Department of Medicine, Dalhousie University, QEII Health Sciences Centre, VG Site, Suite 442 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada.
The Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, and The Provincial Laboratory for Public Health, 8440 112 St, Edmonton, Alberta T6G 2J2, Canada.
Vaccine. 2018 May 17;36(21):2985-2990. doi: 10.1016/j.vaccine.2018.04.032.
The consequences of the introduction of various pneumococcal protein conjugate vaccines (PCV) for children and adults is poorly understood.
We undertook a population-based cohort study of invasive pneumococcal disease (IPD) in Northern Alberta (Canada) from 2000 to 2014, years spanning pre-and early PCV (2000-2004) vs PCV-7 (2005-2009) vs PCV-13 (2010-2014) time periods.
We collected clinical, laboratory, and Streptococcus pneumoniae serotype information on all patients from 2000 to 2014. We determined changes in presentation, outcomes, serotypes, and incidence in children and adults across time periods.
There were 509 cases of IPD in children, an 80% decrease over time. Rates of empyema (4.0-15.7%, p < 0.001), ICU admission (13.1-20%), and mortality (1.8-8.4%, p < 0.001) increased over time. There were 2417 cases of IPD in adults. Unlike children, incidence of IPD did not change nor did rates of empyema. ICU admissions increased (p = 0.004) and mortality decreased (18.7-16.5%, p = 0.002). The total number of serotypes causing IPD remained stable in children (22 vs 26 vs 20) while they decreased in adults (49 vs 47 vs 42).
For children, PCV vaccination strategies resulted in decreased overall rates of IPD and we observed increased rates of empyema and mortality; for adults, there was no change in IPD rates although disease severity increased while mortality decreased. On a population-wide basis, our results suggest that current PCV vaccination strategies are associated with an overall decrease in IPD but disease severity seems to be increasing in both children and adults.
人们对各种肺炎球菌蛋白结合疫苗（PCV）在儿童和成人中的应用所带来的后果知之甚少。
我们对 2000 年至 2014 年期间加拿大阿尔伯塔省北部的侵袭性肺炎球菌病（IPD）进行了一项基于人群的队列研究，研究跨越了 PCV-7（2005-2009 年）、PCV-13（2010-2014 年）时期之前和早期 PCV 时期。
我们收集了 2000 年至 2014 年期间所有患者的临床、实验室和肺炎链球菌血清型信息。我们确定了不同时期儿童和成人的临床表现、结局、血清型和发病率的变化。
儿童 IPD 病例 509 例，随时间推移呈 80%下降趋势。脓胸（4.0-15.7%，p<0.001）、重症监护病房（ICU）入院（13.1-20%）和死亡率（1.8-8.4%，p<0.001）的发生率随时间推移而增加。成人 IPD 病例 2417 例。与儿童不同，成人 IPD 的发病率没有变化，脓胸发生率也没有变化。ICU 入院率增加（p=0.004），死亡率下降（18.7-16.5%，p=0.002）。引起 IPD 的血清型总数在儿童中保持稳定（22 种、26 种和 20 种），而在成人中则减少（49 种、47 种和 42 种）。
对于儿童，PCV 疫苗接种策略导致 IPD 总发病率下降，我们观察到脓胸和死亡率的上升；对于成年人，IPD 发病率没有变化，尽管疾病严重程度增加，而死亡率下降。在人群范围内，我们的结果表明，目前的 PCV 疫苗接种策略与 IPD 的总体下降有关，但儿童和成人的疾病严重程度似乎都在增加。
