Changing Epidemiology of Invasive Pneumococcal Disease in Canada, 1998-2007: Update from the Calgary-Area Streptococcus pneumoniae Research (CASPER) Study
Changing Epidemiology of Invasive Pneumococcal Disease in Canada, 1998-2007: Update from the Calgary-Area Streptococcus pneumoniae Research (CASPER) Study
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DOI：
10.1086/599827
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发表时间：
2009-07-15
影响因子：
11.8
通讯作者：
Scheifele, David W.
中科院分区：
文献类型：
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作者：
Kellner, James D.;Vanderkooi, Otto G.;Scheifele, David W.
背景2002年，卡尔加里卫生区（加拿大阿尔伯塔）开始对婴儿常规接种7价肺炎球菌结合疫苗（PCV 7）。我们测量了该疫苗项目对侵袭性肺炎球菌病（IPD）的影响。从1998年1月至2007年12月，对所有IPD病例进行了前瞻性、基于人群的监测（使用从无菌部位获得的培养标本）。收集人口统计学和临床数据。保存所有存活的分离株并进行分型。在10年期间有1182例IPD病例。疫苗接种期（2003-2007年）与疫苗接种前（1998-2001年）的比较显示，在6-23个月、2-4岁、16-64岁和65-84岁年龄组中，由PCV 7血清型引起的IPD的发病率分别显著降低了86%、59%、38%和78%。6-23个月、2-4岁和65-84岁年龄组的IPD病例总数分别下降了77%、45%和34%。在16-64岁的成年人中，由于非PCV 7血清型引起的IPD发病率增加了183%，IPD的总发病率增加了73%;然而，这种增加主要归因于2005-2007年期间无家可归的成年人中血清型5 IPD的大爆发。在接种疫苗期间，有5例儿童因PCV 7血清型而发生IPD。自从引入PCV 7疫苗以来，儿童IPD病例总数以及卡尔加里所有年龄段受试者中因PCV 7血清型引起的病例数量大幅下降，表明疫苗的直接效应和群体效应很强。现在引起IPD的血清型已经发生了显著变化。由非PCV 7血清型引起的替代IPD的程度和影响尚不清楚。
Background. Routine infant vaccination with 7-valent pneumococcal conjugate vaccine (PCV7) began in the Calgary Health Region (Alberta, Canada) in 2002. We measured the impact of this vaccine program on invasive pneumococcal disease (IPD).Methods. Prospective, population-based surveillance of all cases of IPD (with culture specimens obtained from sterile sites) was conducted from January 1998 through December 2007. Demographic and clinical data were collected. All viable isolates were saved and serotyped.Results. There were 1182 IPD cases over the 10-year period. Comparison of the vaccine period (2003-2007) with the prevaccine period (1998-2001) revealed that the incidence of IPD due to PCV7 serotypes decreased significantly by 86%, 59%, 38%, and 78% in the 6-23-month, 2-4-year, 16-64-year, and 65-84-year age groups, respectively. The total number of IPD cases decreased by 77%, 45%, and 34% in the 6-23-month, 2-4-year, and 65-84-year age groups, respectively. The incidence of IPD due to non-PCV7 serotypes increased by 183%, and the total incidence of IPD increased by 73% among adults aged 16-64 years; however, this increase was primarily attributed to a large outbreak of serotype 5 IPD among homeless adults during the period 2005-2007. There were 5 cases of IPD due to PCV7 serotypes among vaccinated children in the vaccine period.Conclusions. Since the introduction of PCV7 vaccine, there has been a profound decrease in the total number of cases of IPD among children and in cases due to PCV7 serotypes among subjects of all ages in Calgary, indicating a strong direct effect and herd effect of the vaccine. The serotypes that now cause IPD have changed significantly. The magnitude and impact of replacement IPD caused by non-PCV7 serotypes is not yet known.