背景:急性中耳炎(AOM)是由肺炎链球菌引起的常见儿童疾病。肺炎球菌结合疫苗(PCV7,PCV10,PCV13)可以降低AOM的风险,但也可能改变AOM的病因和血清型分布。本研究的目的是回顾在过去10年中广泛使用PCV后,欧洲AOM负担的已发表文献中的估计,关注发病率,病因学,肺炎链球菌的血清型分布和耐药性,和经济负担。
方法:本系统综述包括来自31个欧洲国家的已发表文献,对于≤5岁的儿童,2011年后出版。使用PubMed进行搜索,Embase,Google,和三个疾病会议网站。使用ISPOR-AMCP-NPC评估偏倚风险,Ecobias或Robis,取决于研究的类型。
结果:总计,确定了107个相关记录,这揭示了研究方法和报告的巨大差异,从而限制了跨结果的比较。没有发现各国发病率的同质趋势,或随着时间的推移检测肺炎链球菌作为AOM的原因。有迹象表明住院率有所下降(下降24.5-38.8%,取决于国家,PCV类型和自PCV引入以来的时间)和抗生素耐药性(降低14-24%,视国家而定),随着时间的推移PCV的广泛使用。最后两个趋势意味着经济负担可能会减少,虽然这是不可能确认与确定的成本数据。还有证据表明,在所有可获得非PCV血清型数据的国家中,非疫苗血清型的血清型分布都有所增加,以及非疫苗血清型中抗生素耐药性增加的有限数据。
结论:尽管一些因素表明欧洲的AOM负担减少,负担仍然很高,来自未发现的血清型的残余负担是存在的,很难提供全面的,从发表的文献中准确和最新的估计所述负担。这可以通过标准化的方法来改进,报告和更广泛地使用监控系统。
BACKGROUND: Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to
review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden.
METHODS: This systematic
review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study.
RESULTS: In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes.
CONCLUSIONS: Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.