13 价肺炎球菌结合疫苗（PCV13）对以色列南部儿童急性乳突炎的影响：一项 12 年回顾性对比研究（2005-2016 年）。
Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016).
机构信息
Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel.
Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel.
出版信息
Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110485. doi: 10.1016/j.ijporl.2020.110485. Epub 2020 Nov 5.
OBJECTIVES
To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction.
METHODS
Medical records of all AM patients <15 years of age diagnosed during 2005-2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005-2008), interim (2009-2011) and post-PCV13 vaccination (2012-2016).
RESULTS
238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 serotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes.
CONCLUSIONS
The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period.
目的
在 13 价肺炎球菌结合疫苗（PCV13）引入前后，定义儿童急性乳突炎（AM）发病率、微生物学、并发症和管理的趋势。
方法
回顾了 2005 年至 2016 年间所有<15 岁诊断为 AM 的患者的病历。研究年份分为三个时期：疫苗前（2005-2008 年）、中期（2009-2011 年）和 PCV13 疫苗接种后（2012-2016 年）。
结果
共纳入 238 例（男性 53.4%）患者，3 个时期分别为 81、56 和 101 例。总体而言，238 例患者中<5 岁的有 177 例（75.2%）。全人群 AM 发病率平均为 10.32/100,000，研究期间无变化。204 例可评估患者中，93 例（45.6%）中耳液/乳突培养阳性；47/93（50.5%）例分离出肺炎链球菌（SP）。研究期间 SP-AM 的平均发病率为 2.49 例/100,000。记录到疫苗前和疫苗后期间 SP-AM 的平均发病率呈下降趋势（3.05/100,000 与 1.82/100,000，P=0.069）。<5 岁患者中，SP-AM 发病率从疫苗前到疫苗后期间下降（19/50，38%与 15/73，20.6%，P=0.034）。与疫苗前相比，PCV13 后时期培养阴性 AM 和 AM 并发症的百分比无变化。记录到 PCV13 血清型的分布显著减少（17/19，89.5%与 8/12，66.6%和 7/16，43.75%，三个研究期间，P=0.015），同时非疫苗血清型的比例增加。
结论
PCV13 的引入与<5 岁儿童 SP-AM 病例的显著减少有关。PCV13 血清型作为 SP-AM 的病原体显著减少，而非疫苗血清型和培养阴性 AM 在接种疫苗后变得更为常见。
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