Mohanty Salini, Podmore Bélène, Cuñado Moral Ana, Matthews Ian, Sarpong Eric, Lacetera Alessandra, Qizilbash Nawab
Merck & Co., Inc, Center for Observational and Real-World Evidence (CORE), Rahway, NJ, USA.
OXON Epidemiology Ltd, Epidemiology & Statistics, Madrid, Spain.
Pneumonia (Nathan). 2023 Jan 23;15(1):2. doi: 10.1186/s41479-022-00103-3.
Pneumococcal disease is a leading cause of communicable disease morbidity and mortality globally. We aimed to estimate invasive pneumococcal disease (IPD), pneumococcal pneumonia (PP) and all-cause pneumonia (ACP) incidence rates (IRs) in children aged 0-17 years in England from 2003 to 2019.
A retrospective study in children ≤17 years old from 2003 to 2019 using the Clinical Practice Research Datalink (CPRD) Gold and Hospital Episodes Statistics Admitted Patient Care (HES APC) databases. IPD episodes were identified in hospital records (HES APC). PP (caused by Streptococcus pneumoniae only) and ACP episodes (caused by any pathogen) were identified in primary care (CPRD) and in hospital records (HES APC). Annual IRs by age-group were calculated as the number of episodes/person-years (PY) at risk, with 95% confidence intervals (95% CI). Interrupted time series analyses were conducted to assess changes in IRs across the post-PCV7 (2007-2009), early post-PCV13 (2011-2014) and late post-PCV13 (2015-2019) periods compared to the pre-PCV7 period (2003-2005) using generalized linear models.
170 IPD episodes, 769 PP episodes and 12,142 ACP episodes were identified in 1,500,686 children in 2003-2019. The overall IPD, PP and ACP IRs (per 100,000 PY) were 2.29 (95% CI 1.96-2.66), 10.34 (95% CI 9.62-11.10) and 163.37 (95% CI 160.47-166.30), respectively. The highest IPD, PP and ACP IRs were observed in children aged < 2 years compared to older children (2-4 and 5-17 years). IPD IRs decreased between the pre-PCV7 period and the late post-PCV13 period from 3.28 (95% CI 2.42-4.33) to 1.41 (95% CI 0.80-2.29), IRR 0.28 (95% CI 0.09-0.90), p-value 0.033. PP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 14.65 (95% CI 12.77-16.72) to 3.87 (95% CI 2.81-5.20), IRR 0.19 (95% CI 0.09-0.38), p-value < 0.001. ACP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 167.28 (95% CI 160.78-173.96) to 124.96 (95% CI 118.54-131.63), IRR 0.77 (95% CI 0.66-0.88), p-value < 0.001.
The clinical burden of IPD, PP and ACP declined in children in England aged 0-17 years between 2003 and 2019, especially in the late post-PCV13 period. This study highlights the importance of PCV vaccination in reducing the burden of PD and ACP in children in England.
肺炎球菌疾病是全球传染病发病和死亡的主要原因。我们旨在估计2003年至2019年英格兰0至17岁儿童的侵袭性肺炎球菌疾病（IPD）、肺炎球菌肺炎（PP）和全因性肺炎（ACP）发病率（IRs）。
一项对2003年至2019年17岁及以下儿童的回顾性研究，使用临床实践研究数据链（CPRD）黄金数据库和医院住院统计入院患者护理（HES APC）数据库。在医院记录（HES APC）中识别IPD病例。在初级保健（CPRD）和医院记录（HES APC）中识别PP（仅由肺炎链球菌引起）和ACP病例（由任何病原体引起）。按年龄组计算的年度发病率为病例数/风险人年（PY），并给出95%置信区间（95%CI）。进行中断时间序列分析，以评估与PCV7接种前时期（2003 - 2005年）相比，在PCV7接种后（2007 - 2009年）、PCV13接种后早期（2011 - 2014年）和PCV13接种后晚期（2015 - 2019年）期间发病率的变化，使用广义线性模型。
在2003 - 2019年的1,500,686名儿童中，识别出170例IPD病例、769例PP病例和12,142例ACP病例。IPD、PP和ACP的总体发病率（每100,000 PY）分别为2.29（95%CI 1.96 - 2.66）、10.34（95%CI 9.62 - 11.10）和163.37（95%CI 160.47 - 166.30）。与大龄儿童（2 - 4岁和5 - 17岁）相比，2岁以下儿童的IPD、PP和ACP发病率最高。IPD发病率在PCV7接种前时期和PCV13接种后晚期从3.28（95%CI 2.42 - 4.33）降至1.41（95%CI 0.80 - 2.29），发病率比值比（IRR）为0.28（95%CI 0.09 - 0.9），p值为0.033。PP发病率在PCV7接种前时期和PCV13接种后晚期从14.65（95%CI 12.77 - 16.72）降至3.87（95%CI 2.81 - 5.20），IRR为0.19（95%CI 0.09 - 0.38），p值<0.001。ACP发病率在PCV7接种前时期和PCV13接种后晚期从167.28（95%CI 160.78 - 173.96）降至124.96（95%CI 118.54 - 131.63），IRR为0.77（95%CI 0.66 - 0.88），p值<0.001。
2003年至2019年英格兰0至17岁儿童中IPD、PP和ACP的临床负担有所下降，尤其是在PCV13接种后晚期。本研究强调了PCV疫苗接种在减轻英格兰儿童肺炎球菌疾病和ACP负担方面的重要性。
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