The Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA.
Clin Infect Dis. 2011 Mar 1;52(5):633-40. doi: 10.1093/cid/ciq207.
Vaccination with protein-conjugate pneumococcal vaccine (PCV) provides children with extraordinary protection against pneumococcal disease, although the protective effect may be blunted by the emergence of replacement strains. Studies in adults have compared PCV with pneumococcal polysaccharide vaccine (PPV) using surrogate markers of protection, namely, serum anticapsular IgG antibody and opsonic activity. Results suggest that PCV is at least as effective as PPV for the strains covered, but a definitive and consistent advantage has not been demonstrated. Unfortunately, persons who are most in need of vaccine do not respond as well as otherwise healthy adults to either vaccine. Newer formulations of PCV will protect against the most prevalent of the current replacement strains, but replacement strains will create a moving target for PCVs. Unless an ongoing trial comparing 13-valent PCV with placebo (not to PPV) demonstrates a clearly better effect than that seen in the past with PPV, cost-effectiveness considerations are likely to prevent widespread use of PCV in adults.
接种蛋白结合型肺炎球菌疫苗（PCV）可使儿童获得针对肺炎球菌疾病的卓越保护，尽管替代菌株的出现可能会削弱这种保护作用。在成人中进行的研究使用保护的替代标志物（即血清荚膜 IgG 抗体和调理活性）比较了 PCV 和肺炎球菌多糖疫苗（PPV）。结果表明，PCV 针对涵盖的菌株与 PPV 一样有效，但尚未证明具有明确和一致的优势。不幸的是，最需要疫苗的人群对任何一种疫苗的反应都不如其他健康成年人。新型 PCV 制剂将预防当前最常见的替代菌株，但替代菌株将为 PCV 带来不断变化的目标。除非正在进行的比较 13 价 PCV 与安慰剂（而非 PPV）的试验证明其效果明显优于过去使用 PPV 的效果，否则成本效益考虑可能会阻止 PCV 在成人中的广泛使用。
