Iroh Tam Pui-Ying, Thielen Beth K, Obaro Stephen K, Brearley Ann M, Kaizer Alexander M, Chu Haitao, Janoff Edward N
University of Minnesota Medical School, Minneapolis, MN, USA; Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
University of Minnesota Medical School, Minneapolis, MN, USA.
Vaccine. 2017 Apr 4;35(15):1817-1827. doi: 10.1016/j.vaccine.2017.02.045. Epub 2017 Mar 9.
Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV).
To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000 to 2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models.
We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively.
Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.
在广泛引入肺炎球菌结合疫苗（PCV）之前，确定非洲儿童侵袭性肺炎球菌疾病（IPD）的发病率、与疾病相关的血清型及抗菌药物敏感性对于监测这些感染的影响至关重要。
为提供非洲地区引起疾病的肺炎链球菌发病率、血清型分布及抗菌药物敏感性概况的最新估计值，我们使用Ovid Medline和Embase对2000年至2015年发表的文章进行了系统评价。我们纳入了应用预定义诊断标准的前瞻性研究和监测研究。所有汇总分析的荟萃分析均基于随机效应模型。
我们纳入了38项研究，涉及21个国家的386,880名参与者，总计350,613人年。IPD的汇总发病率为每10万人年62.6（95%可信区间16.9, 226.5），其中脑膜炎的汇总发病率为每10万人年24.7（95%可信区间11.9, 51.6）。青霉素敏感性的汇总患病率为78.1%（95%可信区间61.9, 89.2）。累计而言，PCV10和PCV13分别涵盖了66.9%（95%可信区间55.9, 76.7）和80.6%（95%可信区间66.3, 90.5）的IPD血清型。
我们的研究提供了非洲大陆在广泛引入PCV之前5岁及以下儿童肺炎链球菌发病率数据、血清型分布和抗菌药物敏感性的综合且可靠的总结。研究的异质性以及非洲大陆发病率的广泛范围表明，应加强非洲所有地区的监测工作，以提高流行病学数据的完整性、疫苗影响及成本效益。尽管非洲幼儿中IPD的发病率很高，但据估计，目前可用的结合疫苗可覆盖大多数引起侵袭性疾病的肺炎球菌血清型。这些数据提供了一个可靠的基线，可据此监测广泛引入PCV的影响。
