Effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-serotype community acquired pneumococcal diseases among children in China: A test-negative case-control study.

BACKGROUND: In 2016, China licensed 13-valent pneumococcal conjugate vaccine (PCV13) based on a study that demonstrated its immunogenicity is non-inferior to PCV7. However, the real-world effectiveness of PCV13 against vaccine-serotype pneumococcal diseases in China has limited evidence. METHODS: A test-negative case-control study was conducted among children under 5 years old admitted to the Children's Hospital of Soochow University (SCH) with respiratory tract infections from January 2018 to December 2020. Cases were defined as children from whom the isolates were tested positive for Streptococcus pneumoniae (S. pneumoniae) with serotypes included in PCV13. Two control groups were included, one represented children with isolates positive for S. pneumoniae of non-PCV13 serotypes and the other comprised children who tested negative for S. pneumoniae. The S. pneumoniae-negative controls were selected by matching them to the cases based on gender, age and admission date in a 1:1 ratio. Vaccine effectiveness (VE) was calculated using a logistic regression model as (1- adjusted odds ratio) * 100 %. RESULTS: A total of 2371 pneumococcal isolates were included in the analysis, of which 75.0 % (1779/2371) were covered by PCV13 serotypes. Consequently, these 1779 children were classified as cases, and 592 children were designated as non-PCV13 serotype controls. Another 1779 children were correspondingly recruited as S. pneumoniae-negative controls. Overall, 40 cases (2.3 %) and 148 controls (6.2 %) had received vaccination. The overall VE in the PCV13/non-PCV13 serotypes case-control study was 50.0 % (95 % CI: 15.0, 70.7), which was lower than the VE of 74.4 % (95 % CI: 60.7, 83.3) in the matched PCV13/S. pneumoniae-negative case-control study. VE was higher for ≥ 2 or ≥ 3 doses of vaccination compared to ≥ 1 dose. VE against specific PCV13 serotypes (6B, 6A and 19F) was higher than for other serotypes. CONCLUSIONS: PCV13 vaccination demonstrates effectiveness against vaccine-serotype pneumococcal diseases in children, particularly for serotypes 6B, 6A and 19F.

Epidemiological characteristics and antibiotics susceptibility of Streptococcus pneumoniae isolated from children in Suzhou area during 2010 to 2017 / 中华传染病杂志

Objective:To explore the epidemiological characteristics and the antibiotic resistance of Streptococcus pneumoniae isolates, and to provide the evidence for the rational use of antimicrobial agents to treat Streptococcus pneumoniae infection. Methods:The positive microbiological laboratory identification and antimicrobial susceptibility testing of Streptococcus pneumoniae from sputum of children with respiratory infections during January 2010 to December 2017 in Children′s Hospital of Soochow University were retrospectively analyzed. The positive rates of Streptococcus pneumoniae of different genders, ages, years and seasons were compared. The annual detection rates and trends of drug resistance of Streptococcus pneumoniae to penicillin, amoxicillin and cefotaxime were analyzed by Mann-Kendall trend test. The seasonal decomposition of time series was conducted to assess the association between Streptococcus pneumoniae detection rate and season. Enumeration data was compared using χ2 test. Results:Of the 88 480 sputum specimens, the total positive rate of Streptococcus pneumoniae was 10.3%(9 081/88 480). The detection rates of Streptococcus pneumoniae in children aged 0 to <0.5 years old, 0.5 to <2 years old, 2 to <3 years old, 3 to <5 years old, and 5 to <15 years old were 4.2%(1 407/33 224), 13.1%(3 191/24 390), 14.9%(2 417/16 252), 17.9%(1 474/8 246) and 9.3%(592/6 368), respectively. The difference was statistically significant ( χ2=2 421.6, P<0.01). The detection rates were 8.1%(1 321/16 306) from January to March, 10.9%(2 194/20 207) from April to June, 8.5%(2 141/25 058) from July to September, and 12.7%(3 425/26 909) from October to December. The discrepancy of positive rates in different seasons showed statistical significance ( χ2=311.5, P<0.01). During 2010 to 2017, significant decreases in antibiotic resistant rates of Streptococcus pneumoniae to penicillin, amoxicillin and cefotaxime were detected (tau=-0.93, -0.93 and -0.71, respectively, all P<0.05). Conclusions:The detection rate of Streptococcus pneumoniae in sputum of children with respiratory infections may present seasonal pattern and vary between different ages of children. The resistance to β-lactam antibiotics has declined.

Progress of coxsackievirus A10 / 国际儿科学杂志

Hand, foot and mouth disease(HFMD)is a common class C infectious disease for children under 5 years of age in our country, which pathogens are multiple enteroviruses.Recent studies have found that coxsackievirus A10(CVA10)has become one of the main pathogens of HFMD gradually, and its infection is on the rise.Moreover, enterovirus 71(EV71), coxsackievirus A16(CVA16), coxsackievirus A6(CVA6), and CVA10 co-circulate has appeared.The CVA10 cell receptor is recombinant kringle containing transmembrane protein 1(KRM1), and the specific neutralizing antibody is named 2G8.The vaccines in related animal models are inactivated vaccines and virus-like particle vaccines.This paper reviews on aspects of cell receptors, neutralizing antibodies, vaccines researches and animal models about CVA10, providing some ideas for the prevention and control of HFMD.

Hospitalization rates for influenza-associated severe acute respiratory illness in children younger than five years old in Suzhou of China, 2016-2018 / 中华预防医学杂志

We analyzed the influenza surveillance data of Children′s Hospital of Suzhou University from 2016 to 2018 and estimated the hospitalization burden of children under 5 years old due to influenza infection in Suzhou. The results showed that the influenza virus positive rate of 1 451 severe acute respiratory infection (SARI) cases in Children′s Hospital of Suzhou University was 13.6% (95%CI: 11.8%-15.3%; 197 cases), among which the influenza pandemic intensity in 2017-2018 was relatively high, and A/H1N1 was the main pandemic virus. It was estimated that the hospitalization rate of influenza-related SARI in children under 5 years old in Suzhou was 6.9‰ (95%CI: 6.6‰-7.2‰), among which the hospitalization rate of children aged<6 months was higher, up to 11.4‰ (95%CI: 9.9‰-12.8‰).

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou,China,2011-2017.Methods From March 2011 to February 2017,we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital.Through standard questionnaires and follow-up survey via telephone,we collected information regarding the demographic characteristics,medical history,clinical symptoms and both direct and indirect costs associated with influenza,of the patients.We then compared clinical characteristics and economic burden of influenza A/H1N1,A/H3N2,and B infections among children with ILI.Results We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs.791 (12.9％) of the swabs showed positive for influenza virus,including 88 (11.1％) subtype influenza A/H1N1,288 (36.4％) subtype influenza A/H3N2,and 415 (52.5％) type influenza B.The proportions of cough,rhinorrhea,wheezing,vomiting and convulsion in influenza-positive children were higher than those influenza-negative children.Except for the prevalence rates of cough (x2=9.227,P=0.010),wheezing (x2=7.273,P=0.026) and vomiting (x2=8.163,P=0.017),other clinical symptoms appeared similar between the three viral subtypes.Among all the ILI children,the average total cost per episode of influenza was 688.4 Yuan (95％ CI:630.1-746.7) for influenza-negative children;768.0 Yuan (95％CI:686.8-849.3) for influenza-positive children and 738.3 Yuan (95％CI:655.5-821.1) for influenza B.Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (x2=7.237,P=0.028).Conclusion Children infected influenza showed higher prevalence rates of cough,rhinorrhea,wheezing,vomiting and convulsion than those without influenza.Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017 / 中华流行病学杂志

Objective To understand the clinical characteristics and economic burden of influenza-like illness (ILI) children aged 0-59 months in the outpatient settings in Suzhou,China,2011-2017.Methods From March 2011 to February 2017,we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children's Hospital.Through standard questionnaires and follow-up survey via telephone,we collected information regarding the demographic characteristics,medical history,clinical symptoms and both direct and indirect costs associated with influenza,of the patients.We then compared clinical characteristics and economic burden of influenza A/H1N1,A/H3N2,and B infections among children with ILI.Results We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs.791 (12.9％) of the swabs showed positive for influenza virus,including 88 (11.1％) subtype influenza A/H1N1,288 (36.4％) subtype influenza A/H3N2,and 415 (52.5％) type influenza B.The proportions of cough,rhinorrhea,wheezing,vomiting and convulsion in influenza-positive children were higher than those influenza-negative children.Except for the prevalence rates of cough (x2=9.227,P=0.010),wheezing (x2=7.273,P=0.026) and vomiting (x2=8.163,P=0.017),other clinical symptoms appeared similar between the three viral subtypes.Among all the ILI children,the average total cost per episode of influenza was 688.4 Yuan (95％ CI:630.1-746.7) for influenza-negative children;768.0 Yuan (95％CI:686.8-849.3) for influenza-positive children and 738.3 Yuan (95％CI:655.5-821.1) for influenza B.Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost (x2=7.237,P=0.028).Conclusion Children infected influenza showed higher prevalence rates of cough,rhinorrhea,wheezing,vomiting and convulsion than those without influenza.Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.

Association between activity of hand, foot and mouth disease and meteorological factors in Suzhou / 中华传染病杂志

Objective To study the association between activity of hand,foot and mouth disease (HFMD) and the meteorological factors in Suzhou.Methods A total of 17 653 children diagnosed with HFMD in Children's Hospital Affiliated to Suzhou University during 2008 to 2011 were enrolled.The meteorological factors in(c)luding mean temperature,relative humidity,rainfall amount,sum of sunshine and mean wind velocity during Jan 2008 to Dec 2011 were collected monthly.Numeration data were analyzed using chi square or Fisher exact test.Normal distribution data were analyzed using Pearson correlation and non-normal distribution data were analyzed using Spearman rank correlation.Results HFMD could be found all over the year and had obvious seasonality which peaked in Summer,followed by Spring and Autumn and HFMD decreased markedly in Winter.The activity of HFMD was positive correlated with mean temperature(r=0.716,P＜0.01),wind velocity (r=0.630,P＜0.01),rainfall(r=0.477,P＜0.01) and sum of sunshine(r=0.311,P＜0.05).No statistical significance was observed between relative humidity and HFMD(r =0.276,P＞0.05).Multivariate stepwise regression analysis showed that only mean temperature and rainfall were associated with HFMD and mean temperature had stronger influence on HFMD than rainfall (t =4.687,P ＜ 0.01 ; t =2.258,P ＜ 0.05).Conclusions HFMD has obvious seasonality.Mean temperature and rainfall are the main factors affecting this seasonality.