Tsai Chiaojung Jillian, Griffin Marie R, Nuorti J Pekka, Grijalva Carlos G
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37212, USA.
Clin Infect Dis. 2008 Jun 1;46(11):1664-72. doi: 10.1086/587897.
Although hospitalizations due to invasive pneumococcal disease decreased after routine vaccination of young children with a 7-valent pneumococcal conjugate vaccine (PCV7) began in 2000, information on the trends in pneumococcal meningitis is limited.
We estimated national trends in rates of hospitalization for pneumococcal meningitis, using data from the Nationwide Inpatient Sample, 1994-2004. Pneumococcal meningitis cases and deaths were identified on the basis of the International Classification of Diseases, Ninth Edition, Clinical Modification coded primary discharge diagnosis, and rates were calculated using US Census data as denominators. The year 2000 was considered to be a transition year, and the average annualized rate after PCV7 introduction (2001-2004) was compared with that during the baseline years (1994-1999).
During 1994-2004, there were 21,396 hospitalizations and 2684 deaths (12.5%) due to pneumococcal meningitis in the United States. In children aged < 2 years, the average annualized rates of pneumococcal meningitis hospitalizations per 100,000 population decreased from 7.7 in 1994-1999 to 2.6 in 2001-2004 (change, -66.0%; 95% confidence interval [CI], -73.5% to -56.3%). Among children aged 2-4 years, the hospitalization rate decreased from 0.9 to 0.5 per 100,000 (change, -51.5%; 95% CI, -66.9% to -28.9%). Average rates also decreased by 33.0% (95% CI, -43.4% to -20.9%) among adults aged > or = 65 years. After PCV7 introduction (2001-2004), an estimated 1822 and 573 pneumococcal meningitis hospitalizations were prevented in persons aged < 5 years and > or = 65 years, respectively. Overall, an estimated 3330 pneumococcal meningitis hospitalizations and 394 deaths were prevented in persons of all ages during 2001-2004 in the United States.
After implementation of routine childhood vaccination with PCV7, hospitalizations for pneumococcal meningitis decreased significantly for both children and adults. Most pneumococcal meningitis cases now occur among adults.
尽管自2000年开始对幼儿常规接种7价肺炎球菌结合疫苗（PCV7）后，侵袭性肺炎球菌病导致的住院率有所下降，但关于肺炎球菌性脑膜炎趋势的信息有限。
我们利用1994 - 2004年全国住院患者样本数据估算了肺炎球菌性脑膜炎的全国住院率趋势。根据《国际疾病分类》第九版临床修订本编码的主要出院诊断来确定肺炎球菌性脑膜炎病例和死亡情况，并以美国人口普查数据为分母计算发病率。将2000年视为过渡年，比较引入PCV7后（2001 - 2004年）的年均发病率与基线年份（1994 - 1999年）的年均发病率。
在1994 - 2004年期间，美国有21396例因肺炎球菌性脑膜炎住院，2684例死亡（12.5%）。在2岁以下儿童中，每10万人口中肺炎球菌性脑膜炎的年均住院率从1994 - 1999年的7.7降至2001 - 2004年的2.6（变化率为 - 66.0%；95%置信区间[CI]， - 73.5%至 - 56.3%）。在2 - 4岁儿童中，住院率从每10万人口0.9降至0.5（变化率为 - 51.5%；95% CI， - 66.9%至 - 28.9%）。65岁及以上成年人的平均发病率也下降了33.0%（95% CI， - 43.4%至 - 20.9%）。引入PCV7后（2001 - 2004年），估计5岁以下人群和65岁及以上人群分别预防了1822例和573例肺炎球菌性脑膜炎住院。总体而言，2001 - 2004年期间，美国所有年龄段人群估计预防了3330例肺炎球菌性脑膜炎住院和394例死亡。
在实施儿童常规接种PCV7后，儿童和成人因肺炎球菌性脑膜炎导致的住院率均显著下降。现在大多数肺炎球菌性脑膜炎病例发生在成年人中。
