Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37212, USA.
Clin Infect Dis. 2010 Mar 15;50(6):805-13. doi: 10.1086/650573.
The incidence of childhood pneumonia decreased following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in the United States. Recent regional reports suggest an increase in the incidence of childhood pneumonia complicated by empyema. We assessed whether early decreases in pneumonia hospitalization rates were sustained and trends in such hospitalizations complicated by empyema in United States children aged <5 years.
Nationwide Inpatient Sample and Census data were used to calculate annual all-cause and pneumococcal pneumonia hospitalization rates for pre-PCV7 (1996-1999) and post-PCV7 years (2001-2007) and to analyze national trends in total and pathogen-specific pneumonia-associated empyema.
Among children aged <2 years, all-cause pneumonia hospitalizations decreased 33% (95% confidence interval, 28%-37%) from 1267 cases per 100,000 children in pre-PCV7 years to 852 cases per 100,000 children in post-PCV7 years. Pneumococcal pneumonia hospitalization rates decreased 61% (95% confidence interval, 55%-67%) post-PCV7, compared with pre-PCV7 years. Pneumonia hospitalizations complicated by empyema increased 2.01-fold from 3.5 cases per 100,000 children in 1996-1998 to 7.0 cases per 100,000 children in 2005-2007. Rates of pneumococcal and streptococcal empyema remained stable, whereas rates of staphylococcal and other or unspecified empyema increased 4.08- and 1.89-fold, respectively. Among children aged 2-4 years, all-cause pneumonia rates remained stable, whereas pneumococcal pneumonia decreased by 26% (95% confidence interval, 16-34). Pneumonia complicated by empyema increased 2.81-fold from 3.7 cases per 100,000 children in 1996-1998 to 10.3 cases per 100,000 children in 2005-2007. In this age group, there were 2.17-, 2.80-, 3.76-, and 3.09-fold increases in rates of pneumococcal, streptococcal, staphylococcal, and other or unspecified empyema, respectively.
Decreases in childhood pneumonia hospitalization rates following PCV7 introduction were sustained. Although empyema complicated only a small fraction of pneumonia hospitalizations, its prevalence increased substantially. This increase was due to several pathogens and warrants continuing monitoring.
在美国引入 7 价肺炎球菌结合疫苗(PCV7)后,儿童肺炎的发病率有所下降。最近的区域性报告表明,儿童肺炎合并脓胸的发病率有所上升。我们评估了美国 <5 岁儿童肺炎住院率的早期下降是否持续,以及此类住院率合并脓胸的趋势。
利用全国住院患者样本和人口普查数据,计算了 PCV7 前(1996-1999 年)和 PCV7 后(2001-2007 年)的全因和肺炎球菌性肺炎住院率,并分析了总住院率和病原体特异性肺炎相关脓胸的全国趋势。
在 <2 岁的儿童中,全因肺炎住院率从 PCV7 前的每 100,000 名儿童 1267 例下降了 33%(95%置信区间,28%-37%),降至 PCV7 后的每 100,000 名儿童 852 例。与 PCV7 前相比,肺炎球菌性肺炎的住院率下降了 61%(95%置信区间,55%-67%)。脓胸合并肺炎的住院率从 1996-1998 年的每 100,000 名儿童 3.5 例增加到 2005-2007 年的每 100,000 名儿童 7.0 例,增加了 2.01 倍。肺炎球菌和链球菌性脓胸的发病率保持稳定,而葡萄球菌和其他或未特指的脓胸的发病率分别增加了 4.08 倍和 1.89 倍。在 2-4 岁的儿童中,全因肺炎发病率保持稳定,而肺炎球菌性肺炎的发病率下降了 26%(95%置信区间,16%-34%)。脓胸合并肺炎的住院率从 1996-1998 年的每 100,000 名儿童 3.7 例增加到 2005-2007 年的每 100,000 名儿童 10.3 例,增加了 2.81 倍。在这个年龄组中,肺炎球菌、链球菌、葡萄球菌和其他或未特指的脓胸的发病率分别增加了 2.17 倍、2.80 倍、3.76 倍和 3.09 倍。
PCV7 引入后,儿童肺炎住院率的下降趋势持续存在。尽管脓胸仅占肺炎住院的一小部分,但它的患病率显著增加。这种增加是由多种病原体引起的,需要持续监测。