Telethon Institute for Child Health Research, Centre for Child Health Research, Queensland, Australia.
Clin Infect Dis. 2010 Jun 1;50(11):1477-86. doi: 10.1086/652440.
BACKGROUND. In 2001, Australia introduced a unique 7-valent pneumococcal conjugate vaccine (7vPCV) 2-, 4-, and 6-month schedule with a 23-valent pneumococcal polysaccharide vaccine (23vPPV) booster for Aboriginal children, and in 2005, 7vPCV alone in a 2-, 4-, and 6-month schedule for non-Aboriginal children. Aboriginal adults are offered 23vPPV but coverage is poor. We investigated trends in invasive pneumococcal disease (IPD) in Western Australia (WA). METHODS. Enhanced IPD surveillance has been ongoing since 1996. We calculated IPD incidence rates for Aboriginal and non-Aboriginal Australians before and after introduction of 7vPCV. RESULTS. A total of 1792 cases occurred during the period 1997-2007; the IPD incidence rate was 47 cases per 100,000 population per year among Aboriginal people and 7 cases per 100,000 population per year in non-Aboriginal people. After introduction of 7vPCV, IPD rates among Aboriginal children decreased by 46% for those <2 years of age and by 40% for those 2-4 years of age; rates decreased by 64% and 51% in equivalent age groups for non-Aboriginal children. IPD rates decreased by >30% in non-Aboriginal people 50 years of age but increased among Aboriginal adults (eg, from 59.1 to 109.6 cases per 100,000 population per year among those 30-49 years of age). Although IPD due to 7vPCV serotypes decreased in all age groups, IPD incidence due to non-7vPCV serotypes increased, and it almost doubled among Aboriginal adults 30-49 years of age (from 48.3 to 97.0 cases per 100,000 population per year). Among non-Aboriginal children, 37% of IPD is now due to serotype 19A. CONCLUSIONS. IPD incidence rates have decreased markedly among children and non-Aboriginal adults with a 3-dose infant 7vPCV schedule. However, IPD due to non-7vPCV serotypes has increased and is of particular concern among young Aboriginal adults, for whom an intensive 23vPPV campaign is needed. An immunization register covering all age groups should be established.
2001 年，澳大利亚引入了一种独特的 7 价肺炎球菌结合疫苗（7vPCV），并为原住民儿童制定了 2、4 和 6 个月的 23 价肺炎球菌多糖疫苗（23vPPV）加强针计划，而非原住民儿童则在 2、4 和 6 个月的计划中单独接种 7vPCV。原住民成年人可接种 23vPPV，但接种率很低。我们调查了西澳大利亚州（WA）侵袭性肺炎球菌病（IPD）的趋势。方法：自 1996 年以来，我们一直在进行增强型 IPD 监测。我们计算了原住民和非原住民澳大利亚人在引入 7vPCV 前后的 IPD 发病率。结果：1997 年至 2007 年期间共发生 1792 例病例；原住民人群的 IPD 发病率为每年每 10 万人中有 47 例，而非原住民人群的发病率为每年每 10 万人中有 7 例。引入 7vPCV 后，2 岁以下和 2-4 岁的原住民儿童的 IPD 发病率分别下降了 46%和 40%；在同等年龄组中，非原住民儿童的发病率分别下降了 64%和 51%。50 岁以上的非原住民人群的 IPD 发病率下降了>30%，但原住民成年人的发病率却有所上升（例如，30-49 岁人群的发病率从每 10 万人中有 59.1 例增加到 109.6 例）。尽管所有年龄段的 7vPCV 血清型导致的 IPD 发病率都有所下降，但非 7vPCV 血清型导致的 IPD 发病率却有所上升，30-49 岁的原住民成年人的发病率几乎翻了一番（从每 10 万人中有 48.3 例增加到 97.0 例）。在非原住民儿童中，37%的 IPD 现在由血清型 19A 引起。结论：3 剂婴儿 7vPCV 计划显著降低了儿童和非原住民成年人的 IPD 发病率。然而，由于非 7vPCV 血清型引起的 IPD 发病率有所上升，这在年轻的原住民成年人中尤为令人担忧，他们需要加强 23vPPV 疫苗接种。应该建立一个涵盖所有年龄段的免疫登记册。
