PCV 时代婴幼儿脑膜炎、菌血症性肺炎和其他侵袭性肺炎球菌病的发病动态和血清型比较：来自以色列监测研究的结果。
Comparative incidence dynamics and serotypes of meningitis, bacteremic pneumonia and other-IPD in young children in the PCV era: Insights from Israeli surveillance studies.
机构信息
The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
出版信息
Vaccine. 2018 Aug 28;36(36):5477-5484. doi: 10.1016/j.vaccine.2017.05.059. Epub 2017 Jun 1.
INTRODUCTION
Widespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD. We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5years in Israel.
METHODS
A prospective, population-based, active nationwide surveillance. All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000-2008), PCV7 (2009-2011) and PCV13 (2014-2016). Incidence rate ratios (IRRs) were calculated.
RESULTS
Overall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD. In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p<0.001) and similar to that of meningitis (37.6%, p=0.1). The proportion of episodes in children <12months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p<0.001 for both). The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR=0.76; 95% CI 0.57-1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction. Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD.
CONCLUSIONS
Following PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities.
简介
肺炎球菌结合疫苗（PCV）的广泛应用对侵袭性肺炎球菌病（IPD）产生了影响。然而，IPD 各类型的减少情况可能并不相同。我们评估了 PCV7/PCV13 对以色列 5 岁以下儿童中肺炎球菌性脑膜炎、菌血症性肺炎（BP）和其他（非脑膜炎、非肺炎）IPD 病例的影响。
方法
这是一项前瞻性、基于人群的、全国性主动监测研究。纳入了 2000 年 7 月至 2016 年 6 月期间所有血/CSF 培养阳性的侵袭性肺炎球菌病例。定义了三个亚时期：PCV 前（2000-2008 年）、PCV7（2009-2011 年）和 PCV13（2014-2016 年）。计算了发病率比值比（IRR）。
结果
共记录了 4321 例病例；456 例（10.6%）为脑膜炎，1478 例（34.2%）为肺炎，2387 例（55.2%）为其他 IPD。在 PCV 前时期，BP 中 PCV13 但不是 PCV7 血清型（主要为血清型 1、5 和 19A）的比例（43.3%）高于其他 IPD 病例（32.8%，p<0.001），与脑膜炎相似（37.6%，p=0.1）。在 12 个月以下的儿童中，脑膜炎的病例比例（52.1%）高于肺炎（23.2%）和其他 IPD 病例（39.5%；p<0.001 均如此）。这三种疾病的下降情况并不相似；脑膜炎的发病率下降了 24%，但无统计学意义（IRR=0.76；95%CI 0.57-1.01），而 BP 和其他 IPD 的发病率分别显著下降了 57%和 70%。与其他实体不同，BP 在引入 PCV7 后并未显著下降，而是在引入 PCV13 后才开始下降。与 PCV13 前时期相比，脑膜炎、肺炎和其他 IPD 由 PCV13 血清型（VT13）引起的发病率分别显著下降了 88%、95%和 97%。然而，非 VT13 引起的疾病增加了 256%、302%（分别在脑膜炎和肺炎中），而在其他 IPD 中仅增加了 116%。
结论
在引入 PCV7/PCV13 后，所有 3 组中由 VT13 引起的病例发病率均显著降低。然而，年龄分布、血清型替代和特定血清型下降的差异表明，这三种疾病的发病机制和宿主易感性不同。
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