Health Sciences Unit, Faculty of Social Sciences, University of Tampere, Finland.
National Reference Centre for Bacterial Meningitis (NRCBM), Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
Vaccine. 2019 Feb 28;37(10):1365-1373. doi: 10.1016/j.vaccine.2018.12.028. Epub 2019 Jan 9.
Poland introduced the 10-valent conjugate pneumococcal vaccine (PCV10) into the childhood immunization program in January 2017. During previous decades, considerable changes had occurred in the surveillance system for invasive pneumococcal disease. Therefore, to provide baseline data on pneumococcal diseases before PCV10 introduction, we evaluated the epidemiology of pneumococcal meningitis (PM), the only syndrome monitored consistently since 1970.
Based on laboratory-confirmed cases reported during 2005-2015, we calculated the reported rates, serotypes distribution and antimicrobial resistance of pneumococcal meningitis isolates. Data from the mandatory national surveillance system was linked with data on cerebrospinal fluid isolates submitted to the National Reference Centre for Bacterial Meningitis. We used negative binomial regression with Newey West method to test for trend in rates of pneumococcal meningitis notified during 2005-2015 and Chi-squared test to assess changes in the serotype distribution from 2008-2011 to 2012-2015.
From 2005 to 2015, the overall reported incidence of PM increased from 0.21 to 0.47 cases per 100,000 population, average yearly increase of 7% (rate ratio 1.07; 95% CI 1.06-1.08). The increase was primarily due to annual increase of 3% (1.02-1.05) among 15-49 years of age, 12% (95% CI: 1.10-1.13) among 50-64 years of age, 18% (95% CI: 1.16-1.19) among persons 65-74 years of age and 9% (95% CI 1.07-1.10) among persons ≥75 years of age. In children <5 years of age, serotypes included in PCV10 and PCV13 accounted for 75% and 80% of reported isolates, respectively. From 2008-2011 to 2012-2015, the proportion of PM cases caused by PCV10 serotypes decreased from 52% to 41% (p < 0.01). Overall, 28% of isolates were resistant to penicillin and 13% were non-susceptible to cefotaxime.
The introduction of PCV10 into national immunization program may have considerable impact on disease burden, especially on number of cases caused by isolates non-susceptible to antimicrobials.
波兰于 2017 年 1 月将 10 价结合型肺炎球菌疫苗（PCV10）引入儿童免疫计划。在过去几十年中，侵袭性肺炎球菌病的监测系统发生了重大变化。因此，为了在 PCV10 引入之前提供肺炎球菌病的基线数据，我们评估了肺炎球菌性脑膜炎（PM）的流行病学，这是自 1970 年以来一直持续监测的唯一综合征。
基于 2005-2015 年报告的实验室确诊病例，我们计算了肺炎球菌性脑膜炎分离株的报告率、血清型分布和抗生素耐药性。国家强制性监测系统的数据与提交给国家细菌脑膜炎参考中心的脑脊液分离株数据相关联。我们使用带有 Newey-West 方法的负二项回归来检验 2005-2015 年期间报告的肺炎球菌性脑膜炎发病率的趋势，并使用卡方检验来评估 2008-2011 年至 2012-2015 年血清型分布的变化。
2005 年至 2015 年，PM 的总体报告发病率从每 100,000 人口 0.21 例增加到 0.47 例，平均每年增加 7%（发病率比 1.07；95%CI 1.06-1.08）。这种增加主要是由于 15-49 岁年龄组每年增加 3%（1.02-1.05），50-64 岁年龄组每年增加 12%（95%CI：1.10-1.13），65-74 岁年龄组每年增加 18%（95%CI：1.16-1.19），75 岁及以上年龄组每年增加 9%（95%CI 1.07-1.10）。在 5 岁以下儿童中，PCV10 和 PCV13 包含的血清型分别占报告分离株的 75%和 80%。2008-2011 年至 2012-2015 年，由 PCV10 血清型引起的 PM 病例比例从 52%下降到 41%（p<0.01）。总体而言，28%的分离株对青霉素耐药，13%对头孢噻肟不敏感。
PCV10 被纳入国家免疫计划可能会对疾病负担产生重大影响，尤其是对抗生素耐药的分离株引起的病例数量。
