Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Pediatric Infectious Diseases Unit, Soroka University Medical Center.
Clin Infect Dis. 2017 Nov 13;65(11):1853-1861. doi: 10.1093/cid/cix673.
Reductions in otitis media (OM) burden following rollout of pneumococcal conjugate vaccines (PCVs) have exceeded predictions of vaccine impact. In settings with active surveillance, reductions in OM caused by vaccine-targeted pneumococcal serotypes have co-occurred with reductions in OM caused by other pathogens carried in the upper-respiratory tract of children. To understand these changes, we investigated the progression of vaccine-targeted and non-vaccine pneumococcal serotypes from carriage to OM before and after vaccine rollout.
Nasopharyngeal carriage prevalence of pneumococcus was monitored in prospective studies of Bedouin and Jewish children <3 years old in southern Israel between 2004 and 2016. Incidence of OM necessitating middle-ear fluid culture (predominantly complex OM including recurrent, spontaneously-draining, non-responsive, and chronic cases) was monitored via prospective, population-based active surveillance. We estimated rates of pneumococcal serotype-specific progression from carriage to disease before and after rollout of PCV7/13, measured as OM incidence per carrier. We pooled serotype-specific estimates using Bayesian random-effects models.
On average, rates of progression declined 92% (95% credible interval: 79-97%) and 80% (46-93%) for PCV7/13 serotypes among Bedouin and Jewish children <12 months old, respectively, and 32% (-58-71%) and 61% (-5-86%) among children aged 12-35m. For non-vaccine serotypes, rates of progression among Bedouin and Jewish children aged <12m declined 74% (55-85%) and 43% (4-68%), respectively.
Vaccine-targeted and non-vaccine pneumococcal serotypes showed lower rates of progression to complex OM after rollout of PCV7/13. Early-life OM episodes historically associated with vaccine-serotype pneumococci may impact the susceptibility of children to OM progression.
肺炎球菌结合疫苗（PCV）推出后，中耳炎（OM）负担的减少超过了疫苗影响的预测。在有主动监测的环境中，疫苗针对的肺炎球菌血清型引起的 OM 减少与儿童上呼吸道携带的其他病原体引起的 OM 减少同时发生。为了了解这些变化，我们调查了疫苗针对和非疫苗肺炎球菌血清型从携带到疫苗推出前后 OM 的进展。
在 2004 年至 2016 年期间，对以色列南部的贝都因和犹太儿童进行了前瞻性研究，监测鼻咽部肺炎球菌携带率。通过前瞻性、基于人群的主动监测，监测需要中耳液培养的 OM 发病率（主要是复杂 OM，包括复发性、自发性引流、无反应性和慢性病例）。我们估计了 PCV7/13 推出前后从携带到疾病的肺炎球菌血清型特异性进展率，以每携带者 OM 发病率来衡量。我们使用贝叶斯随机效应模型汇总了血清型特异性估计值。
平均而言，PCV7/13 血清型在 12 个月以下的贝都因和犹太儿童中的进展率分别下降了 92%（95%可信区间：79-97%）和 80%（46-93%），而在 12-35 个月的儿童中分别下降了 32%（-58-71%）和 61%（-5-86%）。对于非疫苗血清型，12 个月以下的贝都因和犹太儿童的进展率分别下降了 74%（55-85%）和 43%（4-68%）。
PCV7/13 推出后，疫苗针对和非疫苗肺炎球菌血清型向复杂 OM 进展的速度较慢。历史上与疫苗血清型肺炎球菌相关的婴儿期 OM 发作可能会影响儿童对 OM 进展的易感性。
