论文部分内容阅读
目的了解中国≤18岁人群肺炎球菌相关病例中肺炎球菌血清型分布,及7价肺炎球菌多糖结合疫苗(7-valent Pneumococcal Polysaccharide Conjugate Vaccine,PPCV7)、13价(13-valent)PPCV(PPCV13)血清型覆盖情况,为制定疫苗免疫策略提供参考。方法采用系统评价方法,在中国医院知识数据库、万方数据库和美国国立图书馆(Pubmed)中检索相关文献,对符合条件文献的信息进行提取,采用中位数(Median,M)和四分位数区间(Quartile Range,Q)对血清型分布和疫苗的血清型覆盖情况进行分析。结果系统评价共收集符合条件的文献28篇,结果显示,中国1996~2004年≤18岁人群肺炎球菌相关病例中,肺炎球菌主要血清型分布是:23F占16.7%(Q:11.6%~20.4%)、19F占13.8%(Q:11.9%~34.1%)、6A占9.9%(Q:7.1%~13.2%)。在南方,19F占30.2%(Q:16.3%~35.3%)、23F占16.9%(Q:14.0%~19.6%)、6A占9.4%(Q:7.6%~11.0%);在北方,6A占13.2%(Q:6.6%~16.5%)、23F占11.6%(Q:10.8%~20.9%)、19F占10.0%(Q:8.7%~11.9%)。2005~2013年,19F占28.7%(Q:20.8%~42.2%)、19A占15.2%(Q:10.2%~19.7%)、23F占9.7%(Q:5.9%~12.3%)。在南方,19F占42.3%(Q:28.6%~62.2%)、19A占16.9%占(Q:3.3%~19.6%)、23F占11.5%(Q:4.3%~15.2%);在北方,19A占20.6%(Q:6.4%~33.9%)、19F占18.6%(Q:11.5%~28.6%)、23F占9.8%(Q:9.3%~13.6%)。≤5岁人群侵袭性肺炎球菌血清型分布是:19A占33.3%(Q:31.2%~33.3%)、19F占16.7%(Q:14.1%~19.6%)、14占12.9%(Q:9.2%~16.3%)。≤18岁人群疫苗血清型覆盖情况为:1996~2004年,PPCV7为59.5%(Q:40.0%~64.2%),南方为63.6%(Q:60.4%~65.4%),北方为40.0%(Q:36.8%~46.7%);PPCV13为75.7%(Q:66.7%~83.3%),南方为79.5%(Q:68.9%~83.8%),北方为70.0%(Q:58.4%~75.1%)。2005~2013年,PPCV7为60.2%(Q:52.0%~67.1%),南方为68.1%(Q:60.9%~80.0%),北方为49.2%(Q:46.0%~54.0%);PPCV13为84.8%(Q:82.1%~91.9%),南方为91.5%(Q:84.8%~94.9%),北方为74.6%(Q:72.6%~89.8%)。≤5岁人群侵袭性菌株疫苗血清型覆盖情况为:PPCV7为60.2%(Q:45.2%~66.7%),PPCV13为87.7%(Q:82.6%~93.4%)。结论≤18岁人群肺炎球菌相关病例中,血清型19F、19A比例上升,23F、6A、23F下降,PPCV7血清型覆盖率变化较小,约为60.0%,PPCV13覆盖率上升为84.8%。南方血清型集中于19F,北方血清型分散,南方两疫苗覆盖率均高于北方。≤5岁人群侵袭性菌株19A、19F、14比例和超过50%,PPCV7、PPCV13覆盖率分别为60.2%、87.7%。总之,PPCV13能提供更高的覆盖率。
Objective To investigate the distribution of pneumococcal serotypes in pneumococcal related cases of ≤18-year-old Chinese population, and to investigate the distribution of pneumococcal serotypes in 7-valent Pneumococcal Polysaccharide Conjugate Vaccine (PPCV7), 13-valent PPCV (13) Type coverage, to provide a reference for the development of vaccine immunization strategies. Methods The systematic reviews were performed to search for relevant articles in Chinese Hospital Knowledge Database, Wanfang Database and Pubmed, and the information of eligible documents was extracted. The median (Median, M) and quartile Quartile Range (Q) Analysis of serotype distribution and vaccine serotype coverage. Results A total of 28 eligible articles were collected from the systematic reviews. The results showed that the major serotypes of pneumococci in Chinese pneumococcal patients ≤18 years of age from 1996 to 2004 were: 23F accounting for 16.7% (Q: 11.6% -20.4% ), 19F accounted for 13.8% (Q: 11.9% ~ 34.1%) and 6A accounted for 9.9% (Q: 7.1% ~ 13.2%). 19F accounted for 30.2% (Q: 16.3% -35.3%), 23F accounted for 16.9% (Q: 14.0% -19.6%), 6A accounted for 9.4% (Q: 7.6% ~ 11.0%), and in the North, 6A 13.2% (Q: 6.6% to 16.5%), 23F accounted for 11.6% (Q: 10.8% to 20.9%) and 19F accounted for 10.0% (Q: 8.7% to 11.9%). From 2005 to 2013, 19F accounted for 28.7% (Q: 20.8% -42.2%), 19A 15.2% (Q: 10.2% -19.7%) and 23F 9.7% (Q 5.9% -12.3%). 19F accounted for 16.9% (Q: 3.3% ~ 19.6%), 23F accounted for 11.5% (Q: 4.3% ~ 15.2%); in the north, 19F accounted for 42.3% (Q: 28.6% ~ 62.2% Accounting for 20.6% (Q: 6.4% -33.9%), 19F accounting for 18.6% (Q: 11.5% -28.6%) and 23F accounting for 9.8% (Q: 9.3% -13.6%). Serotypes of invasive pneumococci in ≤5 years of age were 19.3% (Q: 31.2% -33.3%), 19.7% (Q: 14.1% -19.6%), 14.9% (Q: 9.2% ~ 16.3%). The serotype coverage of the vaccine population aged ≤18 years was 59.5% (Q: 40.0% -64.2%) for PPCV7 in 1996-2004, 63.6% (Q: 60.4% -65.4%) in the south and 40.0% in the north : 36.8% -46.7%); PPCV13 was 75.7% (Q: 66.7% -83.3%), 79.5% (Q: 68.9% -83.8%) in the south and 70.0% (Q: 58.4% -75.1%) in the north. From 2005 to 2013, PPCV7 was 60.2% (Q: 52.0% -67.1%), South China was 68.1% (Q: 60.9% -80.0%), North was 49.2% (Q: 46.0% -54.0%), PPCV13 was 84.8 % (Q: 82.1% ~ 91.9%), 91.5% (Q: 84.8% ~ 94.9%) in the south and 74.6% (Q: 72.6% ~ 89.8%) in the north. The coverage of the serotypes of the invasive strains of patients ≤ 5 years of age was 60.2% for PPCV7 (Q: 45.2% -66.7%) and 87.7% for PPCV13 (Q: 82.6% -93.4%). Conclusions Serum 19F, 19A increased, 23F, 6A, 23F decreased in pneumococcal related cases ≤18 years old. The coverage of PPCV7 serotypes was small, about 60.0%. The coverage rate of PPCV13 was 84.8%. Southern serotypes concentrated at 19F, northern serotypes were dispersed, and the coverage of the two southern vaccines was higher than that of the north. The proportion of invasive strains 19A, 19F, 14 and more than 50% in ≤5 years of age, the coverage rate of PPCV7 and PPCV13 were 60.2% and 87.7% respectively. In summary, PPCV13 provides higher coverage.