Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute.
School of Medicine, University of Western Australia.
Clin Infect Dis. 2018 Mar 19;66(7):1075-1085. doi: 10.1093/cid/cix923.
Pneumococcal conjugate vaccine (PCV) was included in Australia's National Immunisation Program for all children from 2005. We assessed the impact of PCV on all-cause and pathogen-specific pneumonia hospitalizations in Western Australian (WA) children aged ≤16 years.
All hospitalizations with pneumonia-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes occurring in WA-born children (1996-2012) were linked to pathology records. Age-specific incidence rate ratios and temporal trends for all-cause and pathogen-specific pneumonia hospitalizations were calculated before and after PCV introduction.
Among 469589 births, there were 15175 pneumonia-related hospitalizations. Hospitalization rates were 6.7 (95% confidence interval, 6.4-6.9) times higher in Aboriginal than in non-Aboriginal children. Following PCV introduction, all-cause pneumonia hospitalizations showed significant declines across all age groups. A pathogen was identified in 2785 of 6693 (41.6%) pneumonia hospitalizations that linked to a pathology record. Respiratory syncytial virus (RSV) was most frequently identified, with RSV-associated pneumonia hospitalization rates of 89.6/100000 child-years in Aboriginal and 26.6/100000 child-years in non-Aboriginal children. The most common bacterial pathogen was Streptococcus pneumoniae in Aboriginal children (32.9/100000 child-years) and Mycoplasma pneumoniae in non-Aboriginal children (8.4/100000 child-years). Viral pneumonia rates declined in all children following PCV introduction, with the greatest declines seen in non-Aboriginal children; declines in bacterial pneumonia were observed in non-Aboriginal children.
Based on our ecological analyses, PCV seems to have had an impact on hospitalizations for pneumonia, suggesting that the pneumococcus is likely to play a role in both bacterial and viral pneumonia. Respiratory viruses remain an important pathogen in childhood pneumonia. Vaccines targeting respiratory viruses are needed to combat the residual burden of childhood pneumonia.
肺炎球菌结合疫苗（PCV）于 2005 年被纳入澳大利亚国家免疫计划，为所有儿童接种。我们评估了 PCV 对西澳大利亚（WA）≤16 岁儿童所有病因和病原体特异性肺炎住院的影响。
WA 出生的儿童（1996-2012 年）中，所有与肺炎相关的国际疾病分类和相关健康问题第十次修订版（澳大利亚修订版）诊断代码的住院病例均与病理学记录相关联。在 PCV 引入前后，计算了所有病因和病原体特异性肺炎住院的年龄特异性发病率比值和时间趋势。
在 469589 例出生中，有 15175 例与肺炎相关的住院病例。土著儿童的住院率是非土著儿童的 6.7（95%置信区间，6.4-6.9）倍。在 PCV 引入后，所有年龄组的全因肺炎住院率均呈显著下降趋势。在与病理学记录相关联的 6693 例肺炎住院病例中，有 2785 例（41.6%）确定了病原体。呼吸道合胞病毒（RSV）是最常见的病原体，土著儿童的 RSV 相关肺炎住院率为 89.6/100000 儿童年，非土著儿童为 26.6/100000 儿童年。土著儿童中最常见的细菌病原体是肺炎链球菌（32.9/100000 儿童年），非土著儿童中最常见的细菌病原体是肺炎支原体（8.4/100000 儿童年）。在 PCV 引入后，所有儿童的病毒性肺炎发生率均下降，非土著儿童下降幅度最大；非土著儿童的细菌性肺炎也有所下降。
基于我们的生态分析，PCV 似乎对肺炎住院有影响，表明肺炎球菌可能在细菌性和病毒性肺炎中均发挥作用。呼吸道病毒仍然是儿童肺炎的一个重要病原体。需要针对呼吸道病毒的疫苗来对抗儿童肺炎的残余负担。
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