New York City Department of Health and Mental Hygiene, New York.
Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Pediatr. 2015 Jul;169(7):646-52. doi: 10.1001/jamapediatrics.2015.0612.
Invasive pneumococcal disease (IPD) is a leading cause of pneumonia, meningitis, and bacteremia in children. In March 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to the routine childhood immunization schedule. The PCV13 contains 6 serotypes not included in the previously recommended 7-valent pneumococcal conjugate vaccine, including serotype 19A, the predominant cause of IPD prior to the introduction of PCV13.
To describe changes in the epidemiology and incidence of IPD in children younger than 5 years in New York City (NYC) after the introduction of PCV13 and assess PCV13 coverage in NYC.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of population-based IPD surveillance data of the general population residing in NYC between January 1, 2007, and December 31, 2012. Invasive pneumococcal disease cases were identified by laboratory reporting of positive pneumococcal cultures from a normally sterile body site in NYC residents younger than 5 years. Isolates were serotyped. Participants included 468 cases younger than 5 years with IPD reported through routine surveillance to the NYC Department of Health and Mental Hygiene.
Absolute differences and percentage changes in IPD incidence before and after the introduction of PCV13 by serotype grouping, age, and race/ethnicity. The number of PCV13 doses administered to children younger than 5 years was calculated using the NYC immunization information system.
There were 468 IPD cases from 2007 to 2012. The incidence of IPD decreased by 69.6% (95% CI, -79.3% to -55.5%) from 21.0 cases per 100 000 (2007-2009 mean) pre-PCV13 to 6.4 cases per 100 000 (2011-2012 mean) post-PCV13. Estimates of disease caused by serotypes included in the PCV13 decreased by 82.5% (95% CI, -90.0% to -69.3%), including a 79.7% reduction in serotype 19A (95% CI, -89.0% to -62.4%). Reductions in IPD incidence were seen in all age groups, with the largest reduction in children younger than 12 months (80.4%; P = .005). Incidence decreased significantly in all racial/ethnic groups. The percentage of children younger than 5 years in NYC with 1 or more doses of PCV13 increased from 47.8% in 2010 to 89.8% in 2012.
The incidence of IPD in NYC children younger than 5 years and, particularly, the incidence of IPD caused by serotype 19A decreased dramatically following the introduction of PCV13, with reductions among all age and racial/ethnic groups. This represents a significant achievement for public health immunization programs and underscores the importance of achieving high immunization coverage.
侵袭性肺炎球菌病（IPD）是儿童肺炎、脑膜炎和菌血症的主要病因。2010 年 3 月，13 价肺炎球菌结合疫苗（PCV13）被纳入儿童常规免疫接种计划。PCV13 包含 6 种血清型，而之前推荐的 7 价肺炎球菌结合疫苗不包含这 6 种血清型，其中包括血清型 19A，这是 PCV13 引入前导致 IPD 的主要原因。
描述 PCV13 引入后纽约市（NYC）5 岁以下儿童 IPD 的流行病学和发病率变化，并评估 NYC 的 PCV13 覆盖率。
设计、地点和参与者：对 2007 年 1 月 1 日至 2012 年 12 月 31 日期间居住在 NYC 的普通人群进行基于人群的 IPD 监测数据的回顾性分析。通过对 NYC 5 岁以下居民来自正常无菌部位的阳性肺炎球菌培养物的实验室报告来确定侵袭性肺炎球菌病病例。分离株进行血清分型。参与者包括通过常规监测向 NYC 卫生和精神卫生部报告的 468 例 IPD 病例。
按血清型分组、年龄和种族/族裔划分，PCV13 引入前后 IPD 发病率的绝对差异和百分比变化。使用 NYC 免疫信息系统计算 5 岁以下儿童接受的 PCV13 剂量数。
2007 年至 2012 年期间共发生 468 例 IPD 病例。与 PCV13 引入前相比（2007-2009 年平均值为 21.0 例/100000 人），IPD 的发病率下降了 69.6%（95%CI，-79.3%至-55.5%），2011-2012 年平均值为 6.4 例/100000 人。包括 PCV13 在内的血清型引起的疾病估计减少了 82.5%（95%CI，-90.0%至-69.3%），其中血清型 19A 减少了 79.7%（95%CI，-89.0%至-62.4%）。所有年龄组的 IPD 发病率均有所下降，12 个月以下儿童的降幅最大（80.4%；P=0.005）。所有种族/族裔群体的发病率均显著下降。NYC 5 岁以下儿童接受 1 剂或多剂 PCV13 的比例从 2010 年的 47.8%增加到 2012 年的 89.8%。
NYC 5 岁以下儿童 IPD 的发病率，特别是血清型 19A 引起的 IPD 发病率，在 PCV13 引入后显著下降，所有年龄组和种族/族裔组的发病率均有所下降。这是公共卫生免疫规划的一项重大成就，突显了实现高免疫覆盖率的重要性。
