Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev.
Faculty of Health Sciences, Ben-Gurion University of the Negev Department of Otolaryngology, Soroka University Medical Center, Beer-Sheva, Israel.
Clin Infect Dis. 2016 Sep 1;63(5):611-8. doi: 10.1093/cid/ciw347. Epub 2016 May 25.
Pneumococcal conjugated vaccines (PCVs) impact on complex otitis media (OM; including recurrent, nonresponsive, and chronic OM with effusion) was greater than that on simple, acute OM in previous studies. Since complex OM is often a polymicrobial disease, we speculated that reduction of complex OM by PCVs would be associated with reduction of non-pneumococcal OM.
In a prospective, population-based, active surveillance, all OM episodes submitted for middle ear fluid culture in children <3 years from 2004 through 2015 were included. Three sub-periods were established: pre-PCV, PCV7, and PCV13. Incidence rate ratios (IRRs) comparing the 3 periods were calculated for pneumococcal, nontypable Haemophilus influenzae (NTHi), Moraxella catarrhalis, Streptococcus pyogenes, and culture-negative OM.
Overall, 7475 episodes were included. Of all-NTHi cases in the pre-PCV period, 34% were mixed with Streptococcus pneumoniae IRRs (95% confidence interval) comparing the pre-PCV to the PCV13 period were 0.02 (0.01-0.04), 0.12 (0.08-0.20), and 0.18 (0.15-0.21) for PCV7+6A serotypes, 5 additional PCV13 serotypes, and all-pneumococcal OM, respectively; non-PCV13 serotype episodes were not significantly reduced. IRRs for single NTHi, mixed NTHi + S. pneumoniae, and all-NTHi OM were 0.30 (0.25-0.35), 0.18 (0.13-0.24), and 0.25 (0.22-0.29), respectively. Moraxella catarrhalis, S. pyogenes, and culture-negative episodes were also significantly reduced.
Both pneumococcal and non-pneumococcal OM episodes, enriched with complex cases, declined substantially in children <3 years following sequential PCV7/PCV13 introduction. The reduction in non-pneumococcal episodes may be attributed to early OM episodes prevention, resulting in a lower rate of complex, often non-pneumococcal OM.
在之前的研究中，肺炎球菌结合疫苗（PCV）对复杂中耳炎（包括复发性、无反应性和慢性伴渗出性中耳炎）的影响大于对单纯性急性中耳炎的影响。由于复杂中耳炎通常是一种多微生物疾病，我们推测 PCV 对复杂中耳炎的减少将与非肺炎球菌中耳炎的减少相关。
在一项前瞻性、基于人群的主动监测中，纳入了 2004 年至 2015 年期间 3 岁以下儿童提交的中耳液培养的所有中耳炎发作。建立了三个子时间段：PCV7 前、PCV7 和 PCV13。计算了比较三个时间段的肺炎球菌、非典型流感嗜血杆菌（NTHi）、卡他莫拉菌、化脓性链球菌和培养阴性中耳炎的发病率比值（IRR）。
总体而言，共纳入了 7475 例发作。在 PCV7 前时期所有 NTHi 病例中，34%为混合性肺炎链球菌。比较 PCV7 前时期与 PCV13 时期的 IRR 分别为 0.02（0.01-0.04）、0.12（0.08-0.20）和 0.18（0.15-0.21），用于 PCV7+6A 血清型、5 种额外的 PCV13 血清型和所有肺炎球菌性中耳炎；非 PCV13 血清型发作未显著减少。单独的 NTHi、混合的 NTHi+S. pneumoniae 和所有 NTHi 中耳炎的 IRR 分别为 0.30（0.25-0.35）、0.18（0.13-0.24）和 0.25（0.22-0.29）。卡他莫拉菌、化脓性链球菌和培养阴性发作也显著减少。
在序贯 PCV7/PCV13 引入后，3 岁以下儿童的肺炎球菌和非肺炎球菌中耳炎发作均显著减少，其中复杂病例较多。非肺炎球菌发作的减少可能归因于早期中耳炎发作的预防，从而导致复杂、常为非肺炎球菌中耳炎的发生率降低。
