgren B,Konradsen HB,Benfield T.Serotype-specific mortality from invasive Streptococcus Pneumoniae disease serotypes in the13-valent pneumococcal con-jugate vaccine.Vaccine.2011;29:9127–31.46.Gopi T,Ranjith J,Anandan S,Balaji V.Epidemiologicalcharacterisation of streptococcus pneumonia from India using multilocus sequence typing.Indian J Med Microbiol.2016;34:17–21.。