肺炎球菌结合疫苗降低急性中耳炎负担：以色列的一项基于人群的研究。
Pneumococcal Conjugated Vaccines Decreased Acute Otitis Media Burden: A Population-Based Study in Israel.
机构信息
Clalit Health Services, Tel Aviv-Yafo, Israel; Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel.
Research Authority, Kaplan Medical Center, Rehovot, Israel; Department of Biochemistry and Molecular Biology, Institute for Medical Research Israel-Canada, The Hebrew University, Jerusalem, Israel.
出版信息
J Pediatr. 2021 Aug;235:233-238.e3. doi: 10.1016/j.jpeds.2021.04.025. Epub 2021 Apr 22.
OBJECTIVE
To study time trends in all-cause acute otitis media (AOM) burden by calculating incidence rates of AOM episodes and recurrent acute otitis media (rAOM) cases in highly immunized pediatric population during the pre- and post-pneumococcal conjugated vaccine (PCV) years.
STUDY DESIGN
In this population-based study, AOM episodes and rAOM cases were identified in Clalit Health Services-insured Israeli children aged 0-10 years between 2005 and 2018 by using a data-sharing platform. Because a near-sequential implementation of PCV-7/PCV-13 occurred within a 1-year period (2009/2010), we compared AOM visits before (2005-July 2009) and after (August 2009-2018) the introduction of PCVs. We focused on children younger than 2 years of age, who are the target population of PCVs and are at AOM peak age.
RESULTS
We identified 805 389 AOM episodes contributed by 270 137 children. The median number of AOM episodes was 2 (IQR 1-4). A downward trend of incidence rates of AOM episodes was observed during the post-PCV years in children younger than age 9 years (P < .001). The largest decrease (21%) was observed in children younger than 1 year, from 807/1000 children during the pre-PCV years to 640/1000 during the post-PCV years (P < .001). An average annual decrease of ∼14/1000 AOM episodes was calculated in children younger than 1 year old (β = -13.39, 95% CI -16.25 to -10.53, P < .001). Of rAOM cases, documented in 84 237 (31.2%) children, 74% were in children younger than 2 years, and 55% were in boys. The risk to develop rAOM significantly decreased during the post-PCV years in children younger than 2 years (hazard ratio 0.893, 95% CI 0.878-0.908; P < .001).
CONCLUSIONS
AOM burden significantly decreased following PCVs introduction in highly immunized children.
目的
通过计算高免疫人群中儿童在接种肺炎球菌结合疫苗（PCV）前后的急性中耳炎（AOM）发作次数和复发性急性中耳炎（rAOM）病例，研究全因急性中耳炎负担的时间趋势。
研究设计
在这项基于人群的研究中，使用数据共享平台，确定了在 2005 年至 2018 年期间，参加克利夫健康服务（Clalit Health Services）的 0-10 岁以色列儿童的 AOM 发作次数和 rAOM 病例。由于 PCV-7/PCV-13 的近乎连续实施在一年内（2009/2010 年）发生，因此我们比较了 PCV 引入前后（2005 年 7 月至 2009 年 8 月）的 AOM 就诊情况。我们重点关注年龄小于 2 岁的儿童，他们是 PCV 的目标人群，也是 AOM 的高发年龄。
结果
我们共发现 805389 例 AOM 发作，涉及 270137 名儿童。AOM 发作的中位数为 2（IQR 1-4）。在接种 PCV 后的年份中，9 岁以下儿童的 AOM 发作发生率呈下降趋势（P<0.001）。在 1 岁以下儿童中，下降幅度最大（21%），从接种 PCV 前的 807/1000 例降至接种 PCV 后的 640/1000 例（P<0.001）。计算出 1 岁以下儿童的 AOM 发作平均每年减少约 14/1000 例（β=-13.39，95%CI-16.25 至-10.53，P<0.001）。在 84237 名（31.2%）有 rAOM 记录的儿童中，74%为 2 岁以下儿童，55%为男孩。2 岁以下儿童在接种 PCV 后发生 rAOM 的风险显著降低（风险比 0.893，95%CI 0.878-0.908；P<0.001）。
结论
在高免疫人群中接种 PCV 后，AOM 负担显著降低。
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