Flannery Brendan, Schrag Stephanie, Bennett Nancy M, Lynfield Ruth, Harrison Lee H, Reingold Arthur, Cieslak Paul R, Hadler James, Farley Monica M, Facklam Richard R, Zell Elizabeth R, Whitney Cynthia G
Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
JAMA. 2004 May 12;291(18):2197-203. doi: 10.1001/jama.291.18.2197.
Historically, incidence of pneumococcal disease in the United States has been higher among blacks than among whites. Following recommendation of a new 7-valent pneumococcal conjugate vaccine for children in October 2000, the incidence of invasive pneumococcal disease has declined dramatically, but the impact of vaccination on racial disparities in incidence of pneumococcal disease is unknown.
To assess the effect of conjugate vaccine introduction on rates of pneumococcal disease among whites and blacks in the United States.
DESIGN, SETTING, AND PATIENTS: Analysis of data from the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, an active, population-based surveillance system in 7 states. Patients were 15,923 persons with invasive pneumococcal disease occurring between January 1, 1998, and December 31, 2002.
Age- and race-specific pneumococcal disease incidence rates (cases per 100 000 persons), rate ratios, and rate differences.
Between 1998 and 2002, annual incidence rates for invasive pneumococcal disease decreased from 19.0 to 12.1 cases per 100 000 among whites and from 54.9 to 26.5 among blacks. Due to these declines, 14,730 fewer cases occurred among whites and 8780 fewer cases occurred among blacks in the United States in 2002, compared with 2 prevaccine years, 1998 and 1999. Before vaccine introduction, incidence among blacks was 2.9 times higher than among whites (95% confidence interval [CI], 2.7-3.0); in 2002, the black-white rate ratio had been reduced to 2.2 (95% CI, 2.0-2.4). Incidence among black children younger than 2 years went from being 3.3 times higher (95% CI, 3.0-3.7) than among white children in the prevaccine period to 1.6 times higher (95% CI, 1.1-2.2) in 2002. By 2002, 74% of white children and 68% of black children aged 19 to 35 months in the 7 states had received at least 1 dose of pneumococcal conjugate vaccine; 43% of white and 39% of black children received 3 or more doses.
Although blacks remain at higher risk of invasive pneumococcal disease, introduction of childhood pneumococcal vaccination has reduced the racial disparity in incidence of pneumococcal disease.
从历史上看，美国肺炎球菌疾病的发病率在黑人中一直高于白人。2000年10月针对儿童推荐使用一种新的7价肺炎球菌结合疫苗后，侵袭性肺炎球菌疾病的发病率大幅下降，但疫苗接种对肺炎球菌疾病发病率种族差异的影响尚不清楚。
评估引入结合疫苗对美国白人和黑人肺炎球菌疾病发病率的影响。
设计、地点和患者：对来自活跃细菌核心监测（ABCs）/新发感染项目网络的数据进行分析，该网络是一个在7个州开展的基于人群的活跃监测系统。患者为1998年1月1日至2002年12月31日期间发生侵袭性肺炎球菌疾病的15923人。
按年龄和种族划分的肺炎球菌疾病发病率（每10万人中的病例数）、发病率比和发病率差异。
1998年至2002年期间，白人侵袭性肺炎球菌疾病的年发病率从每10万人19.0例降至12.1例，黑人从每10万人54.9例降至26.5例。由于这些下降，与疫苗接种前的1998年和1999年这两个年份相比，2002年美国白人中的病例减少了14730例，黑人中的病例减少了8780例。在引入疫苗之前，黑人的发病率比白人高2.9倍（95%置信区间[CI]，2.7 - 3.0）；2002年，黑人与白人的发病率比降至2.2（95%CI，2.0 - 2.4）。2岁以下黑人儿童的发病率在疫苗接种前比白人儿童高3.3倍（95%CI，3.0 - 3.7），到2002年则高1.6倍（95%CI，1.1 - 2.2）。到2002年，7个州中19至35个月大的白人儿童中有74%、黑人儿童中有68%至少接种了1剂肺炎球菌结合疫苗；43%的白人儿童和39%的黑人儿童接种了3剂或更多剂次。
尽管黑人患侵袭性肺炎球菌疾病的风险仍然较高，但儿童肺炎球菌疫苗的引入降低了肺炎球菌疾病发病率的种族差异。
Zotero 插件