Teaching Hospital, Centre Hospitalier Universitaire AnosialaAntananarivo, Madagascar.
Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant TsaralàlanaAntananarivo, Madagascar.
Clin Infect Dis. 2019 Sep 5;69(Suppl 2):S121-S125. doi: 10.1093/cid/ciz504.
The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age.
During 2010-2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010-2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013-2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction.
In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died.
Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.
2012 年，马达加斯加引入了 10 价肺炎球菌结合疫苗（PCV10）。本研究旨在确定 PCV10 对 5 岁以下住院儿童细菌性脑膜炎的影响。
2010 年至 2017 年期间，从医院住院记录中记录了 5 岁以下细菌性脑膜炎和肺炎住院儿童的数据。在 2011 年 4 月至 2017 年 12 月期间，在哨点实验室（SSL）通过显微镜检查、培养和抗原检测试验对符合世界卫生组织疑似细菌性脑膜炎病例定义的 3312 名儿童的脑脊液（CSF）样本进行了分析。共有 2065 份 CSF 样本被转介到区域参考实验室进行实时聚合酶链反应（RT-PCR）分析。2010-2011 年定义为疫苗前时期，2012 年为疫苗引入年，2013-2017 年为疫苗后时期。比较 PCV10 引入前后的病例数、病原体和肺炎住院情况。
在疫苗前时期，细菌性脑膜炎和肺炎住院占所有住院的 4.5%和 24.5%，而疫苗后时期分别为 2.6%和 19%（P<.001）。在 SSL 检测的样本中，有 154 份呈阳性，其中 80%为肺炎链球菌，20%为其他细菌。通过 RT-PCR 诊断的肺炎球菌脑膜炎从 2012 年的 14%下降到 2017 年的 3%。此外，14%的肺炎球菌脑膜炎患儿死亡。
PCV10 引入后，肺炎球菌脑膜炎、细菌性脑膜炎和肺炎住院率下降。应继续进行监测，以监测 PCV10 的影响。
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