Pediatría Distrito Sanitario Málaga-Guadalhorce, Pediatría Hospital Regional Universitario de Málaga, Programa del Doctorado de Universidad de Ciencias de la Salud.
Facultativo Especialista de Área de Neuropediatría, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga.
Int J Infect Dis. 2020 Sep;98:194-199. doi: 10.1016/j.ijid.2020.06.034. Epub 2020 Jun 14.
Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP.
From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records.
A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children.
The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).
社区获得性肺炎（CAP）是儿童住院最常见的原因之一。我们的目的是衡量肺炎球菌结合疫苗的引入对因 CAP 而住院的健康儿童的影响。
从 2011 年到 2016 年，对需要住院的患有 CAP 的健康儿科患者（3 个月至 14 岁）进行了部分回顾性、前瞻性和描述性研究。收集了临床、流行病学和人口统计学特征，并从病历中获得了疫苗接种情况。
共纳入 292 例病例，平均年龄为 33.4 个月，男性占 54%。每年住院人数呈渐进性显著下降，42%，每年类肺炎性胸腔积液（PPE）的比例无显著变化。56%的患者接种了肺炎球菌结合疫苗（PCV）。未接种疫苗的儿童比例下降了 14%，而 PCV-13 的覆盖率增加了 46%。这表明接种 PCV-7 的儿童 PPE 明显增加（63%），与未接种疫苗的儿童（45%）和接种 PCV-13 的儿童（57%）相比，且与严重 PPE 的存在无关。此外，与未接种疫苗的患者相比，接种疫苗的患者在严重程度或住院时间方面没有差异。在>2 岁的患者中，我们观察到 PPE 显著增加（59%），而 45%在年龄较小的儿童中。
PCV-13 疫苗接种覆盖率的增加导致 CAP 和 PPE 的住院人数减少。我们的样本中，PCV-7 接种与 PPE 增加相关，但与严重 PPE 或住院时间增加无关。肺炎和脓胸的严重形式在年龄较大时（>2 岁）发生了流行病学转移。
