BACKGROUND:Characterisation of risk groups who may benefit from pneumococcal vaccination is essential for the generation of recommendations and policy. METHODS:We reviewed the literature to provide information on the incidence and risk of invasive pneumococcal disease (IPD) in at-risk children in Europe and North America. The PubMed database was searched using predefined search terms and inclusion/exclusion criteria for papers reporting European or North American data on the incidence or risk of IPD in children with underlying medical conditions. RESULTS:Eighteen references were identified, 11 from North America and 7 from Europe, with heterogeneous study methods, periods and populations. The highest incidence was seen in US children positive for human immunodeficiency virus infection, peaking at 4167 per 100,000 patient-years in 2000. Studies investigating changes in incidence over time reported decreases in the incidence of IPD between the late 1990s and early 2000s. The highest risk of IPD was observed in children with haematological cancers or immunosuppression. Overall, data on IPD in at-risk children were limited, lacking incidence data for a wide range of predisposing conditions. There was, however, a clear decrease in the incidence of IPD in at-risk children after the introduction of 7-valent pneumococcal conjugate vaccine into immunisation programmes, as previously demonstrated in the general population. CONCLUSION:Despite the heterogeneity of the studies identified, the available data show a substantial incidence of IPD in at-risk children, particularly those who are immunocompromised. Further research is needed to determine the true risk of IPD in at-risk children, particularly in the post-PCV period, and to understand the benefits of vaccination and optimal vaccination schedules.

译文

背景:可能从肺炎球菌疫苗接种中受益的风险人群的表征对于产生建议和政策至关重要。
方法:我们回顾了文献,以提供有关欧洲和北美高危儿童的侵袭性肺炎球菌疾病(IPD)的发生率和风险的信息。使用预定义的搜索词和纳入/排除标准对PubMed数据库进行了搜索,以检索报告欧洲或北美患有基础疾病的儿童中IPD发生率或风险的数据。
结果:共确定了18篇参考文献,其中11篇来自北美,7篇来自欧洲,其研究方法,时期和人群各不相同。在人类免疫缺陷病毒感染呈阳性的美国儿童中发生率最高,在2000年达到峰值,每10万患者年中有4167名。调查随时间变化的研究报告说,在1990年代末至2000年代初,IPD发生率下降。在患有血液系统癌症或免疫抑制的儿童中,发生IPD的风险最高。总体而言,高危儿童的IPD数据有限,缺乏各种易患病情况的发病率数据。但是,将7价肺炎球菌结合疫苗引入免疫接种计划后,高危儿童IPD发生率明显下降,这在以前的一般人群中已得到证实。
结论:尽管已确定研究的异质性,但现有数据显示高危儿童,特别是免疫受损儿童的IPD发生率很高。需要进一步的研究来确定高危儿童中IPD的真正风险,尤其是在PCV后时期,并了解疫苗接种的好处和最佳的疫苗接种时间表。

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