Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the Intermountain West:: Emergence of nonvaccine serogroups
Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the Intermountain West:: Emergence of nonvaccine serogroups
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DOI：
10.1086/430604
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发表时间：
2005-07-01
影响因子：
11.8
通讯作者：
Pavia, AT
中科院分区：
文献类型：
--
作者：
Byington, CL;Samore, MH;Pavia, AT
背景七价肺炎球菌结合疫苗（PCV-7[Prevnar]）的使用与美国儿童侵袭性肺炎球菌病（IPD）发病率的降低有关。在1996-2003年期间，确定了由山间保健保险或接受保健的18岁以下儿童的IPD病例。S.对1997-2003年期间在Primary Children's Medical Center（PCMC;湖城，UT）治疗的患有IPD的儿童中的肺炎支原体进行血清分型。分析IPD的时间趋势、肺炎球菌的血清型分布和肺炎球菌的耐药性。共确定了1535例IPD病例。在引入PCV 7后，IPD的发生率下降了27%。在接受PCMC治疗的IPD儿童中，1997-2000年73%的疾病是由PCV 7血清群引起的，而2001-2003年为50%（P < .001），对青霉素耐药的分离株百分比从1997-2000年的34%下降到2001-2003年的22%（P = .04）。积脓的IPD病例百分比从16%增加到30%（P = 0.015），严重IPD病例百分比从57%增加到71%（P = 0.026）。非PCV 7血清群所致IPD患儿年龄较大，更易发生胸膜旁脓胸，住院时间较长。在引进PCV 7疫苗后，IMW的IPD发病率下降了27%。在疫苗接种后期间（2001-2003年），由PCV 7和耐药血清群引起的IPD病例比例显著下降。这些益处伴随着非PCV 7血清群所致IPD病例比例的显著增加，脓胸和重度IPD的发生率增加。
Background. Use of the heptavalent pneumococcal conjugate vaccine (PCV-7[Prevnar]) has been associated with decreased a incidence of invasive pneumococcal disease (IPD) among children in the United States.Methods. Cases of IPD in children < 18 years of age insured by or receiving health care from Intermountain Health Care during 1996-2003 were identified. Isolates of S. pneumoniae from children with IPD treated at Primary Children's Medical Center (PCMC; Salt Lake City, UT) during 1997-2003 were serogrouped. Temporal trends of IPD, serogroup distribution of pneumococci, and antibiotic resistance among pneumococci were analyzed.Results. A total of 1535 cases of IPD were identified. The rate of IPD decreased 27% after the introduction of PCV7. Among children with IPD who were cared for at PCMC, disease in 73% was caused by PCV7 serogroups in 1997-2000, compared with 50% in 2001-2003 (P < .001), and the percentage of isolates resistant to penicillin decreased from 34% in 1997-2000 to 22% in 2001-2003 (P = .04). The percentage of IPD cases that were empyema increased from 16% to 30% (P = .015), and the percentage of severe cases of IPD increased from 57% to 71% (P = .026). Children with IPD due to non-PCV7 serogroups were older, were more likely to have parapneumonic empyema, and had longer hospital stays.Conclusions. The incidence of IPD in the IMW decreased by 27% after the introduction of the PCV7 vaccine. During the postvaccine period (2001-2003), there were significant decreases in the proportion of cases of IPD caused by PCV7 and antibiotic-resistant serogroups. These benefits were accompanied by a significant increase in the proportion of IPD cases due to non-PCV7 serogroups, with increases in the incidence of empyema and severe IPD.