Palmu Arto A, Rinta-Kokko Hanna, Nohynek Hanna, Nuorti J Pekka, Jokinen Jukka
Pediatr Infect Dis J. 2018 Jan;37(1):97-102. doi: 10.1097/INF.0000000000001810.
Otitis media in young children is associated with major resource use including antimicrobial consumption and tympanostomy tube placements (TTPs). We evaluated the impact of 10-valent pneumococcal conjugate vaccine (PCV10) introduction into the Finnish National Vaccination Programme (NVP) against these outcomes in vaccine-eligible children.
PCV10-NVP began September 2010 with a 2 + 1 schedule; uptake in 2012 was estimated at 92%. The relative and absolute reduction in the NVP-eligible target cohort was compared with a season and age-matched (3-54 months) cohort before NVP introduction. Outpatient antimicrobial purchase data were collected from the Social Insurance Institution register. Data on purchases of antimicrobials recommended for treatment of acute otitis media by the Finnish Current Care Guidelines (amoxicillin with/without enzyme inhibitor, cefuroxime, cefaclor, clarithromycin, azithromycin) were collected, but full data on penicillin and sulfadiazine/trimethoprim were not available. Data on all TTP procedures were obtained from national hospital discharge register and Social Insurance Institution benefits register. Generalized Cox regression was used in the analysis.
The incidence rates of antimicrobial purchases in the reference and target cohorts were 1.09 and 0.89 per person-year, respectively. The relative rate reduction was 17.5% (95% confidence interval: 17.0-18.1) and the absolute rate reduction 0.20 per person-year. The rates of TTP in the reference and target cohorts were 5.41/100 and 4.56/100 person-years, respectively. The relative rate reduction was 14.8% (95% confidence interval: 13.1-16.5) and the absolute rate reduction 0.86/100 person-years.
Use of antimicrobials and TTPs reduced after PCV10 was introduced into a routine vaccination program. This suggests considerable savings in health care resource use.
幼儿中耳炎与大量资源使用相关，包括抗菌药物消费和鼓膜置管术（TTP）。我们评估了在芬兰国家疫苗接种计划（NVP）中引入10价肺炎球菌结合疫苗（PCV10）对符合疫苗接种条件儿童的这些结局的影响。
PCV10-NVP于2010年9月开始，采用2+1接种程序；2012年的接种率估计为92%。将符合NVP条件的目标队列与NVP引入前季节和年龄匹配（3-54个月）的队列进行相对和绝对减少率比较。门诊抗菌药物购买数据从社会保险机构登记处收集。收集了芬兰现行护理指南推荐用于治疗急性中耳炎的抗菌药物（含/不含酶抑制剂的阿莫西林、头孢呋辛、头孢克洛、克拉霉素、阿奇霉素）的购买数据，但青霉素和磺胺嘧啶/甲氧苄啶的完整数据不可用。所有TTP手术的数据从国家医院出院登记处和社会保险机构福利登记处获得。分析中使用广义Cox回归。
参考队列和目标队列中抗菌药物购买的发病率分别为每人每年1.09次和0.89次。相对发病率降低17.5%（95%置信区间：17.0-18.1），绝对发病率降低每人每年0.20次。参考队列和目标队列中TTP的发生率分别为5.41/100和4.56/100人年。相对发病率降低14.8%（95%置信区间：13.1-16.5），绝对发病率降低0.86/100人年。
将PCV10引入常规疫苗接种计划后，抗菌药物和TTP的使用减少。这表明在医疗资源使用方面可节省大量费用。
