新型冠状病毒病（COVID-19）大流行对侵袭性肺炎球菌病的影响以及与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）发生肺炎球菌合并感染的风险：英格兰全国前瞻性队列研究。
Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Invasive Pneumococcal Disease and Risk of Pneumococcal Coinfection With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Prospective National Cohort Study, England.
机构信息
Immunisation and Countermeasures Division, Public Health England, London, United Kingdom.
Respiratory and Vaccine Preventable Bacterial Reference Unit (RVBRU), Public Health England, London, United Kingdom.
出版信息
Clin Infect Dis. 2021 Mar 1;72(5):e65-e75. doi: 10.1093/cid/ciaa1728.
BACKGROUND
Streptococcus pneumoniae coinfection with influenza results in synergistic lethality, but there are limited data on pneumococcal coinfection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
METHODS
Public Health England conducts invasive pneumococcal disease (IPD) and SARS-CoV-2 surveillance in England. IPD trends during 2000/2001-2019/2020 epidemiological years were analyzed and cases during February-June 2020 linked with laboratory-confirmed SARS-CoV-2 infections. Multivariable logistic regression was used to assess risk factors for death.
RESULTS
IPD incidence in 2019/2020 (7.6/100 000; n = 3964) was 30% (IRR, .70; 95% CI, .18-2.67) lower compared with 2018/2019 (10.9/100 000; n = 5666), with large reductions observed across all age groups during March-June 2020. There were 160 886 SARS-CoV-2 and 1137 IPD cases during February-June 2020, including 40 IPD/coronavirus disease 2019 (COVID-19) co-infections (.025% [95% CI, .018-.034] of SARS-CoV-2 infections; 3.5% [2.5-4.8] of IPD cases), 21 with COVID-19 diagnosed 3-27 days after IPD, and 27 who developed COVID-19 ≥28 days after IPD. Case-fatality rates (CFRs) were 62.5 (25/40), 47.6% (10/21), and 33.3% (9/27), respectively (P < .001). In addition to an independent association with increasing age and serotype group, CFR was 7.8-fold (95% CI, 3.8-15.8) higher in those with IPD/COVID-19 coinfection and 3.9-fold (95% CI, 1.4-10.7) higher in patients who developed COVID-19 3-27 days after IPD compared with patients with IPD only.
CONCLUSIONS
Large declines in IPD were observed following COVID-19 lockdown. IPD/COVID-19 coinfections were rare but associated with high CFR, mainly in older adults. The rarity, age and serotype distribution of IPD/COVID-19 coinfections do not support wider extension of pneumococcal vaccination.
背景
肺炎链球菌与流感的合并感染可导致协同致死性，但关于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）与肺炎链球菌合并感染的数据有限。
方法
英国公共卫生部在英格兰开展侵袭性肺炎球菌病（IPD）和 SARS-CoV-2 监测。分析了 2000/2001 年至 2019/2020 年流行病学年间的 IPD 趋势，并将 2020 年 2 月至 6 月期间的病例与实验室确诊的 SARS-CoV-2 感染联系起来。采用多变量逻辑回归评估死亡的危险因素。
结果
2019/2020 年（7.6/100000；n=3964）的 IPD 发病率比 2018/2019 年（10.9/100000；n=5666）低 30%（IRR，0.70；95%CI，0.18-2.67），在 2020 年 3 月至 6 月期间，所有年龄组的降幅均较大。2020 年 2 月至 6 月期间，有 160886 例 SARS-CoV-2 和 1137 例 IPD 病例，其中包括 40 例 IPD/新型冠状病毒病 2019（COVID-19）合并感染（占 SARS-CoV-2 感染的 0.025%[95%CI，0.018-0.034]；占 IPD 病例的 3.5%[2.5-4.8]），21 例 COVID-19 在 IPD 后 3-27 天确诊，27 例在 IPD 后≥28 天发生 COVID-19。病例病死率（CFR）分别为 62.5%（25/40）、47.6%（10/21）和 33.3%（9/27）（P<0.001）。除了与年龄和血清型组的独立关联外，与仅发生 IPD 的患者相比，IPD/COVID-19 合并感染患者的 CFR 高 7.8 倍（95%CI，3.8-15.8），在 IPD 后 3-27 天发生 COVID-19 的患者的 CFR 高 3.9 倍（95%CI，1.4-10.7）。
结论
在 COVID-19 封锁后，IPD 大幅下降。IPD/COVID-19 合并感染很少见，但与高病死率相关，主要发生在老年人中。IPD/COVID-19 合并感染的罕见性、年龄和血清型分布不支持更广泛地推广肺炎球菌疫苗接种。
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