Jackson Lisa A, Janoff Edward N
Group Health Center for Health Studies, Seattle, Washington 98101, USA.
Clin Infect Dis. 2008 Nov 15;47(10):1328-38. doi: 10.1086/592691.
Pneumococcal polysaccharide vaccine has been licensed for use in the United States for >30 years, and two-thirds of the elderly population in the United States have received this vaccine. Observational studies have demonstrated that pneumococcal polysaccharide vaccine reduces the risk of invasive pneumococcal disease in immunocompetent elderly individuals, but neither observational studies nor clinical trials have demonstrated consistent evidence for a reduction in the incidence of pneumonia in vaccinated older adults. The introduction of pneumococcal protein conjugate vaccine among children has led to a herd immunity effect that has resulted in a 38% decrease in the rate of invasive pneumococcal disease among elderly adults. The high efficacy of pneumococcal protein conjugate vaccine in children has renewed interest in evaluating pneumococcal protein conjugate vaccines in adults for prevention of invasive pneumococcal disease and pneumonia. Moreover, the recognition of the presence and function of noncapsular pneumococcal protein antigens and the increasing availability of adjuvants highlight the promise of new vaccination strategies to decrease the burden of pneumococcal infection in this high-risk population.
肺炎球菌多糖疫苗在美国已获许可使用超过30年，美国三分之二的老年人口已接种该疫苗。观察性研究表明，肺炎球菌多糖疫苗可降低免疫功能正常的老年人患侵袭性肺炎球菌疾病的风险，但无论是观察性研究还是临床试验，都没有一致的证据表明接种疫苗的老年人肺炎发病率有所降低。儿童中引入肺炎球菌蛋白结合疫苗产生了群体免疫效应，导致老年成年人侵袭性肺炎球菌疾病发病率下降了38%。肺炎球菌蛋白结合疫苗在儿童中的高效性重新引发了人们对评估成人肺炎球菌蛋白结合疫苗预防侵袭性肺炎球菌疾病和肺炎的兴趣。此外，对非荚膜肺炎球菌蛋白抗原的存在和功能的认识以及佐剂可用性的增加，凸显了新疫苗接种策略有望减轻这一高危人群肺炎球菌感染负担。
