Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Lancet Child Adolesc Health. 2020 Jun;4(6):425-434. doi: 10.1016/S2352-4642(20)30090-0.
The burden of acute lower respiratory infection (ALRI) in Indigenous children of Australia's Northern Territory is among the highest globally. No published data exists on the effect of pneumococcal conjugate vaccine (PCV) introduction on ALRIs in this population beyond 2005. The aim of this study was to describe the rates of ALRI admissions to hospital in Indigenous infants in the Northern Territory from 2006 to 2015, across three periods of different PCV use. We hypothesised that broader valency PCVs would be more effective against hospitalisations for pneumonia.
We did a retrospective population-based cohort study of Indigenous infants born in the Northern Territory followed up until age 12 months. Data were from administrative hospital and perinatal datasets. International classification of diseases codes (tenth revision, Australian modification; ICD-10AM) were used to identify respiratory hospitalisations of interest: all-cause ALRI, all-cause pneumonia, bacterial pneumonia, viral pneumonia, influenza-like illness (ILI), respiratory syncytial virus ALRI (RSV-ALRI), and pneumococcal ALRI. Incidence rates were compared between PCV eras (7-valent PCV [PCV7], 2006-09; 10-valent PCV [PCV10], 2009-11; and 13-valent PCV [PCV13], 2011-15) using interrupted time trend analysis and negative binomial regression.
For children born between Jan 1, 2006, and Dec 31, 2015, 4138 ALRI episodes (31% of all hospitalisations) occurred among 2888 (20%) of the 14 594 infants. The overall ALRI hospitalisation rate was 29·7 episodes per 100 child-years. Prominent risk factors associated with ALRI hospitalisation were living in a remote community or the Central desert region, being born preterm or with low birthweight. ALRI rates were lowest in the PCV13 era, in association with a significant reduction in bacterial pneumonia hospitalisations in the PCV13 era compared with the PCV10 (incidence rate ratio 0·68, 95% CI 0·57-0·81) and PCV7 (0·70, 0·60-0·81) eras. In contrast, RSV-ALRI rates were 4·9 episodes per 100 child-years in each era.
A 30% reduction in bacterial-coded pneumonia hospitalisations in the Northern Territory during the era of PCV13 immunisation supports its ongoing use in the region. Despite the reduction, one in five Indigenous infants born in the region continue to be hospitalised with an ALRI in their first year of life. Future gains require multifaceted environmental and biomedical approaches.
National Health and Medical Research Council of Australia.
澳大利亚北部地区原住民儿童急性下呼吸道感染（ALRI）的负担是全球最高的。在该人群中，尚无关于肺炎球菌结合疫苗（PCV）引入对 2005 年以后的 ALRI 影响的发表数据。本研究的目的是描述 2006 年至 2015 年北领地原住民婴儿因 ALRI 住院的比率，分为三个不同 PCV 使用时期。我们假设更广泛的价 PCV 对肺炎住院治疗更有效。
我们对北领地出生的原住民婴儿进行了回顾性基于人群的队列研究，随访至 12 个月龄。数据来自医院和围产期数据集。采用国际疾病分类（第十版，澳大利亚修正版；ICD-10AM）对感兴趣的呼吸道住院情况进行编码：所有原因的 ALRI、所有原因的肺炎、细菌性肺炎、病毒性肺炎、流感样疾病（ILI）、呼吸道合胞病毒 ALRI（RSV-ALRI）和肺炎球菌 ALRI。使用中断时间趋势分析和负二项式回归比较 PCV 时代（7 价 PCV [PCV7]，2006-09 年；10 价 PCV [PCV10]，2009-11 年；和 13 价 PCV [PCV13]，2011-15 年）之间的发病率。
对于 2006 年 1 月 1 日至 2015 年 12 月 31 日期间出生的儿童，在 14594 名婴儿中的 2888 名（20%）中发生了 4138 例 ALRI 发作（占所有住院治疗的 31%）。ALRI 总住院率为每 100 名儿童年 29.7 例。与 ALRI 住院相关的显著风险因素包括居住在偏远社区或中部沙漠地区、早产或出生体重低。在 PCV13 时代，ALRI 发病率最低，与 PCV13 时代与 PCV10（发病率比 0.68，95%CI 0.57-0.81）和 PCV7（0.70，0.60-0.81）时代相比，细菌性肺炎住院率显著降低。相比之下，在每个时代，RSV-ALRI 的发病率为每 100 名儿童年 4.9 例。
在 PCV13 免疫接种时代，北领地细菌性肺炎住院率降低了 30%，这支持了该地区持续使用 PCV13。尽管有所减少，但该地区五分之一的原住民婴儿在出生后的第一年仍因 ALRI 住院。未来的收益需要多方面的环境和生物医学方法。
澳大利亚国家卫生和医学研究委员会。
