Pediatric Infectious Disease Unit The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Otolaryngology, Soroka University Medical Center The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Clin Infect Dis. 2014 Dec 15;59(12):1724-32. doi: 10.1093/cid/ciu683. Epub 2014 Aug 25.
Otitis media (OM) is common in early childhood. Streptococcus pneumoniae caused approximately 30%-60% of episodes before the pneumococcal conjugate vaccine (PCV) era. The 7-valent PCV (PCV7) was introduced to the Israeli National Immunization Plan in July 2009, and was gradually replaced by the 13-valent PCV (PCV13) starting in November 2010. We aimed at assessing the impact of PCV7/PCV13 sequential introduction on pneumococcal and overall OM necessitating middle ear fluid culture in children aged <2 years in southern Israel.
This was a prospective, population-based, active surveillance. Our medical center is the only one in the region, enabling incidence calculation. All pneumococcal episodes submitted for culture between July 2004 and June 2013 were included. Three subperiods were defined: pre-PCV, PCV7, and PCV13.
Overall, 6122 OM episodes were recorded, and 1893 were pneumococcal. Compared with the pre-PCV period, OM caused by PCV7 plus serotype 6A and the 5 additional PCV13 serotypes (5VT : 1, 3, 5, 7F, 19A) decreased by 96% and 85%, respectively (incidence rate ratios [IRRs], 0.04 [95% confidence interval {CI}, .02-.08] and 0.15 [95% CI, .07-.30], respectively) in a 2-step pattern: In the PCV7 period, only OM caused by PCV7 + 6A serotypes was decreased; in the PCV13 period, 5VT OM rates decreased, along with an additional PCV7 + 6A OM reduction. A nonsignificant increase in non-PCV13 serotype OM was observed (IRR, 1.07 [95% CI, .72-1.58]). In total, 77% and 60% reductions of all-pneumococcal and all-cause OM incidences, respectively, were observed.
A substantial 2-step reduction of pneumococcal OM rates, with near-elimination of PCV13 disease, was observed shortly after PCV7/PCV13 introduction.
中耳炎（OM）在幼儿中很常见。在肺炎球菌结合疫苗（PCV）时代之前，肺炎链球菌大约引起 30%-60%的病例。7 价 PCV（PCV7）于 2009 年 7 月被引入以色列国家免疫计划，并从 2010 年 11 月开始逐步被 13 价 PCV（PCV13）取代。我们旨在评估 PCV7/PCV13 序贯接种对 2 岁以下儿童中需要中耳液培养的肺炎球菌和整体 OM 的影响。
这是一项前瞻性、基于人群的主动监测。我们的医疗中心是该地区唯一的一家，能够计算发病率。所有在 2004 年 7 月至 2013 年 6 月期间提交培养的肺炎球菌病例均被纳入研究。定义了三个亚期：PCV 前、PCV7 和 PCV13。
总体而言，共记录了 6122 例 OM 发作，其中 1893 例为肺炎球菌。与 PCV 前时期相比，PCV7 加血清型 6A 和 5 种额外的 PCV13 血清型（5VT：1、3、5、7F、19A）引起的 OM 分别减少了 96%和 85%（发病率比[IRR]，0.04[95%CI，0.02-0.08]和 0.15[95%CI，0.07-0.30]），呈 2 步模式：在 PCV7 时期，只有 PCV7+6A 血清型引起的 OM 减少；在 PCV13 时期，5VT OM 率下降，同时 PCV7+6A OM 减少。观察到非 PCV13 血清型 OM 呈非显著性增加（IRR，1.07[95%CI，0.72-1.58]）。总的来说，观察到所有肺炎球菌和所有病因 OM 发生率分别降低 77%和 60%。
在 PCV7/PCV13 引入后不久，肺炎球菌 OM 发生率呈显著 2 步下降，PCV13 疾病几乎消除。
