1974rRNA (Streptococcus

pneumoniae)(capsule)

90

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2-3

3

(COPD)4

( 2 ) (65 )( ) (

) ()

3

XX (radio-opacity)

X

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( )( )

5,6 2007 IDSA/ATS(Infectious Disease Society of America/American Thoracic Society)7

2014 58 1 21

( 12000/L)

(ALT100 U/L) ( 4000/ L)

( 100%)8

9

2007 IDSA/ATS7

macrolide(azi thromycin clar i thromycin

erythromycin)beta-lactam (high-dose amoxicillin

amoxici l l in-clavulanate cef t r iaxoneCefuroxime) macrolide

respiratory quinolone(moxifloxacingemifloxacin levofloxacin)

2007 1

penici l l in macrol idepenicillin

cephalosporin macrolide

23 (PPV23 pneumococcal polysaccharide vaccine) Pneumovax

Pnu-Immune 1983 23(capsule)

23

1 3 ( P C V 1 3pneumococcal conjugate vaccine)Prevenar 2010 2000PCV7

PCV7 98%67% 10

PCV13 13

1313

2014 58 1 22

PPV23 2008 Cochrane review 11 PPV23

74%76% 29%

21% (all-cause mortality)

201012 PPV23 63.8%

44.8%

PPV23PPV23

1991 13

50-60 PPV23 90%

9020%

PCV PPV

(mucosal immunity)(colonization)

(herd effect) 201014 PCV7

5 65

PCVPCV7

PCV13PCV72010

PPV23 PCV13

PCV13PPV23

PPV23

- (Guillian-Barre syndrome)

PCV13( 10%)

()

PPV23 PCV132013 ACIP (Advisory

Committee on Immunization Practices)15 1

ACIP 651 PPV23 65

PCV13 2011(FDA) 50

PCV1316 2013

ACIP 19

2014 58 1 23

PCV13 PPV23PPV23

PCV13 PPV23PCV13 8

PPV23

1. 2007

2. Centers for Disease Control and PreventionP n e u m o c o c c a l d i s e a s e . A c c e s s e d a t October 15th 2013, at: http://www.cdc.gov/pneumococcal/about/infection-types.html

3 . U p t o d a t e o n l i n e s e a r c h I n v a s i v e pneumococcal (Streptococcus pneumoniae)

infections and bacteremia. Accessed at October 15th 2013.

4. Uptodate online search Pneumococcal pneumonia in Adults. Accessed at October 15th 2013.

5 . G u t i é r r e z F E v a l u a t i o n o f t h e immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin Infect Dis 2003; 36(3): 286.

6. Rosón B Contribution of a urinary antigen assay (Binax NOW) to the early diagnosis of pneumococcal pneumonia. Clin Infect Dis 2004; 38(2): 222.

1 PCV13 PPV23

PCV13 PPV23 PPV23 Revax.VVVVVV

V V V65 V VHIV V V V

V V VV V VV V VV V VV V VV V VV V V

PPV23 Revax. PPV23

2014 58 1 24

7. Mandell LA Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Clin Infect Dis 2007; 44(2): 27.

8. Petti CA Streptococcus pneumoniae antigen test using positive blood culture bottles as an alternative method to diagnose pneumococcal bacteremia. J Clin Microbiol 2005; 43(5): 2510.

9. Baggett HC Pneumococcal antigen testing of blood culture broth to enhance the detection of Streptococcus pneumoniae bacteremia. Eur J Clin Microbiol Infect Dis 2012 ; 31(5): 753-6.

10. Black SB Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than ve years aof age for prevention of pneumonia. Pediatr Infect Dies J 2002; 21(9): 810-5.

11. Moberley S Vaccines for preventing pneumococcal infection in adults(Review) published on 22 June, 2012.

12. Moruyama T Eff icacy of 23-valent pneumococca l vacc ine in p reven t ing pneumonia and improving survival in sursing home residents: double blind, randomized and placebo controlled trial. BMJ 2010; 230: c1004.

13. Shapiro ED The protective efficacy of polyvalent pneumococcal polysaccharide

vaccine. N Eng J Med 1991; 325(21): 1453.

14. Pilishvili T Sustained reductions in invasive pneumococcal diseases in the era of conjugate vaccine. J Infect Dis 2010; 201: 32-41.

15. Advisory Committee on Immunization P r a c t i c e s ( A C I P ) R e c o m m e n d e d Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older United States, 2013 MMWR Morb Mortal Wkly Rep 2013; 62.

16. Uptodate online search Pneumococcal vaccine in Adults. Accessed at October 15th 2013.

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