The Pediatric Infectious Disease Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Vaccine. 2012 Oct 12;30(46):6600-7. doi: 10.1016/j.vaccine.2012.08.012. Epub 2012 Aug 30.
The 7-valent conjugated vaccine (PCV7) was introduced into the Israeli National Immunization Program (NIP) in July 2009 (2, 4, 12 months schedule; 2 dose catch-up in second year of life). Nationwide active prospective surveillance on invasive pneumococcal disease (IPD) has been conducted in children since 1989. In the current study, IPD epidemiology in children <5 years during the 20 years before and 18 months after PCV7 NIP initiation, is reported.
All 27 centers performing blood/cerebrospinal fluid (CSF) cultures in children reported monthly IPD cases. Capture-recapture approach was used for completeness.
During 1989-2010, 6022 IPD cases were reported in children <5 years; PCV7 serotypes (7VST) caused ∼50% of all episodes. In 2009 and 2010, 7VST IPD incidences <5 years of age (per 100,000) were 15.9 and 5.4, respectively (a 43% and 81% decrease, respectively) compared to 2003-2007 (mean incidence 27.8). Serotype 6A dynamics resembled those of 7VST. The respective overall IPD incidence decreases were 23% and 42%. The incidence dynamics of serotypes 1, 3, 5, 7F and 19A IPD were characterized by considerable fluctuations over the study period without any upwards or downwards trend in any of the age groups. The overall incidence of serotypes not included in the 13-valent pneumococcal conjugate vaccine (PCV13) did not vary significantly during the study period. By the end of 2010, 72% of the remaining IPD was caused by pneumococcal serotypes included in PCV13.
An active prospective long-term surveillance, showed a rapid and sharp decline in IPD in children <5 years following initiation of NIP with PCV7. No serotype replacement has been observed so far. The transition from PCV7 to PCV13 initiated in October 2010 may lead to a further substantial decrease in IPD. Follow-up is needed to better determine the long-term PCV effects.
7 价结合疫苗（PCV7）于 2009 年 7 月被引入以色列国家免疫计划（NIP）（2、4、12 个月的接种程序；第二年进行两剂补种）。自 1989 年以来，一直在儿童中开展全国性的侵袭性肺炎球菌病（IPD）主动前瞻性监测。在本研究中，报告了 PCV7 NIP 启动前 20 年和启动后 18 个月期间 <5 岁儿童的 IPD 流行病学。
所有进行儿童血液/脑脊液（CSF）培养的 27 个中心每月报告 IPD 病例。采用捕获-再捕获方法进行完整性评估。
1989 年至 2010 年，报告了 6022 例 <5 岁儿童 IPD 病例；PCV7 血清型（7VST）引起了约 50%的所有病例。2009 年和 2010 年，<5 岁儿童的 7VST IPD 发病率（每 100,000 人）分别为 15.9 和 5.4（分别下降 43%和 81%），而 2003-2007 年（平均发病率为 27.8）。6A 血清型的动态变化与 7VST 相似。总的 IPD 发病率分别下降了 23%和 42%。1、3、5、7F 和 19A IPD 的血清型发病率在整个研究期间波动较大，任何年龄组均无上升或下降趋势。研究期间，未包含在 13 价肺炎球菌结合疫苗（PCV13）中的血清型的总体发病率没有明显变化。到 2010 年底，剩余的 IPD 中有 72%由 PCV13 中包含的肺炎球菌血清型引起。
一项主动的长期前瞻性监测显示，在 PCV7 启动 NIP 后，<5 岁儿童的 IPD 迅速而急剧下降。到目前为止，尚未观察到血清型替代。2010 年 10 月启动的从 PCV7 到 PCV13 的过渡可能会导致 IPD 进一步显著下降。需要进行随访以更好地确定长期 PCV 效果。
