Invazivna oboljenja izazvana pneumokokom i hemofilusom influence tipa b u Autonomnoj Pokrajini Vojvodini, Srbija (2003–2024): trendovi, uticaj vakcinacije i dinamika serotipova pneumokoka
Sažetak
Uvod/Cilj. Invazivna pneumokokna bolest (invasive pneumococcal disease – IPD) i invazivna bolest izazvana bakterijom Haemophilus influenzae tipa b (Hib) i dalje su povezane sa značajnim morbiditetom i mortalitetom. Cilj rada bio je da se analiziraju dugoročni trendovi, obrasci specifični za uzrast i sezonski obrasci bolesti, klinički ishodi, distribucija serotipova IPD i uticaj programa imunizacije na ta oboljenja u Autonomnoj Pokrajini (AP) Vojvodini, Srbija, u periodu od 2003. do 2024. godine. Metode. Sprovedena je deskriptivna epidemiološka studija korišćenjem podataka iz regionalnog sistema nadzora nad zaraznim bolestima, kojim koordinira Institut za javno zdravlje Vojvodine. U analizu su uključeni svi prijavljeni slučajevi IPD i Hib-izazvane invazivne bolesti. Rezultati. Program imunizacije protiv infekcija izazvanih Hib, uveden 2006. godine, doveo je do trajnog sniženja učestalosti Hib-izazvane invazivne bolesti, sa sporadičnim slučajevima oboljenja prijavljenim posle 2009. godine. Incidencija IPD varirala je tokom posmatranog perioda i porasla je u poslednjim godinama, uprkos visokom obuhvatu (≥ 90%) primarnom serijom pneumokokne konjugovane vakcine (pneumococcal conjugate vaccine – PCV) od 2019. godine. Uvođenje PCV značajno je smanjilo učestalost serotipova obuhvaćenih PCV10. Serotip 3 i nevakcinalni serotipovi opstali su, naročito među odraslima i odojčadima starosti < 1 godine. Odrasle osobe starosti ≥ 40 godina pretežno su bile pogođene IPD, dok se Hib-izazvana invazivna bolest javljala uglavnom kod dece uzrasta 1–4 godine. Nijedan od obolelih nije prethodno bio vakcinisan protiv IPD ili Hib-izazvane invazivne bolesti. Stopa smrtnosti bila je značajno viša kod IPD (9,6%) nego kod Hib-izazvane bolesti (3,5%) (p = 0,0361). U ukupnoj populaciji, učestalost serotipova PCV10 naglo je opala posle uvođenja vakcine (sa 55% na 22%), dok su serotipovi PCV13-ne-PCV10 ostali stabilni (~40%), a prisustvo nevakcinalnih serotipova se povećalo (sa 11% na 28%), uz dodatnu pojavu serotipova PCV20-ne-PCV15. Zaključak. Program imunizacije protiv Hib-izazvanih oboljenja obezbedio je zadovoljavajuću kontrolu bolesti u AP Vojvodini, dok, zbog perzistentnog serotipa 3 i novih serotipova koji nisu obuhvaćeni vakcinom, IPD i dalje predstavlja značajan javnozdravstveni problem. Kontinuirani nadzor i razmatranje primene viševalentnih pneumokoknih vakcina (najmanje PCV13) ili strategije vakcinacije usmerene na odrasle osobe su od ključnog značaja za dalje smanjenje tereta bolesti.
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