Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates
Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates
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DOI：
10.1016/s0140-6736(09)61204-6
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发表时间：
2009-09-12
期刊：
影响因子：
168.9
通讯作者：
Cherian, Thomas
中科院分区：
文献类型：
--
作者：
O'Brien, Katherine L.;Wolfson, Lara J.;Cherian, Thomas
背景肺炎链球菌是全球儿童细菌性肺炎、脑膜炎和败血症的主要病因。然而，许多国家缺乏对疾病负担的国家估计。有有效的干预措施，包括肺炎球菌结合疫苗和病例管理。为支持地方和全球肺炎链球菌疾病防治的决策，我们估计了5岁以下儿童严重病例和死亡的国别发病率。方法通过将疫苗试验的疗效估计得出的S肺炎病例所占比例应用于世卫组织对全原因肺炎病例和死亡的国别估算，来衡量肺炎球菌肺炎的负担。我们还使用系统性文献综述中的发病率和病死率数据来评估脑膜炎和非肺炎、非脑膜炎侵袭性疾病的负担。当从一个国家获得高质量的数据时，这些数据被用于国家估计。除此之外，估计是根据儿童死亡率相近的邻国的数据进行的。对艾滋病毒流行率和获得护理的机会进行了估计，并在适用时对b型流感嗜血杆菌疫苗的使用进行了调整。2000年，估计发生了约1450万起严重肺炎球菌病(不确定范围为1110万至1800万)。肺炎球菌病导致1-59个月儿童死亡约82.6万人(582000-926000人)，其中91000人(63000-102000人)为艾滋病毒阳性，735000人(519000-825000人)为艾滋病毒阴性儿童。在艾滋病毒阴性儿童的死亡中，超过61%(449 000[316 000-501 000])发生在10个非洲和亚洲国家。S肺炎引起的死亡约占1-59个月儿童死亡的11%(8-12%)(不包括艾滋病毒阳性儿童肺炎球菌死亡)。通过预防和治疗肺炎球菌病，尤其是在世界上负担最重的地区，可以加速实现联合国千年发展目标4中关于降低儿童死亡率的目标。
Background Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis in children worldwide. However, many countries lack national estimates of disease burden. Effective interventions are available, including pneumococcal conjugate vaccine and case management. To support local and global policy decisions on pneumococcal disease prevention and treatment, we estimated country-specific incidence of serious cases and deaths in children younger than 5 years.Methods We measured the burden of pneumococcal pneumonia by applying the proportion of pneumonia cases caused by S pneumoniae derived from efficacy estimates from vaccine trials to WHO country-specific estimates of all-cause pneumonia cases and deaths. We also estimated burden of meningitis and non-pneumonia, non-meningitis invasive disease using disease incidence and case-fatality data from a systematic literature review. When high-quality data were available from a country, these were used for national estimates. Otherwise, estimates were based on data from neighbouring countries with similar child mortality. Estimates were adjusted for HIV prevalence and access to care and, when applicable, use of vaccine against Haemophilus influenzae type b.Findings In 2000, about 14.5 million episodes of serious pneumococcal disease (uncertainty range 11.1-18.0 million) were estimated to occur. Pneumococcal disease caused about 826 000 deaths (582 000-926 000) in children aged 1-59 months, of which 91 000 (63 000-102 000) were in HIV-positive and 735000 (519 000-825 000) in HIV-negative children. Of the deaths in HIV-negative children, over 61% (449 000 [316 000-501 000]) occurred in ten African and Asian countries.Interpretation S pneumoniae causes around 11% (8-12%) of all deaths in children aged 1-59 months (excluding pneumococcal deaths in HIV-positive children). Achievement of the UN Millennium Development Goal 4 for child mortality reduction can be accelerated by prevention and treatment of pneumococcal disease, especially in regions of the world with the greatest burden.