Benito-Fernández Javier, Raso Santiago Mintegi, Pocheville-Gurutzeta Itziar, SánchezEtxaniz Jesús, Azcunaga-Santibañez Beatriz, Capapé-Zache Susana
Pediatric Emergency Department, Hospital de Cruces, Bizkaia, Spain.
Pediatr Infect Dis J. 2007 Aug;26(8):667-71. doi: 10.1097/INF.0b013e3180f610b3.
The introduction of vaccination with the heptavalent pneumococcal conjugate vaccine (PCV7) has produced an important decrease in the incidence of Streptococcus pneumoniae occult bacteremia (OB). In Spain, PCV7 became available in the last months of 2001, but, to date, it has not been included in the official vaccination schedule of the public health system.
To describe the impact of pneumococcal vaccination with PCV7 on the incidence of OB caused by S. pneumoniae in infants aged 3-36 months presenting to our pediatric emergency department.
This is a retrospective case series of all blood cultures obtained from January 1, 2000 to December 31, 2005 in our pediatric emergency department from infants with fever without known source. We evaluated rates of blood cultures positive with S. pneumoniae before (January 1, 2000-December 31, 2001) and after (January 1, 2004-December 31, 2005) PCV7 introduction, excluding 2 transitional years (January 1, 2002-December 31, 2003).
Implementation of vaccination with PVC7 in our area resulted in a 57.5% reduction of OB caused by S. pneumoniae (1.62-0.69%) (P < 0.05). There were 30 cases of bacteremia caused by S. pneumoniae, 19 before and 11 after PCV7 introduction. Between the 2 periods of time studied the number of cases of infants aged 3-36 months with fever without known source, increased from 8052 to 9799 (21.6%) and the total blood cultures drawn significantly increased from 1171 to 1575 (34.5%) (P < 0.01). Despite more frequent blood culturing in febrile patients, the rate of OB caused by PCV7-serotypes decreased significantly by 79% (1.19-0.25%) (P < 0.01) and the proportion of OB caused by nonvaccine serotypes increased minimally from 0.42 to 0.44%. In the post-PVC7 period, 4 infants presented with S. pneumoniae OB caused by PCV7 serotypes; 2 had not received PCV7, and 2 (6 and 7 months old) had received one dose.
After PCV7 introduction in our area, rates of S. pneumoniae OB caused by vaccine serotypes decreased significantly despite only moderate use of the vaccine in our population.
七价肺炎球菌结合疫苗（PCV7）的引入使肺炎链球菌隐匿性菌血症（OB）的发病率显著下降。在西班牙，PCV7于2001年最后几个月上市，但迄今为止，它尚未被纳入公共卫生系统的官方疫苗接种计划。
描述接种PCV7肺炎球菌疫苗对我院儿科急诊科3至36个月婴儿肺炎链球菌所致OB发病率的影响。
这是一项回顾性病例系列研究，纳入了2000年1月1日至2005年12月31日期间我院儿科急诊科所有不明原因发热婴儿的血培养结果。我们评估了PCV7引入前（2000年1月1日至2001年12月31日）和引入后（2004年1月1日至2005年12月31日）肺炎链球菌血培养阳性率，排除了两个过渡年份（2002年1月1日至2003年12月31日）。
在我们地区实施PCV7疫苗接种后，肺炎链球菌所致OB减少了57.5%（从1.62%降至0.69%）（P<0.05）。共有30例肺炎链球菌菌血症病例，PCV7引入前19例，引入后11例。在研究的两个时间段内，3至36个月不明原因发热婴儿的病例数从8052例增加到9799例（增加了21.6%），采集的血培养总数从1171例显著增加到1575例（增加了34.5%）（P<0.01）。尽管发热患者血培养更频繁，但PCV7血清型所致OB的发生率显著下降了79%（从1.19%降至0.25%）（P<0.01），非疫苗血清型所致OB的比例从0.42%微升至0.44%。在PCV7接种后时期，有4例婴儿出现PCV7血清型所致的肺炎链球菌OB；2例未接种PCV7，2例（6个月和7个月大）接种了一剂。
在我们地区引入PCV7后，尽管该疫苗在我们的人群中使用程度一般，但疫苗血清型所致肺炎链球菌OB的发生率显著下降。
