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接种疫苗、潜在合并症与侵袭性肺炎球菌病风险。

Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease.

机构信息

Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts

Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts.

出版信息

Pediatrics. 2015 Mar;135(3):495-503. doi: 10.1542/peds.2014-2426. Epub 2015 Feb 2.

Abstract

OBJECTIVES

Children with underlying conditions remain at increased risk for invasive pneumococcal diseases (IPD). This study describes the epidemiology, serotype distribution, clinical presentations, and outcomes of IPD in children with and without comorbidity.

METHODS

Cases of childhood IPD in Massachusetts were identified via enhanced surveillance from 2002 through 2014. Demographic and clinical data were collected via follow-up telephone interviews with parents and/or primary care providers. Underlying conditions were classified according to the 2012 Report of the Committee on Infectious Diseases and 2013 recommendations by the Advisory Committee on Immunization Practices.

RESULTS

Among 1052 IPD cases in Massachusetts children <18 years old, 22.1% had at least 1 comorbidity. Immunocompromising conditions (32.7%) and chronic respiratory diseases (22.4%) were most common. Children with comorbidities were older at the time of IPD diagnosis (median 54 vs 23 months, P < .001), had higher hospitalization (odds ratio 2.5; 95% confidence interval 1.7-3.6) and case-fatality rates (odds ratio 3.7; 95% confidence interval 1.5-8.9) compared with children without known underlying conditions after adjusting for age, gender, year of diagnosis, and pneumococcal vaccination status. During the last 2 years of the study, IPD among children with comorbidities was caused by non-pneumococcal conjugate vaccine 13 serotypes in 23-valent polysaccharide pneumococcal vaccine (6/12, 50%) or serotypes that are not included in any of the vaccines (6/12; 50%).

CONCLUSIONS

In children with comorbidity, IPD results in higher mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. Further research is needed, specifically to develop and evaluate additional strategies for prevention of IPD in the most vulnerable children.

摘要

目的

患有基础疾病的儿童仍然存在罹患侵袭性肺炎球菌病(IPD)的风险增加。本研究描述了患有和不患有合并症的儿童中 IPD 的流行病学、血清型分布、临床表现和结局。

方法

通过 2002 年至 2014 年的强化监测,在马萨诸塞州发现了儿童 IPD 病例。通过对父母和/或初级保健提供者的后续电话访谈收集了人口统计学和临床数据。根据 2012 年传染病委员会报告和 2013 年免疫实践咨询委员会建议对基础疾病进行了分类。

结果

在马萨诸塞州<18 岁的 1052 例 IPD 病例中,22.1%有至少 1 种合并症。免疫功能低下的疾病(32.7%)和慢性呼吸道疾病(22.4%)最常见。患有合并症的儿童在 IPD 诊断时年龄更大(中位数 54 与 23 个月,P<0.001),调整年龄、性别、诊断年份和肺炎球菌疫苗接种状态后,与无已知基础疾病的儿童相比,住院率(比值比 2.5;95%置信区间 1.7-3.6)和病死率(比值比 3.7;95%置信区间 1.5-8.9)更高。在研究的最后 2 年中,患有合并症的儿童中,12 例中有 6 例(50%)由非肺炎球菌结合疫苗 13 型引起,而 23 价多糖肺炎球菌疫苗引起 6 例(50%),均不属于任何疫苗的血清型。

结论

在患有合并症的儿童中,IPD 导致更高的死亡率,且很大一部分疾病是由目前结合疫苗中未包含的血清型引起的。需要进一步研究,特别是制定和评估针对最脆弱儿童的 IPD 预防的额外策略。

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