Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage
Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage
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DOI：
10.1001/jama.297.16.1784
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发表时间：
2007-04-25
影响因子：
120.7
通讯作者：
Parkinson, Alan
中科院分区：
文献类型：
--
作者：
Singleton, Rosalyn J.;Hennessy, Thomas W.;Parkinson, Alan
背景 在使用七价肺炎球菌结合疫苗进行常规儿童疫苗接种时，一个令人担忧的问题是七价结合疫苗中未包含的血清型引起的替代疾病的出现和扩大的可能性。目的确定替代疾病是否与阿拉斯加原住民儿童中侵袭性肺炎球菌疾病的总体下降有关。设计、设置和患者从 1 月 1 日起，阿拉斯加全州范围内对侵袭性肺炎球菌感染进行纵向人群实验室监测。 1995 年至 2006 年 12 月 31 日。主要结果指标 2 岁以下儿童肺炎球菌疾病的发病率和类型。结果 在采用七价肺炎球菌结合疫苗常规疫苗接种后的头 3 年里，2 岁以下阿拉斯加原住民儿童的侵袭性肺炎球菌疾病总体下降了 67%（2017 年为每 10 万人中 403.2 例）。从 1995-2000 年每 10 万人每年 134.3 人，到 2001-2003 年每年每 10 万人 134.3 人，P < .001）。然而，2001-2003 年间和 2004-2006 年间，两岁以下阿拉斯加原住民儿童的侵袭性疾病增加了 82%，达到 244.6/100 000 (P = .02)。自2004年以来，非疫苗血清型引起的侵袭性肺炎球菌疾病发病率与疫苗接种前相比增加了140%（从1995-2000年的每10万人中95.1例增加到2004-2006年的228.6例，P = .001）。同期，七价疫苗血清型疾病减少了 96%。 2004-2006 年期间，19A 血清型占阿拉斯加 2 岁以下儿童侵袭性肺炎球菌疾病的 28.3%。 2 岁以下的非阿拉斯加原住民儿童的非疫苗疾病没有显着增加。 结论 阿拉斯加原住民儿童正在经历七价肺炎球菌结合疫苗未涵盖的血清型的替代性侵袭性肺炎球菌疾病。替代性侵袭性肺炎球菌疾病的证明强调了持续监测和开发扩大效价疫苗的重要性。
Context With routine childhood vaccination using heptavalent pneumococcal conjugate vaccine, one concern has been the potential for emergence and expansion of replacement disease caused by serotypes not contained in the heptavalent conjugate vaccine.Objective To determine whether replacement disease is associated with the overall decline in invasive pneumococcal disease among Alaska Native children.Design, Setting, and Patients Alaska statewide longitudinal population-based laboratory surveillance of invasive Streptococcus pneumoniae infections from January 1, 1995, through December 31, 2006.Main Outcome Measures Incidence and types of pneumococcal disease in children younger than 2 years.Results In the first 3 years after introduction of routine vaccination with heptavalent pneumococcal conjugate vaccine, overall invasive pneumococcal disease decreased 67% in Alaska Native children younger than 2 years (from 403.2 per 100 000 in 1995-2000 to 134.3 per 100 000 per year in 2001-2003, P < .001). However, between 2001-2003 and 2004-2006, there was an 82% increase in invasive disease in Alaska Native children younger than 2 years to 244.6/100 000 (P = .02). Since 2004, the invasive pneumococcal disease rate caused by nonvaccine serotypes has increased 140% compared with the prevaccine period (from 95.1 per 100 000 in 1995-2000 to 228.6 in 2004-2006, P = .001). During the same period, there was a 96% decrease in heptavalent vaccine serotype disease. Serotype 19A accounted for 28.3% of invasive pneumococcal disease among Alaska children younger than 2 years during 2004-2006. There was no significant increase in nonvaccine disease in non-Native Alaska children younger than 2 years.Conclusions Alaska Native children are experiencing replacement invasive pneumococcal disease with serotypes not covered by heptavalent pneumococcal conjugate vaccine. The demonstration of replacement invasive pneumococcal disease emphasizes the importance of ongoing surveillance and development of expanded valency vaccines.