Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France.
Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.
JAMA Pediatr. 2019 Apr 1;173(4):362-370. doi: 10.1001/jamapediatrics.2018.5273.
In several countries, 5 years after 13-valent pneumococcal conjugate vaccine (PCV13) implementation, serotype replacement has been reported for invasive pneumococcal disease, which raises concerns about the long-term outcome of PCV13 implementation. The long-term effect of vaccination on community-acquired pneumonia (CAP) remains unknown.
To assess the long-term outcome of PCV13 implementation on CAP in children.
DESIGN, SETTING, AND PARTICIPANTS: This quasi-experimental, population-based, interrupted time-series analysis was based on a prospective multicenter study conducted from June 2009 to May 2017 in 8 French pediatric emergency departments. All patients 15 years and younger with chest radiography-confirmed CAP were included.
Community-acquired pneumonia.
The number of CAP cases per 1000 pediatric emergency department visits over time, analyzed using a segmented regression model, adjusted for influenza-like illness syndromes.
We enrolled 12 587 children with CAP, including 673 cases of CAP with pleural effusion (5.3%), 4273 cases of CAP requiring hospitalization (33.9%), 2379 cases of CAP with high inflammatory biomarkers (18.9%), and 221 cases of proven pneumococcal CAP (1.8%). The implementation of PCV13 in 2010 was followed by a sharp decrease in the frequency of CAP (-0.8% per month [95% CI, -1.0% to -0.5% per month]), from 6.3 to 3.5 cases of CAP per 1000 pediatric emergency department visits until May 2014, then a slight increase since June 2014 (0.9% per month [95% CI, 0.4%-1.4% per month]), until 3.8 cases of CAP per 1000 pediatric emergency department visits in May 2017. There were marked immediate decreases in cases of CAP with pleural effusion (-48% [95% CI, -84% to -12%]), CAP requiring hospitalization (-30% [95% CI, -56% to -5%]), and CAP with high inflammatory biomarkers (-30% [95% CI, -54% to -6%]), without any rebound thereafter.
The changes associated with PCV13 use 7 years after implementation remain substantial, especially for CAP with pleural effusion, CAP requiring hospitalization, and CAP with high inflammatory biomarkers. Emerging non-PCV13 serotypes may be less likely involved in severe CAP than invasive pneumococcal disease.
在几个国家，13 价肺炎球菌结合疫苗（PCV13）实施 5 年后，侵袭性肺炎球菌病的血清型转变已有报道，这引起了人们对 PCV13 实施长期效果的担忧。疫苗接种对社区获得性肺炎（CAP）的长期影响仍不清楚。
评估 PCV13 实施对儿童社区获得性肺炎（CAP）的长期影响。
设计、设置和参与者：这是一项基于 2009 年 6 月至 2017 年 5 月在法国 8 个儿科急诊部门进行的前瞻性多中心研究的准实验、基于人群的、中断时间序列分析。所有 15 岁及以下胸部 X 线检查确诊为 CAP 的患者均被纳入研究。
社区获得性肺炎。
使用分段回归模型分析随时间推移每 1000 次儿科急诊就诊的 CAP 病例数，模型调整了流感样疾病综合征的影响。
我们共纳入了 12587 例 CAP 患儿，其中 673 例（5.3%）为 CAP 合并胸腔积液，4273 例（33.9%）为需要住院治疗的 CAP，2379 例（18.9%）为伴有高炎症生物标志物的 CAP，221 例（1.8%）为确诊的肺炎球菌性 CAP。2010 年 PCV13 的实施后，CAP 的频率急剧下降（每月减少 0.8%[95%CI，每月减少 1.0%至 0.5%]），从每 1000 次儿科急诊就诊 6.3 例降至 2014 年 5 月的 3.5 例，此后自 2014 年 6 月起略有增加（每月增加 0.9%[95%CI，每月增加 0.4%至 1.4%]），直至 2017 年 5 月每 1000 次儿科急诊就诊 3.8 例。CAP 合并胸腔积液（减少 48%[95%CI，减少 84%至减少 12%]）、需要住院治疗的 CAP（减少 30%[95%CI，减少 56%至减少 5%]）和伴有高炎症生物标志物的 CAP（减少 30%[95%CI，减少 54%至减少 6%]）的病例数均出现明显的即刻减少，此后未出现反弹。
实施 PCV137 年后相关变化仍然显著，特别是对于 CAP 合并胸腔积液、需要住院治疗的 CAP 和伴有高炎症生物标志物的 CAP。新出现的非 PCV13 血清型可能不太容易导致严重 CAP，而不是侵袭性肺炎球菌病。
