Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
Clin Infect Dis. 2021 Apr 8;72(7):1200-1207. doi: 10.1093/cid/ciaa197.
Bacterial conjunctivitis is most commonly caused by nontypeable Haemophilus influenzae (NTHi), followed by Streptococcus pneumoniae. No population-based data on the impact of pneumococcal conjugate vaccines (PCVs) on the incidence of bacterial conjunctivitis have been published. We assessed rate dynamics of overall, pneumococcal, and NTHi conjunctivitis in children aged 2-23 months in southern Israel before and after PCV implementation.
This is a 12-year prospective, population-based surveillance, from July 2004 through June 2017. Our medical center serves a captive population of approximately 30 000 children < 2 years of age, and its clinical microbiology laboratory processes > 80% of all community-derived cultures, enabling incidence calculation. The 7-valent and 13-valent PCVs (PCV7 and PCV13, respectively) were implemented in the national immunization program in July 2009 and November 2010, respectively. Pneumococci, NTHi, Moraxella catarrhalis, and Streptococcus pyogenes were considered pathogens. Continuous annual incidences and incidence rate ratios comparing the PCV13 period (2015-2017) to the pre-PCV period (2004-2008) were calculated.
Disease caused by PCV13 serotypes declined by 93%, without significant replacement with non-PCV13 serotypes. Rates of pneumococcal, NTHi, and overall culture-positive episodes declined by 59%, 41%, and 42%, respectively, while rates of culture-negative and other pathogens episodes did not change significantly. An overall reduction in all submitted culture rates of 35% was observed. This pattern was seen across all ages, including infants aged 2-5 months.
PCV7/PCV13 implementation resulted in a marked and significant decline in pneumococcal, NTHi, and overall conjunctivitis rates in children < 2 years of age. The impact on NTHi episodes alludes to the role of pneumococcus-NTHi interaction in conjunctivitis. The impact in infants aged < 6 months suggests herd protection.
细菌性结膜炎最常见的病原体是非典型流感嗜血杆菌（NTHi），其次是肺炎链球菌。目前尚无基于人群的研究报道肺炎球菌结合疫苗（PCV）接种对细菌性结膜炎发病率的影响。我们评估了在 PCV 接种实施前后，以色列南部 2-23 月龄儿童中总体、肺炎球菌和 NTHi 性结膜炎的发病动态。
这是一项为期 12 年的前瞻性、基于人群的监测研究，时间从 2004 年 7 月至 2017 年 6 月。我们的医疗中心服务于一个约 30000 名 2 岁以下儿童的固定人群，其临床微生物学实验室处理超过 80%的所有社区来源培养物，可计算发病率。7 价和 13 价 PCV（PCV7 和 PCV13，分别）于 2009 年 7 月和 2010 年 11 月纳入国家免疫规划。肺炎球菌、NTHi、卡他莫拉菌和酿脓链球菌被视为病原体。连续计算了 PCV13 时期（2015-2017 年）与 PCV 前时期（2004-2008 年）的年度发病率和发病率比值。
PCV13 血清型引起的疾病下降了 93%，但未被非 PCV13 血清型显著替代。肺炎球菌、NTHi 和总培养阳性病例的发生率分别下降了 59%、41%和 42%，而培养阴性和其他病原体病例的发生率无显著变化。观察到所有送检培养物的总减少率为 35%。这种模式在所有年龄段都存在，包括 2-5 月龄的婴儿。
PCV7/PCV13 的实施显著降低了 2 岁以下儿童的肺炎球菌、NTHi 和总体结膜炎发病率。对 NTHi 病例的影响暗示了肺炎球菌-NTHi 相互作用在结膜炎中的作用。在<6 个月的婴儿中的影响表明存在群体保护。
