Agence de Médecine Préventive, 25-28 Rue du Dr, Roux, Paris 75728, France.
BMC Infect Dis. 2010 Feb 10;10:22. doi: 10.1186/1471-2334-10-22.
Pneumococcal conjugate vaccine strategies in GAVI-eligible countries are focusing on infant immunization but this strategy may not be optimal in all settings. We aimed to collect all available population based data on pneumococcal meningitis throughout life in the African meningitis belt and then to model overall meningitis risk to help inform vaccine policy.
After a systematic review of literature published from 1970 through the present, we found robust population-based Streptococcus pneumoniae (Sp) meningitis data across age strata for four African meningitis belt countries that included 35 surveillance years spanning from 1970 to 2005. Using these data we modeled disease risk for a hypothetical cohort of 100,000 persons followed throughout life.
Similar to meningococcal meningitis, laboratory-confirmed pneumococcal meningitis was seasonal, occurring primarily in the dry season. The mean annual Sp meningitis incidence rates were 98, 7.8 to 14, and 5.8 to 12 per 100,000 among persons <1, 1 through 19, and 20 to 99 years of age, respectively, which (in the absence of major epidemics) were higher than meningococcal meningitis incidences for persons less than 1 and over 20 years of age. Mean Sp meningitis case fatality ratios (CFR) among hospitalized patients ranged from 36-66% depending on the age group, with CFR exceeding 60% for all age groups beyond 40 years; depending on the age group, Sp meningitis mortality incidences were 2 to 12-fold greater than those for meningococcal meningitis. The lifetime risks of pneumococcal meningitis disease and death were 0.6% (1 in 170) and 0.3% (1 in 304), respectively. The incidences of these outcomes were highest among children age <1 year. However, the cumulative risk was highest among persons age 5 to 59 years who experienced 59% of pneumococcal meningitis outcomes. After age 5 years and depending on the country, 59-79% of meningitis cases were caused by serotype 1.
In the African meningitis belt, Sp is as important a cause of meningitis as Neisseria meningitidis, particularly among older children and working age adults. The meningitis belt population needs an effective serotype 1 containing vaccine and policy discussions should consider vaccine use outside of early childhood.
在符合 GAVI 条件的国家，肺炎球菌结合疫苗策略侧重于婴儿免疫，但在所有情况下，这种策略可能并非最佳选择。我们旨在收集整个非洲脑膜炎带一生中所有可用的人群为基础的肺炎球菌脑膜炎数据，然后对总体脑膜炎风险进行建模，以帮助制定疫苗政策。
在对 1970 年至目前发表的文献进行系统回顾后，我们在四个非洲脑膜炎带国家发现了跨越年龄层次的稳健的人群为基础的肺炎链球菌（Sp）脑膜炎数据，其中包括 1970 年至 2005 年的 35 年监测数据。使用这些数据，我们对一个假设的 100,000 人的队列进行了终生疾病风险建模。
与脑膜炎球菌性脑膜炎类似，实验室确诊的肺炎球菌性脑膜炎具有季节性，主要发生在旱季。100,000 人中<1 岁、1 至 19 岁和 20 至 99 岁人群中每年每 100,000 人中 Sp 脑膜炎的发病率分别为 98、7.8 至 14 和 5.8 至 12，（在没有重大流行的情况下）高于<1 岁和>20 岁人群的脑膜炎球菌性脑膜炎发病率。住院患者中 Sp 脑膜炎病死率（CFR）因年龄组而异，范围为 36-66%，40 岁以上所有年龄组的 CFR 均超过 60%；根据年龄组，Sp 脑膜炎死亡率是脑膜炎球菌性脑膜炎死亡率的 2 至 12 倍。一生中患肺炎球菌性脑膜炎的疾病和死亡风险分别为 0.6%（1 比 170）和 0.3%（1 比 304）。这些结果的发生率在<1 岁的儿童中最高。然而，5 至 59 岁人群的累积风险最高，他们经历了 59%的肺炎球菌性脑膜炎结局。5 岁以上，根据国家的不同，59-79%的脑膜炎病例由血清型 1 引起。
在非洲脑膜炎带，Sp 是与脑膜炎奈瑟球菌一样重要的脑膜炎病因，特别是在较大的儿童和工作年龄的成年人中。脑膜炎带人群需要一种有效的包含血清型 1 的疫苗，政策讨论应考虑在幼儿期之外使用疫苗。
