From the *Medical Department, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; †Department of Pediatrics, Philippine General Hospital and National Institutes of Health, University of Philippines Manila, Manila, Philippines; ‡Infectious Diseases Section, Philippine Children's Medical Center, Quezon City, Philippines; §Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy, Detroit, MI; ¶Translational Research Divison, International Vaccine Institute, Seoul, Republic of Korea; Former Employee of Pfizer Global Research and Development, Paris, France; **Vaccines Clinical Research, ††Clinical Affairs, Specialty Care Business Unit, Pfizer Inc, Collegeville, PA; and ‡‡Former Employee of On Assignment Inc. contracted to Pfizer Inc, Collegeville, PA.
Pediatr Infect Dis J. 2013 Oct;32(10):e383-9. doi: 10.1097/INF.0b013e318298dfd5.
Worldwide, invasive pneumococcal disease (IPD) causes considerable morbidity and mortality among children, but incidence data in Asia are lacking. This 2-year hospital-based, prospective, surveillance study was conducted at 3 study sites in urban areas of the Philippines to estimate IPD and pneumonia incidence in children and describe the serotype distribution of invasive Streptococcus pneumoniae isolates.
Children aged 28 days to <60 months residing within the 3 surveillance areas presenting with possible IPD were enrolled. Initial diagnosis, history of pneumococcal vaccine receipt and previous antimicrobial treatment were recorded. Blood specimens were collected for S. pneumoniae identification and serotyping. Final diagnosis was determined for hospitalized subjects, subjects whose culture yielded S. pneumoniae and subjects with clinically suspected meningitis.
A total of 5940 subjects were enrolled, 47 IPD cases identified. IPD site rates were 33.49 per 100,000, 25.38 per 100,000 and 25.85 per 100,000. Chest radiograph-confirmed pneumonia incidence ranged from 633.74 to 1683.59 per 100,000. Highest chest radiograph-confirmed pneumonia incidence occurred in those 28 days to <6 months of age at 2 sites (2166.16 and 3891.94 per 100,000) and those 6-12 months of age at the third site (3847.52 per 100,000). Thirty-five S. pneumoniae isolates were serotyped; most commonly identified were serotypes 1, 2, 5, 6B, 14 and 18F. One serotype 14 isolate was erythromycin resistant. Previous antibiotic therapy was documented in 17-53% of subjects; 2 subjects had received pneumococcal vaccine. At 2 sites, one-third of IPD subjects died.
IPD is an important cause of morbidity and mortality among urban children in the Philippines. Our data support the expectation that widespread immunization would decrease IPD disease burden.
在全球范围内，侵袭性肺炎球菌病（IPD）会导致儿童出现大量发病和死亡，但亚洲缺乏相关发病数据。这项为期两年的、以医院为基础的、前瞻性监测研究在菲律宾城市地区的 3 个研究点进行，旨在估计儿童中 IPD 和肺炎的发病情况，并描述侵袭性肺炎链球菌分离株的血清型分布。
研究纳入了居住在 3 个监测区域内、年龄在 28 天至<60 个月之间、疑似患有侵袭性肺炎球菌病的儿童。记录了初始诊断、肺炎球菌疫苗接种史和之前使用过的抗菌药物治疗情况。采集血样进行肺炎链球菌的鉴定和血清分型。对住院患者、培养出肺炎链球菌的患者和疑似脑膜炎的患者进行了最终诊断。
共纳入了 5940 名患者，发现了 47 例 IPD 病例。IPD 部位发生率分别为每 10 万人 33.49、25.38 和 25.85。胸片确诊肺炎的发病率范围为每 10 万人 633.74 至 1683.59。在 2 个研究点，28 天至<6 个月年龄组（每 10 万人 2166.16 和 3891.94）和 6-12 个月年龄组（每 10 万人 3847.52）的胸片确诊肺炎发病率最高。35 株肺炎链球菌分离株进行了血清分型；最常见的血清型为 1、2、5、6B、14 和 18F。1 株 14 血清型分离株对红霉素耐药。17-53%的患者记录了之前的抗生素治疗情况；2 例患者接受过肺炎球菌疫苗接种。在 2 个研究点，三分之一的 IPD 患者死亡。
在菲律宾城市儿童中，侵袭性肺炎球菌病是发病和死亡的一个重要原因。我们的数据支持这样一种预期，即广泛免疫接种将降低 IPD 的疾病负担。
