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Evaluation of the effectiveness of pneumococcal conjugate vaccine for children in Korea with high vaccine coverage using a propensity score matched national population cohort.

使用倾向评分匹配的全国人群队列评估疫苗覆盖率高的韩国儿童肺炎球菌结合疫苗的有效性。

  • 影响因子:2.89
  • DOI:10.1016/j.ijid.2020.01.034
  • 作者列表:"Sohn S","Hong K","Chun BC
  • 发表时间:2020-04-01
Abstract

OBJECTIVES:This study was performed to evaluate the vaccine effectiveness (VE) of protein conjugated pneumococcal vaccines (PCV) in children with regard to all-cause pneumonia (ACP), pneumococcal pneumonia (PP), invasive pneumococcal disease (IPD), and acute otitis media (AOM), in a country where the unvaccinated group is very small. METHODS:Children born between 2013 and 2015 were identified in the national population registry for retrospective observation. Vaccination history from the National Immunization Program registry and medical records from the National Health Insurance System were linked together to set up a cohort. VE based on original and propensity score matched cohorts were estimated and compared. RESULTS:A total of 990 224 children were included and 98% were vaccinated. The crude incidence of ACP, PP, and AOM for the original cohort was heavily skewed to the vaccinated group. Adjusting for age, sex, comorbidity, and healthcare utilization rate, the vaccine was found to be effective against PP (VE 60.15%, 95% confidence interval (CI) 21.21-79.85%) and AOM (VE 19.13%, 95% CI 13.42-24.46%). The propensity score matched cohort showed VE against ACP (5.95%, 95% CI 0.88-11.57%), PP (48.61%, 95% CI 23.60-65.43%), and AOM (33.21%, 95% CI 31.01-35.33%). CONCLUSIONS:The direct effect of the PCV program was confirmed for ACP, PP, and AOM. The propensity score matched cohort is a feasible solution for measuring and tracing nationwide VE in countries with a very high level of vaccine coverage.

摘要

目的: 本研究旨在评估蛋白结合肺炎球菌疫苗 (PCV) 对儿童全因肺炎 (ACP) 的疫苗有效性 (VE)。肺炎球菌肺炎 (PP) 、侵袭性肺炎球菌疾病 (IPD) 和急性中耳炎 (AOM),在未接种疫苗的人群非常小的国家。 方法: 在全国人口登记中确定 2013 年至 2015 年间出生的儿童进行回顾性观察。将国家预防接种规划登记处的疫苗接种史和国家健康保险系统的医疗记录联系在一起,建立了一个队列。基于原始和倾向得分匹配的队列对VE进行了估计和比较。 结果: 共纳入 990 224 名儿童,98% 人接种疫苗。原始队列的ACP、PP和AOM的粗发病率严重偏向接种组。调整年龄、性别、合并症和医疗利用率,发现疫苗对PP有效 (VE 60.15%,95% 置信区间 (CI) 21.21-79.85%) 和AOM (VE 19.13%,95% CI 13.42-24.46%)。倾向评分匹配队列显示VE对ACP (5.95%,95% CI 0.88-11.57%),PP (48.61%,95% CI 23.60-65.43%) 和AOM (33.21%,95% CI 31.01-35.33%)。 结论: PCV程序对ACP、PP和AOM的直接影响得到了证实。倾向评分匹配队列是在疫苗覆盖率非常高的国家测量和追踪全国VE的可行解决方案。

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影响因子:14.71
发表时间:2020-02-01
来源期刊:Nature immunology
DOI:10.1038/s41590-019-0571-2
作者列表:["Adrover JM","Aroca-Crevillén A","Crainiciuc G","Ostos F","Rojas-Vega Y","Rubio-Ponce A","Cilloniz C","Bonzón-Kulichenko E","Calvo E","Rico D","Moro MA","Weber C","Lizasoaín I","Torres A","Ruiz-Cabello J","Vázquez J","Hidalgo A"]

METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.

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影响因子:2.81
发表时间:2020-01-05
DOI:10.3390/ijerph17010356
作者列表:["Yang LC","Suen YJ","Wang YH","Lin TC","Yu HC","Chang YC"]

METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.

翻译标题与摘要 下载文献
影响因子:2.89
发表时间:2020-04-01
DOI:10.1016/j.ijid.2020.01.038
作者列表:["Ngocho JS","Horumpende PG","de Jonge MI","Mmbaga BT"]

METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.

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肺炎方向

肺炎是指终末气道、肺泡和肺间质的炎症。可由细菌、病毒、真菌、寄生虫等致病微生物,以及放射线、吸入性异物等理化因素引起。临床主要症状为发热、咳嗽、咳痰、痰中带血,可伴胸痛或呼吸困难等。

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