Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine

Context  Streptococcus pneumoniae is a serious infection in young infants. A heptavalent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 and recommended for all children aged 2 to 23 months. Objective  To determine the rates of invasive pneumococcal disease (IPD) in young infants before and after PCV7 was incorporated into the childhood immunization schedule in June 2000. Design, Setting, and Participants  A prospective, population-based study of infants aged 0 to 90 days who resided in areas in 8 US states with active laboratory surveillance for invasive S pneumoniae infections from July 1, 1997, to June 30, 2004. Main Outcome Measures  Rates of laboratory-confirmed IPD before (July 1, 1997-June 30, 2000) and after (July 1, 2001-June 30, 2004) PCV7 introduction, excluding a transition year (July 1, 2000-June 30, 2001). Results  There were 146 cases of IPD, 89 before and 57 after PCV7 introduction. Isolated bacteremia occurred in 94 cases (64%), pneumonia in 27 (18%), meningitis in 22 (15%), and septic arthritis and/or osteomyelitis in 3 (2%). Mean rates of IPD for infants aged 0 to 90 days decreased 40% from 11.8 (95% confidence interval [CI], 9.6-14.5) to 7.2 (95% CI, 5.6-9.4; P = .004) per 100 000 live births following PCV7 introduction. Among black infants, mean rates of IPD decreased significantly from 17.1 (95% CI, 11.9-24.6) to 5.3 (95% CI, 2.8-10.1; P = .001) per 100 000 live births, with a nonsignificant decrease from 9.6 (95% CI, 7.3-12.7) to 6.8 (95% CI, 4.9-9.4) per 100 000 live births for white infants. Rates of PCV7-serotype isolates decreased significantly from 7.3 (95% CI, 5.3-10.1) to 2.4 (95% CI, 1.6-3.8; P<.001) per 100 000 live births, while rates of non-PCV7 serotypes remained stable (P = .55). Conclusions  Since PCV7 introduction, rates of IPD in young infants have decreased significantly, providing evidence that vaccinating children aged 2 to 23 months has led to changes in pneumococcal carriage in infants too young to receive PCV7. With a significant decrease in rates of IPD among black infants, the previous racial difference has been eliminated.      

Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children

Context  Concern has been raised about the possible emergence of a bacterial strain that is untreatable by US Food and Drug Administration (FDA)–approved antibiotics and that causes acute otitis media (AOM) in children. Objective  To monitor continuing shifts in the strains of Streptococcus pneumoniae that cause AOM, with particular attention to capsular serotypes and antibiotic susceptibility, following the introduction of a pneumococcal 7-valent conjugate vaccine (PCV7). Design, Setting, and Patients  Prospective cohort study using tympanocentesis to identify S pneumoniae strains that caused AOM in children receiving PCV7 between September 2003 and June 2006. All children were from a Rochester, New York, pediatric practice. Main Outcome Measure  Determination of serotypes and antibiotic susceptibility of S pneumoniae causing AOM. Results  Among 1816 children in whom AOM was diagnosed, tympanocentesis was performed in 212, yielding 59 cases of S pneumoniae infection. One strain of S pneumoniae belonging to serotype 19A was a new genotype and was resistant to all antibiotics approved by the FDA for use in children with AOM. This strain was identified in 9 cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006). Four children infected with this strain had been unsuccessfully treated with 2 or more antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and 3 injections of ceftriaxone; 3 had recurrent AOM; and for 2 others, the infection was their first in life. The first 4 cases required tympanostomy tube insertion after additional unsuccessful antibiotic therapies. Levofloxacin was used in the subsequent 5 cases, with resolution of infection without surgery. Conclusion  In the years following introduction of PCV7, a strain of S pneumoniae has emerged in the United States as an otopathogen that is resistant to all FDA-approved antibiotics for treatment of AOM in children.      

Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine

Context  A conjugate vaccine targeting 7 pneumococcal serotypes was licensed for young children in 2000. In contrast to the 23-valent polysaccharide vaccine used in adults, the 7-valent conjugate vaccine affects pneumococcal carriage and transmission. Early after its introduction, incidence of invasive pneumococcal disease declined among older adults, a group at high risk for pneumococcal disease. Objective  To determine among adults aged 50 years or older whether incidence of invasive pneumococcal disease, disease characteristics, or the spectrum of patients acquiring these illnesses have changed over the 4 years since pneumococcal conjugate vaccine licensure. Design, Setting, and Population  Population-based surveillance of invasive pneumococcal disease in 8 US geographic areas (total population, 18 813 000), 1998-2003. Main Outcome Measures  Incidence of invasive pneumococcal disease by pneumococcal serotype and other characteristics; frequency among case patients of comorbid conditions and other factors influencing mortality. Results  Incidence of invasive pneumococcal disease among adults aged 50 years or older declined 28% (95% confidence interval [CI], –31% to –24%), from 40.8 cases/100 000 in 1998-1999 to 29.4 in 2002-2003. Among those aged 65 years or older, the 2002-2003 rate (41.7 cases/100 000) was lower than the Healthy People 2010 goal (42 cases/100 000). Among adults aged 50 years or older, incidence of disease caused by the 7 conjugate vaccine serotypes declined 55% (95% CI, –58% to –51%) from 22.4 to 10.2 cases/100 000. In contrast, disease caused by any of the 16 serotypes only in polysaccharide vaccine did not change, and disease caused by serotypes not in either vaccine increased somewhat, from 6.0 to 6.8 cases/100 000 (13%; 95% CI, 1% to 27%). Between 1998-1999 and 2002-2003, the proportion of case-patients with human immunodeficiency virus infection increased from 1.7% (47/2737) to 5.6% (124/2231) (P<.001), and those with any comorbid condition that is an indication for pneumococcal polysaccharide vaccination increased from 62.3% (1842/2955) to 72.0% (1721/2390) (P<.001). Conclusions  Our findings indicate that use of conjugate vaccine in children has substantially benefited older adults. However, persons with certain comorbid conditions may benefit less than healthier persons from the indirect effects of the new vaccine.      

23价肺炎球菌多糖疫苗接种对稳定期COPD患者的影响

目的评价23价肺炎球菌多糖疫苗（PPSV-23）接种在稳定期慢性阻塞性肺病（COPD）的作用。方法将100例稳定期COPD患者随机分成干预组和对照组,干预组患者于接种后随访1周观察不良反应。注射疫苗2年内观察病情急性发作、肺部感染、住院次数、死亡率和不良反应,并与对照组进行对比。结果干预组急性发作次数、肺部感染、住院次数、病死率均低于对照组。接种后不良反应多为局部反应,经热敷或休息1～3d可缓解。结论 PPSV-23可以减少稳定期COPD患者急性发作率、肺部感染率、住院率、死亡率。     

EV71感染手足口病患儿血清白细胞介素-37和白细胞介素-33水平检测

目的:研究EV71感染手足口病（HFMD）患儿血清白细胞介素（IL）-37和IL-33水平并分析其意义。方法:收集180例确诊的EV71感染HFMD患儿（观察组）和100名健康体检儿童（对照组）外周血,采用全自动血球分析仪检测外周血中性粒细胞和单核细胞绝对值,采用ELISA法检测血清IL-37和IL-33水平,并分析其相关性。结果:观察组外周血中性粒细胞绝对值、单核细胞绝对值、血清IL-37水平和血清IL-33水平均显著高于对照组（P<0.01）;重症组EV71感染HFMD患儿外周血中性粒细胞绝对值、单核细胞绝对值、血清IL-37水显著平均高于轻症组（P<0.05~P<0.01）;观察组血清IL-37与IL-33水平呈正相关关系（P<0.05）;重症组血清IL-37水平与外周血单核细胞绝对值呈正相关关系（P<0.05）;重症组血清IL-33水平与外周血中性粒细胞绝对值呈正相关关系（P<0.05）。结论:EV71感染手足口病重症患儿IL-37、IL-33水平改变可能与手足口病发病及病情发展有关。     

左卡尼汀治疗柯萨奇A16型病毒感染所致手足口病患儿血清NT-proBNP和BNP水平异常的效果

目的:观察左卡尼汀治疗柯萨奇A16型病毒(CA16型)感染所致手足口病(HFMD)血清氨基末端脑钠肽前体(NT-proBNP和B型脑钠肽(BNP)水平异常的效果。方法:选取68例CA16型病毒感染后血氨基末端脑钠肽(NT-proBNP)和B型脑钠肽(BNP)异常的HFMD患儿,按照病案号奇偶数随机分为对照组(实施基础治疗)和观察组(基础治疗联合左卡尼汀治疗),比较两组血BNP、NTproBNP、肌酸激酶同工酶(CK-MB)、门冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)等指标水平和心电图、心率变化以及重症转化率等指标水平。结果:(1)治疗前,两组患儿的性别、年龄、病程、心率、心肌酶谱、BNP、NT-proBNP等指标水平比较,差异均无统计学意义(P>0.05)。(2)治疗3 d和7 d后,观察组患儿治疗总有效率分别为85.3%、100%,均高于对照组的61.8%、94.1%,两组比较差异有统计学意义(P<0.05)。(3)治疗3 d后,观察组NT-proBNP和BNP、AST、CK-MB水平低于对照组,差异有统计学意义(P<0.05)。(4)治疗7 d后,观察组CK-MB、NT-proBNP、BNP水平和心率恢复时间短于对照组,ECG恢复率高于对照组,差异有统计学意义(P<0.05)。结论:基础治疗联合左卡尼汀治疗柯萨奇A16型病毒感染所致HFMD患儿血NT-proBNP和BNP水平异常的效果优于单纯基础治疗效果,可显著改善患儿BNP、NT-proBNP和心肌酶谱水平,缩短心率恢复时间,提高心电图恢复率。     

SAA、PCT 及WBC 对肠道病毒71 型感染 手足口病患儿的诊断价值

目的 分析肠道病毒71 型感染手足口病（HFMD）患儿的血清淀粉样蛋白A（SAA）、血清降钙 素原（PCT）和白细胞计数（WBC）水平,比较上述指标与患儿肌酸激酶（CK）、肌酸激酶同工酶（CKMB）、 乳酸脱氢酶（LDH）的相关性,探讨其对肠道病毒71 型感染HFMD 患儿的诊断价值。方法 选取2018 年 10 月—2019 年10 月中国人民解放军总医院收治的60 例肠道病毒71 型感染HFMD 患儿作为研究对象,分析 其基本资料和临床感染特征及表现。按照病情分为重症组和普通组,并选取30 例健康体检儿童作为对照组。 比较各组SAA、PCT、WBC,检测各组CK、CKMB、LDH 变化并与上述指标进行相关性分析。结果 普 通组和重症组SAA、PCT、WBC 高于对照组（P <0.05）;重症组SAA、PCT 高于普通组（P <0.05）。重症 组与对照组的SAA、PCT、WBC 的曲线下面积（AUC）分别为0.993（95% CI ：0.976,1.000）、0.995（95% CI ：0.982,1.000）和0.939（95% CI ：0.868,1.000）;重症组与普通组的SAA、PCT、WBC 的AUC 分别 为0.913（95% CI ：0.796,1.000）、0.911（95% CI ：0.793,1.000） 和0.756（95% CI ：0.607,0.906）。重症 组CK、CKMB、LDH 高于普通组和对照组;普通组CK、LDH 高于对照组。经相关性分析,CK 与SAA、 PCT、WBC 呈正相关（r s =0.565、0.759 和0.401,均P <0.05）;CKMB 与SAA、PCT、WBC 呈正相关（r s =0.416、 0.359 和0.315,均P <0.05）;LDH 与SAA、PCT、WBC 呈正相关（r s =0.550、0.358 和0.354,均P <0.05）。 结论 SAA、PCT、WBC 对肠道病毒71 型感染HFMD 病情有一定诊断价值,与CK、CKMB、LDH 共同检 测在预示肠道病毒71 型感染的HFMD 患儿由轻症转为重症方面具有指导意义。     

一氧化氮吸入治疗急性高原病患者血浆内皮素含量变化

目的了解急性高原病患者吸入一氧化氮(nitric oxide,NO)后血浆内皮素(endothelin,ET)含量的变化情况及其意义.方法将47例急性高原病患者随机分为药物治疗组(23例)和NO治疗组(24例).药物治疗组给予吸氧、氨茶碱、地塞米松、速尿等药物常规治疗,NO治疗组仅给予吸入由海拔3 658 m高度的空气平衡的即浓度为0.001%的NO气体,每天两次,上午、下午各1 h.并对两组患者治疗前后的血浆ET含量变化进行对照比较.结果NO治疗组治疗后的血浆ET含量显著低于该组治疗前和药物治疗组治疗后的血浆ET含量(分别为:P＜0.01、P＜0.05).结论吸入NO能显著降低急性高原病患者血浆ET水平,有利于患者康复.     

儿童变应性鼻炎引起中耳病变及对中耳听力功能影响的临床研究

目的 研究儿童变应性鼻炎引起中耳咽鼓管及鼓膜的病变情况,并探讨其对中耳传音功能的影响.方法 选择2012年1～12月来济南军区总医院（以下简称“我院”）就诊的变应性鼻炎患儿80例（160耳）为观察组,同期来我院进行体检的无变应性鼻炎儿童80例（160耳）为对照组.对所有研究对象进行耳镜、鼻内镜检查,同时对其进行纯音测听、声阻抗检查.结果 观察组患儿咽鼓管咽口发病率为38.8％,鼓膜发病率为20.0％,中耳传导性听力减退发生率为36.9％,与对照组儿童比较（3.8％、3.1％、6.9％）差异有统计学意义（P＜0.05）.结论 儿童变应性鼻炎往往引起中耳中咽鼓管及鼓膜的病变,也会导致中耳听力功能的减退,因此,在临床上要注意对变应性鼻炎患儿做好咽鼓管、鼓膜病变及中耳听力减退方面的检查及防护工作.