Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China.
PLoS One. 2011;6(11):e27333. doi: 10.1371/journal.pone.0027333. Epub 2011 Nov 16.
To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials.
Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.
为了了解中国 1 至 59 月龄儿童中肺炎链球菌疾病的负担和流行病学情况，我们对 1980 年至 2008 年期间发表的文献进行了综述，并应用了标准化的算法。由于缺乏针对肺炎链球菌疾病（PD）的基于人群的监测，我们确定了所有病因肺炎、菌血症和脑膜炎的负担，以及与肺炎链球菌最相关的综合征，并应用了这些综合征病因研究中确定的肺炎链球菌在这些疾病中所占的比例，来计算 PD 负担。由于微生物学上难以确定肺炎链球菌引起的肺炎，这可能会低估肺炎负担，因此我们也使用了疫苗效力试验中获得的比例。
1980 年至 2008 年间，1 至 59 月龄儿童的所有病因肺炎的发生率为每 10 万人 12815 例/年，每年有 526 例死亡。脑膜炎的发生率为每 10 万人 14 例。我们估计，截至 2000 年，分别有 260768（113000 至 582382）例和 902（114 至 4463）例肺炎链球菌性肺炎和脑膜炎，分别有 10703（4638 至 23904）例和 75（9 至 370）例肺炎链球菌性肺炎和脑膜炎死亡。当使用疗效试验的参数时，肺炎链球菌性肺炎病例和死亡人数分别增加了两倍多，分别为 695382（173845 至 1216918）例和 28542（7136 至 49949）例。从肺炎/脑膜炎患者中获得的最常见血清型为 19F、19A 和 14。目前可用的疫苗预计将涵盖 79.5%至 88.4%的流行血清型。由于抗生素耐药性高，中国应考虑将肺炎球菌疫苗纳入常规免疫计划。有必要开展基于人群的研究。
