在美国，接种 A 组链球菌疫苗可预防咽炎、鼻窦炎、急性中耳炎和门诊抗生素处方的发生率。

Incidence of Pharyngitis, Sinusitis, Acute Otitis Media, and Outpatient Antibiotic Prescribing Preventable by Vaccination Against Group A Streptococcus in the United States.

机构信息

Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA.

Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, California, USA.

出版信息

Clin Infect Dis. 2021 Jul 1;73(1):e47-e58. doi: 10.1093/cid/ciaa529.

DOI:10.1093/cid/ciaa529

PMID:32374829

Abstract

BACKGROUND

Group A Streptococcus (GAS) is a leading cause of acute respiratory conditions that frequently result in antibiotic prescribing. Vaccines against GAS are currently in development.

METHODS

We estimated the incidence rates of healthcare visits and antibiotic prescribing for pharyngitis, sinusitis, and acute otitis media (AOM) in the United States using nationally representative surveys of outpatient care provision, supplemented by insurance claims data. We estimated the proportion of these episodes attributable to GAS and to GAS emm types included in a proposed 30-valent vaccine. We used these outputs to estimate the incidence rates of outpatient visits and antibiotic prescribing preventable by GAS vaccines with various efficacy profiles under infant and school-age dosing schedules.

RESULTS

GAS pharyngitis causes 19.1 (95% confidence interval [CI], 17.3-21.1) outpatient visits and 10.2 (95% CI, 9.0-11.5) antibiotic prescriptions per 1000 US persons aged 0-64 years, annually. GAS pharyngitis causes 93.2 (95% CI, 82.3-105.3) visits and 53.2 (95% CI, 45.2-62.5) antibiotic prescriptions per 1000 children ages 3-9 years, annually, representing 5.9% (95% CI, 5.1-7.0%) of all outpatient antibiotic prescribing in this age group. Collectively, GAS-attributable pharyngitis, sinusitis, and AOM cause 26.9 (95% CI, 23.9-30.8) outpatient visits and 16.1 (95% CI, 14.0-18.7) antibiotic prescriptions per 1000 population, annually. A 30-valent GAS vaccine meeting the World Health Organization's 80% efficacy target could prevent 5.4% (95% CI, 4.6-6.4%) of outpatient antibiotic prescriptions among children aged 3-9 years. If vaccine prevention of GAS pharyngitis made the routine antibiotic treatment of pharyngitis unnecessary, up to 17.1% (95% CI, 15.0-19.6%) of outpatient antibiotic prescriptions among children aged 3-9 years could be prevented.

CONCLUSIONS

An efficacious GAS vaccine could prevent substantial incidences of pharyngitis infections and associated antibiotic prescribing in the United States.

摘要

背景

A 组链球菌（GAS）是导致急性呼吸道疾病的主要原因，这些疾病经常需要使用抗生素治疗。目前正在开发针对 GAS 的疫苗。

方法

我们使用全国代表性的门诊护理提供调查，辅以保险索赔数据，估计美国因咽炎、鼻窦炎和急性中耳炎（AOM）而就诊和开具抗生素处方的发生率。我们估计了这些疾病中由 GAS 引起的比例，以及一种拟议的 30 价疫苗中包含的 GAS emm 型。我们使用这些结果来估计在婴儿和学龄期给药方案下，具有不同疗效特征的 GAS 疫苗可以预防多少门诊就诊和抗生素处方。

结果

GAS 咽炎每年导致美国 0-64 岁人群每 1000 人中发生 19.1 次（95%置信区间[CI]，17.3-21.1）门诊就诊和 10.2 次（95%CI，9.0-11.5）抗生素处方。GAS 咽炎每年导致 3-9 岁儿童每 1000 人发生 93.2 次（95%CI，82.3-105.3）就诊和 53.2 次（95%CI，45.2-62.5）抗生素处方，占该年龄组所有门诊抗生素处方的 5.9%（95%CI，5.1-7.0%）。总的来说，GAS 相关咽炎、鼻窦炎和 AOM 每年导致每 1000 人发生 26.9 次（95%CI，23.9-30.8）门诊就诊和 16.1 次（95%CI，14.0-18.7）抗生素处方。一种达到世界卫生组织 80%疗效目标的 30 价 GAS 疫苗可以预防 3-9 岁儿童 5.4%（95%CI，4.6-6.4%）的门诊抗生素处方。如果疫苗预防 GAS 咽炎使常规抗生素治疗咽炎变得不必要，那么 3-9 岁儿童中高达 17.1%（95%CI，15.0-19.6%）的门诊抗生素处方可以预防。