7 价肺炎球菌结合疫苗时代三级儿童医院侵袭性肺炎球菌病的流行情况变化：持续监测的必要性。
The changing epidemiology of invasive pneumococcal disease at a tertiary children's hospital through the 7-valent pneumococcal conjugate vaccine era: a case for continuous surveillance.
机构信息
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT 84108, USA.
出版信息
Pediatr Infect Dis J. 2012 Mar;31(3):228-34. doi: 10.1097/INF.0b013e31823dcc72.
BACKGROUND
In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7) was licensed for use among US children. Many sites have since reported changes in invasive pneumococcal disease (IPD). We recognized an opportunity to describe the changes in epidemiology, clinical syndromes, and serotype distribution during a 14-year period including 4 years before vaccine introduction and spanning the entire PCV7 era.
METHODS
Cases were defined as children <18 years of age who were cared for at Primary Children's Medical Center for culture-confirmed IPD. We defined the prevaccine period as the time frame spanning from 1997 to 2000 and the postvaccine period from 2001 to 2010. Demographics, clinical data, and outcomes were collected through electronic query and chart review. Streptococcus pneumoniae serotyping was performed using the capsular swelling method.
RESULTS
The median age of children with IPD increased from 19 months during the prevaccine period to 27 months during postvaccine period (P = 0.02), with a larger proportion of IPD among children older than 5 years. The proportion of IPD associated with pneumonia increased substantially from 29% to 50% (P < 0.001). This increase was primarily attributable to an increase in complicated pneumonia (17% to 33%, P < 0.001). Nonvaccine serotypes 7F, 19A, 22F, and 3 emerged as the dominant serotypes in the postvaccine period. In children with IPD who were younger than 5 years, for whom vaccine is recommended, 67% of the cases were caused by serotypes in 13-valent PCV during 2005 to 2010.
CONCLUSIONS
After PCV7 was introduced, significant changes in IPD were noted. One-third of IPD occurred in children older than 5 years, who were outside the age-group for which PCV is recommended. Continued surveillance is warranted to identify further evolution of the epidemiology, clinical syndromes, and serotype distribution of S. pneumoniae after 13-valent PCV licensure.
背景
2000 年，一种 7 价肺炎球菌结合疫苗（PCV7）在美国儿童中获得许可使用。此后，许多地方都报告了侵袭性肺炎球菌病（IPD）的变化。我们认识到有机会在包括疫苗引入前 4 年和整个 PCV7 时代在内的 14 年期间描述流行病学、临床综合征和血清型分布的变化。
方法
病例定义为在 Primary Children's Medical Center 接受培养证实的 IPD 治疗的<18 岁儿童。我们将疫苗前时期定义为 1997 年至 2000 年的时间段，将疫苗后时期定义为 2001 年至 2010 年的时间段。通过电子查询和图表审查收集人口统计学、临床数据和结果。使用荚膜肿胀法对肺炎链球菌进行血清分型。
结果
IPD 患儿的中位年龄从疫苗前时期的 19 个月增加到疫苗后时期的 27 个月（P = 0.02），5 岁以上患儿的 IPD 比例较大。与肺炎相关的 IPD 比例从 29%大幅增加到 50%（P<0.001）。这种增加主要归因于复杂肺炎的增加（17%至 33%，P<0.001）。非疫苗血清型 7F、19A、22F 和 3 在疫苗后时期成为主要血清型。在<5 岁的推荐接种疫苗的 IPD 患儿中，2005 年至 2010 年期间，13 价 PCV 引起的病例中有 67%是由血清型引起的。
结论
PCV7 推出后，IPD 发生了显著变化。三分之一的 IPD 发生在 5 岁以上的儿童中，他们不在 PCV 推荐的年龄组内。在 13 价 PCV 获得许可后，需要继续进行监测，以确定肺炎链球菌的流行病学、临床综合征和血清型分布的进一步演变。
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