越南儿童中肺炎球菌结合疫苗对分泌性中耳炎患病率的影响。
Effect of pneumococcal conjugate vaccine on prevalence of otitis media with effusion among children in Vietnam.
机构信息
Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Department of Otorhinolaryngology, Nagasaki University Hospital, Nagasaki, Japan.
出版信息
Vaccine. 2022 Aug 26;40(36):5366-5375. doi: 10.1016/j.vaccine.2022.07.047. Epub 2022 Aug 5.
PURPOSE
Otitis media with effusion (OME) is common in young children and is associated with Streptococcus pneumoniae infection. We aimed to determine the impact of pneumococcal conjugate vaccine (PCV) introduction on the prevalence of OME and OME associated with vaccine-type (VT) or non-VT.
METHODS
Population-based cross-sectional surveys were conducted in pre- (2016) and post-PCV periods (2017, 2018, and 2019) at selected communes in Nha Trang, Vietnam. For each survey, we randomly selected 60 children aged 4-11 months and 60 aged 14-23 months from each commune. Nasopharyngeal sample collection and tympanic membrane examination by digital otoscope were performed. S. pneumoniae was detected and serotyped by lytA qPCR and microarray. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Firth's logistic regression, stratified by age group.
RESULTS
Over the four surveys, 2089 children had a bilateral ear examination. Compared to pre-PCV, the prevalence of OME reduced in 2018 (OR 0.51, 95 %CI 0.28-0.93) and in 2019 (OR 0.53, 95 %CI 0.29-0.97) among the <12-month-olds, but no significant reduction among the 12-23-month-olds. The prevalence of OME associated with VT pneumococcus decreased in 2018 and 2019 (2018: OR 0.14, 95 %CI 0.03-0.55; 2019: OR 0.20, 95 %CI 0.05-0.69 in the <12-months-olds, 2018: OR 0.05, 95 %CI 0.00-0.44, 2019: OR 0.41, 95 %CI 0.10-1.61 in the 12-23-months-olds). The prevalence of OME associated with non-VT pneumococcus increased in the 12-23-month-olds in 2017 (OR 3.09, 95 %CI 1.47-7.45) and returned to the pre-PCV level of prevalence in 2018 and 2019 (OR 0.94, 95 %CI 0.40-2.43 and 1.40, 95 %CI 0.63-3.49).
CONCLUSION
PCV10 introduction was associated with a reduction of OME prevalence in infants but not in older children.
目的
分泌性中耳炎（OME）在幼儿中很常见，与肺炎链球菌感染有关。我们旨在确定肺炎球菌结合疫苗（PCV）引入对 OME 以及疫苗型（VT）或非 VT 相关 OME 患病率的影响。
方法
在越南芽庄选定的公社进行了基于人群的横断面调查，分别在 PCV 引入前（2016 年）和后（2017 年、2018 年和 2019 年）进行。对于每个调查，我们从每个公社随机选择 60 名 4-11 个月大的儿童和 60 名 14-23 个月大的儿童。通过数字耳镜进行鼻咽样本采集和鼓膜检查。通过 lytA qPCR 和微阵列检测肺炎链球菌并进行血清分型。使用 Firth 逻辑回归按年龄组计算比值比（OR）和 95%置信区间（CI）。
结果
在四项调查中，共有 2089 名儿童进行了双耳检查。与 PCV 引入前相比，2018 年（OR 0.51，95%CI 0.28-0.93）和 2019 年（OR 0.53，95%CI 0.29-0.97）12 个月以下婴儿 OME 的患病率降低，但 12-23 个月婴儿的 OME 患病率没有显著降低。2018 年和 2019 年与 VT 肺炎球菌相关的 OME 患病率下降（2018 年：OR 0.14，95%CI 0.03-0.55；2019 年：OR 0.20，95%CI 0.05-0.69 于 12 个月以下婴儿，2018 年：OR 0.05，95%CI 0.00-0.44，2019 年：OR 0.41，95%CI 0.10-1.61 于 12-23 个月婴儿）。2017 年，12-23 个月婴儿与非 VT 肺炎球菌相关的 OME 患病率增加（OR 3.09，95%CI 1.47-7.45），并在 2018 年和 2019 年恢复到 PCV 引入前的流行率（OR 0.94，95%CI 0.40-2.43 和 1.40，95%CI 0.63-3.49）。
结论
PCV10 的引入与婴儿 OME 患病率的降低有关，但与年长儿童无关。
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