Microbiology Department, Hospital Clínico San Carlos, Madrid, Spain.
Pediatr Infect Dis J. 2013 Jun;32(6):656-61. doi: 10.1097/INF.0b013e31827e8594.
Differences in invasive pneumococcal disease (IPD) in children are expected after a change from 7-valent pneumococcal conjugate vaccine (PCV7) to 13-valent pneumococcal conjugate vaccine (PCV13). Universal vaccination with PCV7 started in Madrid in November 2006, and it switched to PCV13 in June 2010.
A prospective, laboratory-confirmed (by culture or polymerase chain reaction), clinical surveillance including all pediatric IPD requiring hospitalization in Madrid was performed in all hospitals with a pediatric department and included four 1-year periods from May 2007 to April 2011. Incidence rate (IR) was calculated as number cases per 100,000 inhabitants using children population data.
Six hundred fourteen IPDs were identified: 209 parapneumonic pneumococcal empyema, 191 bacteremic pneumonia, 75 primary bacteremia, 72 meningitis, 38 IPDs secondary to otic foci and 29 others. The incidence of IPD remained unchanged during 2007-2010 (IR=≈17.0), with a marked decrease in 2010-2011 (IR=11.34; P<0.05) attributable to reduction in children younger than 24 months (50.19 in 2008-2009 compared with 24.92 in 2010-2011; P<0.005). The incidence of bacteremic pneumonia (R²=0.966; β=1.132; P=0.017) and meningitis (R²=0.898; β=0.505; P=0.052) showed decreasing linear trends over time. The incidence of parapneumonic pneumococcal empyema increased in 2009-2010 but decreased in 2010-2011 (6.73 vs. 4.14; P=0.019). The incidence of IPDs by PCV13 serotypes was significantly (P≤0.004) lower in 2010-2011 (8.78) than in previous periods (IR=≈13.5).
Early data regarding changing from PCV7 to PCV13 use in the childhood vaccination calendar indicate that reductions in IR of bacteremic pneumonia and meningitis after PCV7 introduction (by reduction of cases by serotypes 1 and 19A) further decreased and there was a reversion of the increase in IR of parapneumonic pneumococcal empyema from 2010-2011, mainly because of reduction in serotype 1 and 19A cases.
7 价肺炎球菌结合疫苗（PCV7）转换为 13 价肺炎球菌结合疫苗（PCV13）后，预计儿童侵袭性肺炎球菌病（IPD）会出现差异。2006 年 11 月，马德里开始对 PCV7 进行普遍疫苗接种，2010 年 6 月改为 PCV13。
对马德里所有需要住院的儿科 IPD 进行了前瞻性、实验室确诊（通过培养或聚合酶链反应）、临床监测，包括所有儿科 IPD，所有有儿科病房的医院均参与了该监测，包括 2007 年 5 月至 2011 年 4 月的四个 1 年期间。发病率（IR）按每 10 万名居民的病例数计算，使用儿童人口数据。
共发现 614 例 IPD：209 例肺炎旁脓性胸腔积液，191 例菌血症性肺炎，75 例原发性菌血症，72 例脑膜炎，38 例中耳炎病灶继发性 IPD，29 例其他。2007-2010 年期间，IPD 的发病率保持不变（IR≈17.0），2010-2011 年期间发病率明显下降（IR=11.34；P<0.05），这主要归因于 24 个月以下儿童的减少（2008-2009 年为 50.19，2010-2011 年为 24.92；P<0.005）。菌血症性肺炎（R²=0.966；β=1.132；P=0.017）和脑膜炎（R²=0.898；β=0.505；P=0.052）的发病率呈线性下降趋势。2009-2010 年期间肺炎旁脓性胸腔积液的发病率增加，但 2010-2011 年期间发病率下降（6.73 比 4.14；P=0.019）。2010-2011 年期间，13 价肺炎球菌结合疫苗血清型所致 IPD 的发病率明显（P≤0.004）降低（IR=≈13.5）。
根据儿童免疫接种日程表从使用 PCV7 转换为使用 PCV13 的早期数据表明，PCV7 引入后菌血症性肺炎和脑膜炎的发病率降低（由于血清型 1 和 19A 病例减少）进一步降低，肺炎旁脓性胸腔积液的发病率从 2010-2011 年开始出现逆转，主要是由于血清型 1 和 19A 病例减少。
