Field Service, Public Health England,Newcastle upon Tyne,UK.
Public Health England North East,Newcastle upon Tyne,UK.
Epidemiol Infect. 2019 Jan;147:e175. doi: 10.1017/S0950268819000657.
Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006-March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89-0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
侵袭性肺炎球菌病 (IPD) 导致的死亡率下降与肺炎球菌结合疫苗的有效应用导致发病率降低同时出现。然而，由于血清型替代，IPD 现在呈上升趋势，我们进行了一项统计分析，以估计英格兰东北部 (NEE) 侵袭性肺炎球菌病后全因 30 天病死率 (CFR) 的趋势。获取了所有实验室确诊的 IPD 病例的临床、微生物学和人口统计学数据（2006 年 4 月至 2016 年 3 月），并使用逻辑回归估计了 CFR 与流行病学年之间的调整关联。在纳入分析的 2510 例 IPD 发作中，486 例在 IPD 后 30 天内死亡（CFR 为 19%）。年龄增长、男性、败血症诊断、处于 ⩾1 个临床风险组、酒精滥用和个别血清型与 CFR 增加独立相关。在调整这些显著预测因素后，观察到 CFR 随时间显著下降（调整后的优势比 0.93，95%置信区间 0.89-0.98；P = 0.003）。在 NEE 中，侵袭性肺炎球菌病后 30 天全因病死率呈下降趋势，但幅度较小。尽管引入了有效的疫苗，但仍需要进一步的策略来降低 IPD 持续的死亡率负担。
