Baggett Henry C, Peruski Leonard F, Olsen Sonja J, Thamthitiwat Somsak, Rhodes Julia, Dejsirilert Surang, Wongjindanon Wanna, Dowell Scott F, Fischer Julie E, Areerat Peera, Sornkij Denchai, Jorakate Possawat, Kaewpan Anek, Prapasiri Prabda, Naorat Sathapana, Sangsuk Leelawadee, Eampokalap Boonchuay, Moore Matthew R, Carvalho Gloria, Beall Bernard, Ungchusak Kumnuan, Maloney Susan A
International Emerging Infections Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Sa Kaeo, Thailand.
Clin Infect Dis. 2009 Mar 1;48 Suppl 2:S65-74. doi: 10.1086/596484.
Population-based estimates of the incidence of invasive pneumococcal disease are unavailable for Thailand and other countries in Southeast Asia. We estimated the incidence of pneumococcal bacteremia cases requiring hospitalization in rural Thailand.
Blood cultures were performed on samples from hospitalized patients in 2 rural provinces where active, population-based surveillance of community-acquired pneumonia is conducted. Blood cultures were performed at clinician discretion and were encouraged for all patients with suspected pneumonia and all children aged <5 years with suspected sepsis. Pneumococcal antigen testing was performed on positive blood culture specimens that failed to grow organisms on subculture.
From May 2005 through June 2007, 23,853 blood culture specimens were collected overall, and 7319 were collected from children aged <5 years, which represented 66% and 47% of target patients, respectively. A total of 72 culture-confirmed pneumococcal bacteremia cases requiring hospitalization were identified. An additional 44 patients had media from positive blood cultures that yielded no growth on subculture but that had positive results of pneumococcal antigen testing. Of the 116 confirmed cases of bacteremia, 27 (23%) occurred in children aged <5 years; of these, 9 (33%) were confirmed by antigen testing only. The incidence of pneumococcal bacteremia cases requiring hospitalization among children aged <5 years had a range of 10.6-28.9 cases per 100,000 persons (incidence range if cases detected by antigen are excluded, 7.5-14.0 cases per 100,000 persons).
Invasive pneumococcal disease is more common than was previously suspected in Thailand, even on the basis of estimates limited to hospitalized cases of bacteremia. These estimates, which are close to estimates of the incidence of hospitalized cases of pneumococcal bacteremia in the United States before introduction of pneumococcal conjugate vaccine, provide important data to guide public health care policy and to inform discussions about vaccine introduction in Thailand and the rest of Southeast Asia.
泰国及东南亚其他国家尚无基于人群的侵袭性肺炎球菌病发病率估计数据。我们对泰国农村地区需住院治疗的肺炎球菌菌血症病例的发病率进行了估计。
在两个实施社区获得性肺炎主动人群监测的农村省份，对住院患者的样本进行血培养。血培养由临床医生自行决定进行，鼓励对所有疑似肺炎患者以及所有年龄<5岁的疑似脓毒症儿童进行血培养。对血培养阳性但在传代培养中未生长出细菌的标本进行肺炎球菌抗原检测。
2005年5月至2007年6月，共采集了23,853份血培养标本，其中7319份来自年龄<5岁的儿童，分别占目标患者的66%和47%。共确定了72例需住院治疗的血培养确诊肺炎球菌菌血症病例。另外44例患者血培养阳性，但传代培养未生长出细菌，但肺炎球菌抗原检测呈阳性。在116例确诊的菌血症病例中，27例（23%）发生在年龄<5岁的儿童中；其中9例（33%）仅通过抗原检测确诊。年龄<5岁儿童中需住院治疗的肺炎球菌菌血症病例发病率为每10万人10.6 - 28.9例（排除抗原检测发现的病例后，发病率范围为每10万人7.5 - 14.0例）。
在泰国，侵袭性肺炎球菌病比之前怀疑的更为常见，即使是基于仅局限于住院菌血症病例的估计。这些估计值接近美国在引入肺炎球菌结合疫苗之前住院肺炎球菌菌血症病例的发病率估计值，为指导公共卫生保健政策以及为泰国和东南亚其他地区关于疫苗引入的讨论提供了重要数据。
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