Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15.
Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15.
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DOI：
10.1016/s2214-109x(18)30247-x
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发表时间：
2018-07
期刊：
影响因子：
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通讯作者：
Knoll MD
中科院分区：
文献类型：
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作者：
Wahl B;O'Brien KL;Greenbaum A;Majumder A;Liu L;Chu Y;Lukšić I;Nair H;McAllister DA;Campbell H;Rudan I;Black R;Knoll MD
肺炎球菌结合疫苗（PCV）和b型流感嗜血杆菌疫苗（Hib）目前在大多数国家使用。为了监测全球和区域在改善儿童健康方面取得的进展，并为国家疾病预防和治疗政策提供信息，我们编制了2000年至2015年全球、区域和国家儿童这些病原体疾病负担估计数。利用世界卫生组织和妇幼流行病学估计合作组织对2000年至2015年肺炎和脑膜炎死亡率和肺炎发病率的国别估计，我们应用肺炎球菌和Hib病因特异性比例来估计病原体特异性死亡和病例。对这些病原体导致的肺炎死亡和病例比例的简要估计来自4种Hib疫苗和6种PCV疗效和有效性研究值。每种病原体导致的脑膜炎死亡比例来自细菌性脑膜炎病因学和调整后的病原体特异性脑膜炎病死率数据。肺炎球菌和Hib脑膜炎病例是从模拟的病原体特异性脑膜炎死亡病例和文献推导的病死率估计中推断出来的。使用文献中病原体特异性非肺炎、非脑膜炎病例与病原体特异性脑膜炎病例的比例来估计肺炎球菌和Hib综合征（肺炎和脑膜炎除外）的病例。我们考虑了年度艾滋病毒感染率、获得护理和疫苗使用情况。我们估计，2015年1-59月龄未感染艾滋病毒的儿童中有29.4万例肺炎球菌死亡（不确定范围[UR] 192 000 - 36.6 000）和29.5万例Hib死亡（18 400-40 700）。据估计，在感染艾滋病毒的儿童中，与肺炎球菌有关的死亡人数增加了23 300人（15 300 - 28 700人），与Hib有关的死亡人数不到1000人。我们估计，从2000年到2015年，肺炎球菌死亡率下降了51% (7-74)，Hib死亡率下降了90%（78-96）。大多数死于肺炎球菌（81%）和Hib（76%）的儿童表现为肺炎。较不保守的假设导致肺炎球菌死亡估计数在2015年可能高达51.5万例死亡（30.2万至60.9万例）。2015年肺炎球菌死亡总数的约50%发生在非洲和亚洲的四个国家：印度（68700例死亡，44600 - 86100例）、尼日利亚（49000例死亡，32400 - 59000例）、刚果民主共和国（14500例死亡，9300 - 18700例）和巴基斯坦（14400例死亡，9700 - 17000例）。2015年，印度（15600例死亡，9800 - 21500例）、尼日利亚（3600例死亡，2200-5100例）、中国（3400例死亡，2300-4600例）和南苏丹（1000例死亡，600 - 1400例）的Hib死亡人数最多。我们估计2015年全球儿童中有370万例（270万~ 430万例）严重肺炎球菌和34万例（196 ~ 669000例）严重Hib。在儿童死亡率高的国家广泛使用Hib疫苗和最近引入PCV与Hib和肺炎球菌病例和死亡的减少有关。肺炎球菌疾病负担的不确定性在很大程度上是由肺炎球菌导致的肺炎死亡比例所驱动的。在进一步减少Hib和肺炎球菌疾病负担的全球负担方面取得进展将取决于非洲和亚洲几个大国的努力。比尔和梅林达·盖茨基金会。
Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine are now used in most countries. To monitor global and regional progress towards improving child health and to inform national policies for disease prevention and treatment, we prepared global, regional, and national disease burden estimates for these pathogens in children from 2000 to 2015. Using WHO and Maternal and Child Epidemiology Estimation collaboration country-specific estimates of pneumonia and meningitis mortality and pneumonia morbidity from 2000 to 2015, we applied pneumococcal and Hib cause-specific proportions to estimate pathogen-specific deaths and cases. Summary estimates of the proportion of pneumonia deaths and cases attributable to these pathogens were derived from four Hib vaccine and six PCV efficacy and effectiveness study values. The proportion of meningitis deaths due to each pathogen was derived from bacterial meningitis aetiology and adjusted pathogen-specific meningitis case–fatality data. Pneumococcal and Hib meningitis cases were inferred from modelled pathogen-specific meningitis deaths and literature-derived case–fatality estimates. Cases of pneumococcal and Hib syndromes other than pneumonia and meningitis were estimated using the ratio of pathogen-specific non-pneumonia, non-meningitis cases to pathogen-specific meningitis cases from the literature. We accounted for annual HIV infection prevalence, access to care, and vaccine use. We estimated that there were 294 000 pneumococcal deaths (uncertainty range [UR] 192 000–366 000) and 29 500 Hib deaths (18 400–40 700) in HIV-uninfected children aged 1–59 months in 2015. An additional 23 300 deaths (15 300–28 700) associated with pneumococcus and fewer than 1000 deaths associated Hib were estimated to have occurred in children infected with HIV. We estimate that pneumococcal deaths declined by 51% (7–74) and Hib deaths by 90% (78–96) from 2000 to 2015. Most children who died of pneumococcus (81%) and Hib (76%) presented with pneumonia. Less conservative assumptions result in pneumococcccal death estimates that could be as high as 515 000 deaths (302 000–609 000) in 2015. Approximately 50% of all pneumococcal deaths in 2015 occurred in four countries in Africa and Asia: India (68 700 deaths, UR 44 600–86 100), Nigeria (49 000 deaths, 32 400–59 000), the Democratic Republic of the Congo (14 500 deaths, 9300–18 700), and Pakistan (14 400 deaths, 9700–17 000]). India (15 600 deaths, 9800–21 500), Nigeria (3600 deaths, 2200–5100), China (3400 deaths, 2300–4600), and South Sudan (1000 deaths, 600–1400) had the greatest number of Hib deaths in 2015. We estimated 3·7 million episodes (UR 2·7 million–4·3 million) of severe pneumococcus and 340 000 episodes (196 000–669 000) of severe Hib globally in children in 2015. The widespread use of Hib vaccine and the recent introduction of PCV in countries with high child mortality is associated with reductions in Hib and pneumococcal cases and deaths. Uncertainties in the burden of pneumococcal disease are largely driven by the fraction of pneumonia deaths attributable to pneumococcus. Progress towards further reducing the global burden of Hib and pneumococcal disease burden will depend on the efforts of a few large countries in Africa and Asia. Bill & Melinda Gates Foundation.