七价肺炎球菌结合疫苗对伴有耳漏的急性中耳炎流行病学的影响。
The impact of the heptavalent pneumococcal conjugate vaccine on the epidemiology of acute otitis media complicated by otorrhea.
机构信息
Second Department of Pediatrics, P and A Kyriakou Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
出版信息
Pediatr Infect Dis J. 2011 Jul;30(7):551-5. doi: 10.1097/INF.0b013e31821038d9.
BACKGROUND
The heptavalent pneumococcal conjugate vaccine (PCV7) has a considerable effect on the epidemiology of pneumococcal disease. The aim of this observational hospital-based study was to examine the effect of the PCV7 (introduced in our settings in 2004) on the epidemiology of spontaneously draining acute otitis media.
METHODS
Results of all middle ear fluid cultures (n = 3446) obtained from children with acute otitis media complicated with otorrhea before the introduction of immunization (between 2000 and 2003) were compared with those (n = 2134) obtained during a similar post-PCV7 period (between 2005 and 2008). Results of cultures obtained between 2006 and 2008 were examined prospectively, whereas those obtained in previous years were retrospectively reviewed.
RESULTS
Following PCV7 immunization, the rates of otorrhea visits per 10,000 emergency department visits decreased by 38% from 133 to 83 (95% confidence interval of the difference, 42-53; P < 0.001), mainly as a result of the decrease in the incidence of pneumococcal disease (48% decrease-25 vs. 13 per 10,000 emergency department visits; P < 0.001). Otorrhea due to Haemophilus influenzae decreased by 20% (20-16 per 10,000 visits; P < 0.001). Serotype 19A accounted for 1 of 47 (2%) pneumococcal strains in 2006, for 5 of 34 (15%) in 2007, and for 13 of 53 (25%) in 2008 (P for trend: 0.001). In the postvaccine years, penicillin-resistant pneumococcal strains (minimum inhibitory concentration ≥ 2 μg/mL) increased from 4% to 13% (P < 0.001). However, the proportion of pneumococci resistant to macrolides decreased (44% vs. 35%; P = 0.01).
CONCLUSIONS
After the introduction of immunization, otorrhea incidents decreased considerably, mainly because of the decrease in pneumococcal disease. H. influenzae is now the predominant organism. Serotype 19A has increased significantly and is the most common nonvaccine pneumococcal serotype. Penicillin resistance has increased in recent years.
背景
七价肺炎球菌结合疫苗（PCV7）对肺炎球菌病的流行病学有显著影响。本基于医院观察性研究的目的在于研究 PCV7（2004 年在我们的环境中引入）对自发性引流性急性中耳炎的流行病学的影响。
方法
比较接种前（2000 年至 2003 年）儿童急性中耳炎伴耳溢液的所有中耳液培养结果（n = 3446）与接种后（2005 年至 2008 年）期间获得的培养结果（n = 2134）。2006 年至 2008 年获得的培养结果进行前瞻性检查，而以前年份的结果则进行回顾性审查。
结果
接种 PCV7 后，每 10000 例急诊就诊的耳溢液就诊率从 133 例下降至 83 例（差异 95%置信区间为 42-53；P <0.001），主要是由于肺炎球菌病发病率下降（48%下降-25 例与每 10000 例急诊就诊 13 例；P <0.001）。流感嗜血杆菌引起的耳溢液减少了 20%（20-16 例/每 10000 次就诊；P <0.001）。2006 年，血清型 19A 占 47 株（2%）肺炎球菌株的 1 株，2007 年占 34 株（15%）的 5 株，2008 年占 53 株（25%）的 13 株（趋势 P 值：0.001）。在疫苗接种年后，青霉素耐药肺炎球菌株（最小抑菌浓度≥2μg/ml）从 4%增加到 13%（P <0.001）。然而，对大环内酯类药物耐药的肺炎球菌比例下降（44%比 35%；P = 0.01）。
结论
免疫接种后，耳溢液事件明显减少，主要是由于肺炎球菌病的减少。流感嗜血杆菌现在是主要的病原体。血清型 19A 显著增加，是最常见的非疫苗肺炎球菌血清型。近年来青霉素耐药性增加。
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