Albrich W C, Baughman W, Schmotzer B, Farley M M
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Clin Infect Dis. 2007 Jun 15;44(12):1569-76. doi: 10.1086/518149. Epub 2007 May 8.
The rate of invasive pneumococcal disease (IPD) has decreased among both immunized children and nonimmunized adults since the licensure of a heptavalent pneumococcal conjugate vaccine (PCV7) for use in infants in the United States in 2000.
Temporal trends in IPD incidence, clinical syndromes, and underlying conditions were analyzed using active laboratory- and population-based surveillance data from the Centers for Disease Control and Prevention-sponsored Georgia Emerging Infections Program for the 20-county Metropolitan Atlanta, Georgia, for the period of July 1997 through June 2004. P values were determined by test for trend.
Since 2000, there have been significant decreases in the rates of invasive pneumococcal pneumonia (relative risk [RR], 0.80; P=.002) and meningitis (RR, 0.41; P=.003) in adults and for primary bacteremia, invasive pneumonia, and meningitis in children (RR, 0.16 [P<.001], 0.60 [P=.003], and 0.70 [P=.009], respectively). Among human immunodeficiency virus-infected persons, there were significant decreases in the overall rates of IPD (decrease of 43%; P<.001) and invasive pneumonia (decrease of 44%; P<.001) since 2000-2001, although the rate of IPD increased significantly (increase of 53%; P=.022) among patients with acquired immunodeficiency syndrome. There was a concurrent increase in the proportion of adults aged > or = 40 years with underlying comorbidities. Rates of non-PCV7 serotypes increased 1.61-fold and 1.28-fold from 2000-2001 to 2003-2004 in children and adults (P=.005 for both).
The decreasing incidence of IPD in Atlanta since 2000-2001 was associated with decreases in cases of pneumonia and meningitis in adult and pediatric subjects and in cases of primary bacteremia in children. The burden of serotype-replacement disease remained small. Adults with comorbidities represent a growing proportion of patients with IPD.
自2000年美国许可七价肺炎球菌结合疫苗（PCV7）用于婴儿以来，免疫儿童和未免疫成人中的侵袭性肺炎球菌病（IPD）发病率均有所下降。
利用疾病控制与预防中心资助的佐治亚州新兴感染项目在佐治亚州亚特兰大大都会区20个县开展的基于实验室和人群的主动监测数据，分析1997年7月至2004年6月期间IPD发病率、临床综合征及基础疾病的时间趋势。P值通过趋势检验确定。
自2000年以来，成人侵袭性肺炎球菌肺炎（相对危险度[RR]，0.80；P = 0.002）和脑膜炎（RR，0.41；P = 0.003）以及儿童原发性菌血症、侵袭性肺炎和脑膜炎的发病率均显著下降（RR分别为0.16[P < 0.001]、0.60[P = 0.003]和0.70[P = 0.009]）。在人类免疫缺陷病毒感染人群中，自2000 - 2001年以来，IPD总体发病率（下降43%；P < 0.001）和侵袭性肺炎发病率（下降44%；P < 0.001）显著下降，尽管获得性免疫缺陷综合征患者中的IPD发病率显著上升（上升53%；P = 0.022）。年龄≥40岁且有基础合并症的成年人比例同时增加。2000 - 2001年至2003 - 2004年，儿童和成人中非PCV7血清型的发病率分别增加了1.61倍和1.28倍（两者P = 0.005）。
自2000 - 2001年以来，亚特兰大IPD发病率的下降与成人和儿童肺炎及脑膜炎病例以及儿童原发性菌血症病例的减少有关。血清型替代疾病的负担仍然较小。有合并症的成年人在IPD患者中所占比例越来越大。
