Jimenez Trujillo Isabel, Lopez de Andres Ana, Hernandez-Barrera Valentin, Martinez-Huedo Maria A, de Miguel-Diez Javier, Jimenez-Garcia Rodrigo
Preventive Medicine Unit, Rey Juan Carlos University, Avda de Atenas s/n, Alcorcón 28922, Madrid, Spain.
Preventive Medicine Department, Hospital La Paz, Madrid, Spain.
Vaccine. 2017 Jun 27;35(30):3733-3740. doi: 10.1016/j.vaccine.2017.05.055. Epub 2017 May 27.
To describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalizations among Spanish children from 2001 to 2014 and to assess the effect of the pneumococcal vaccination (PCV) coverage in this period.
This study was conducted using the Spanish National Hospital Database from 2001 to 2014 including subjects <18years. We selected discharges with a primary diagnosis of CAP. Study variable included age, sex, comorbid conditions, procedures, isolated pathogens and hospital outcome variables. In order to estimate the effect of coverage of pneumococcal vaccination in hospitalizations for CAP, we used the number of commercialized doses of PCV (PCV7 PCV10, and PCV13) for each year. Incidence rates of admissions for CAP were calculated by dividing the number of admissions per year, sex, and age group by the corresponding number of people in that population group according to the census data.
We identified 194,419 admissions for CAP. Incidence rate was highest among children younger than 2years and decreased significantly by 3.67% per year over the study period in this age group. Among children aged 2-4years incidence of CAP seem to decrease after year 2009. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In children aged <2years and 2-4years increase in PVC was associated to a decrease in the incidence of CAP hospitalizations. Overall crude in hospital mortality following CAP fell significantly from 4.1‰ in 2001-2003 to 2.8‰ in 2012-2014.
CAP incidence rates decreased significantly among children <2years of age from 2001 to 2014. S. pneumoniae isolations decreased significantly over time but virus isolations increased. In hospital mortality paralleling CAP fell significantly in children and adolescents from 2001 to 2014. Improvement in vaccination coverage seems to have a mitigating effect on hospitalizations and outcomes for CAP in children.
描述2001年至2014年西班牙儿童社区获得性肺炎（CAP）住院的发病率及转归趋势，并评估该时期肺炎球菌疫苗（PCV）接种覆盖率的影响。
本研究使用2001年至2014年西班牙国家医院数据库，纳入年龄小于18岁的受试者。我们选取了以CAP为主要诊断的出院病例。研究变量包括年龄、性别、合并症、诊疗操作、分离出的病原体及医院转归变量。为评估PCV接种覆盖率对CAP住院的影响，我们使用了每年商业化的PCV（PCV7、PCV10和PCV13）剂量数。CAP住院发病率通过将每年、按性别和年龄组划分的住院人数除以根据人口普查数据该人群组相应的人数来计算。
我们确定了194,419例CAP住院病例。2岁以下儿童的发病率最高，在该年龄组研究期间每年显著下降3.67%。在2至4岁儿童中，2009年后CAP发病率似乎有所下降。肺炎链球菌的分离率随时间显著下降，但病毒分离率上升。在2岁以下和2至4岁儿童中，PCV接种率的增加与CAP住院发病率的下降相关。CAP后总体粗住院死亡率从2001 - 2003年的4.1‰显著降至2012 - 2014年的2.8‰。
2001年至2014年，2岁以下儿童CAP发病率显著下降。肺炎链球菌的分离率随时间显著下降，但病毒分离率上升。2001年至2014年，儿童和青少年中与CAP相关的住院死亡率显著下降。疫苗接种覆盖率的提高似乎对儿童CAP的住院情况及转归有缓解作用。
