Tagarro Alfredo, Bote Patricia, Sánchez Aida, Otheo Enrique, Sanz Juan-Carlos, Sanz-Rosa David
From the *Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; †Biomedical School, Universidad Europea de Madrid, Madrid, Spain; ‡Pediatrics, Tropical and Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain; §Microbiology Department, Laboratory BR, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; ¶Pediatrics Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; and ‖Regional Public Health Laboratory, Comunidad de Madrid, Madrid, Spain.
Pediatr Infect Dis J. 2016 Dec;35(12):1281-1287. doi: 10.1097/INF.0000000000001302.
In the Region of Madrid, universal immunization with the 13-serotypes pneumococcal conjugate vaccine (PCV13) started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. Our aim was to investigate the impact of PCV13 withdrawal from Madrid Region universal immunization program on the incidence of complicated pneumococcal bacteremia.
We performed a multicenter retrospective cohort study, from 2009 to 2014. Participants were children aged <14 years with Streptococcus pneumoniae bacteremia. Complications were defined as any condition requiring intensive care or surgery. Sequelae were conditions lasting ≥90 days.
A total of 168 patients were recruited. One-fourth of both immunized and nonimmunized patients had complications. Global complications increased after PCV13 withdrawal. About 28% of PCV13 serotypes presented complications. Complications caused by PCV13 serotypes did not increase after July 2012. Non-PCV13 serotypes increased progressively from 2009 on, and 23% presented complications. A significant risk of complications was found for patients with meningitis, empyema, C-reactive protein >100 mg/L and serotype 1. A multivariate analysis indicated that complications were associated with meningitis and hospital admission after July 2012. Sequelae were significantly associated with children <2 years of age, meningitis and non-PCV13 serotypes.
The incidence of complications caused by PCV13 serotypes did not increase 2 years after PCV13 withdrawal. Nevertheless, all-serotypes complications increased. The likely cause was that non-PCV13 serotypes (associated with meningitis) are on the rise.
在马德里地区，13价肺炎球菌结合疫苗（PCV13）的普遍免疫接种于2010年5月开始。2012年7月，公共资金停止。疫苗接种覆盖率从2013年的>95%降至82%，并在2014年降至67%。我们的目的是调查从马德里地区普遍免疫计划中撤出PCV13对复杂性肺炎球菌菌血症发病率的影响。
我们进行了一项从2009年至2014年的多中心回顾性队列研究。参与者为年龄<14岁的肺炎链球菌菌血症儿童。并发症定义为任何需要重症监护或手术的情况。后遗症是持续≥90天的情况。
共招募了168名患者。免疫接种和未免疫接种的患者中均有四分之一出现并发症。PCV13撤出后，总体并发症增加。约28%的PCV13血清型出现并发症。2012年7月后，由PCV13血清型引起的并发症并未增加。非PCV13血清型从2009年起逐渐增加，23%出现并发症。发现患有脑膜炎、脓胸、C反应蛋白>100mg/L和血清型1的患者发生并发症的风险显著。多变量分析表明，并发症与脑膜炎和2012年7月后的住院有关。后遗症与2岁以下儿童、脑膜炎和非PCV13血清型显著相关。
PCV13撤出2年后，由PCV13血清型引起的并发症发病率并未增加。然而，所有血清型的并发症均增加。可能的原因是与脑膜炎相关的非PCV13血清型正在增加。
