Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St Georges, University of London.
Department of Immunisation, Hepatitis and Blood Safety.
Clin Infect Dis. 2019 Jun 18;69(1):84-90. doi: 10.1093/cid/ciy842.
Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established.
This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged <1 year diagnosed during 2013-2016.
There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P < .001), with infants born before 28 weeks' gestation having the highest incidence (150/100000; IRR, 8.8; P < .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%-8.6%]). Premature infants did not have a higher CFR than term infants (P = .62).
IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants.
自从肺炎球菌结合疫苗（PCV）问世以来，侵袭性肺炎球菌病（IPD）的发病率显著下降。在已经建立了 13 价肺炎球菌结合疫苗（PCV13）计划的国家，某些婴儿人群是否仍存在更高的 IPD 风险尚不清楚。我们旨在描述 IPD 在婴儿中的流行病学、临床特征、血清型分布和结局，并估计在 PCV13 计划实施后的 4 年内，早产儿与足月儿相比，PCV13 型、非 PCV13 型和总 IPD 的相对风险。
这是一项针对英格兰小于 1 岁的实验室确诊 IPD 的前瞻性、强化国家监测，于 2013 年至 2016 年期间进行。
共发现 517 例 IPD（发病率：19/100000 名婴儿）。与足月儿相比，早产儿的发病率显著更高（49/100000 比 17/100000；发病率比 [IRR]，2.87；P <.001），28 周以下出生的婴儿发病率最高（150/100000；IRR，8.8；P <.001）。在 454 例有血清分型分离株的 IPD 病例中，大多数由非 PCV13 血清型引起（369 例，71.4%），85 例（16.4%）由 PCV13 血清型引起。有 31 例死亡（病死率 [CFR]，6.2%[95%置信区间，4.3%-8.6%]）。早产儿的 CFR 并不高于足月儿（P =.62）。
英格兰婴儿的 IPD 发病率仍低于 PCV7 引入前的报告率。与足月儿相比，早产儿无论 PCV13 还是非 PCV13 血清型，发生 IPD 的风险仍然显著更高。婴儿 PCV13 免疫接种计划的任何变化都可能不成比例地影响早产儿。
