Asner Sandra A, Agyeman Philipp K A, Gradoux Eugénie, Posfay-Barbe Klara M, Heininger Ulrich, Giannoni Eric, Crisinel Pierre A, Stocker Martin, Bernhard-Stirnemann Sara, Niederer-Loher Anita, Kahlert Christian R, Hasters Paul, Relly Christa, Baer Walter, Aebi Christoph, Schlapbach Luregn J, Berger Christoph
Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland.
Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland.
Clin Infect Dis. 2019 Oct 15;69(9):1574-1580. doi: 10.1093/cid/ciy1139.
Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study.
The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS).
Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01).
The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
缺乏基于人群的研究来评估肺炎球菌结合疫苗（PCV）对儿童肺炎球菌败血症负担的影响。我们旨在通过一项全国性队列研究评估引入PCV-13后的这种负担。
瑞士儿童败血症研究（2011年9月至2015年12月）前瞻性招募了17岁以下因肺炎链球菌导致血培养确诊败血症且符合全身炎症反应综合征标准的儿童。已完成PCV免疫接种的儿童感染疫苗血清型被定义为疫苗接种失败。主要结局是入住儿科重症监护病房（PICU）和住院时间（LOS）。
肺炎球菌败血症患儿（n = 117）的粗发病率为每10万名儿童2.0例（95%置信区间[CI] 1.7 - 2.4），占社区获得性败血症发作的25%。病死率为8%。42例（36%）患者需要入住PICU。脑膜炎患儿（29例；25%）更常感染PCV中未包含的血清型（69%对31%；P <.001）。62例已完成PCV免疫接种的儿童中有16例（26%）出现疫苗接种失败，其中11例感染血清型3。在多变量分析中，患有脑膜炎的儿童（比值比[OR] 6.8；95% CI 2.4 - 19.3；P <.001）或感染血清型3的儿童（OR 2.8；95% CI 1.1 - 7.3；P =.04）更常入住PICU。感染血清型3的儿童住院时间更长（β系数0.2，95% CI.1 - 1.1；P =.01）。
引入PCV-13后不久，儿童肺炎球菌败血症的发病率仍然很高。主要由非疫苗血清型引起的脑膜炎和血清型3引起的疾病是严重程度的重要预测因素。
