Communicable Disease Control Branch, SA Health, Australia.
Vaccine. 2012 Mar 9;30(12):2206-11. doi: 10.1016/j.vaccine.2011.12.119. Epub 2012 Jan 23.
Trends in age specific and serotype specific incidence rates for invasive pneumococcal disease (IPD) were examined in South Australia 4 years before and 5 years after the commencement of the Australian universal childhood 7 valent pneumococcal conjugate vaccine (7vPCV) program.
IPD cases were identified by routine enhanced surveillance. IPD serotypes were grouped according to those covered by the 7vPCV, the six serotypes specific to the 13 valent pneumococcal conjugate vaccine (13vPCV), the 11 serotypes specific to the 23 valent pneumococcal polysaccharide vaccine (23vPPV), as well as non-13vPCV and non-23vPPV groups. Poisson regression was used to calculate age-specific and serotype-specific incident rate ratios (IRRs) comparing pre (2002-2004) and post (2007-2009) universal childhood 7vPCV periods.
Following the introduction of the 7vPCV program, the rate of IPD in children aged <2 years decreased by 81% for all serotypes (IRR 0.19, 95% CI, 0.13-0.28) and by 98% for 7vPCV serotypes (IRR 0.02, 95% CI, 0.007-0.07). At the same time, there was some evidence for an increase in IPD caused by 13vPCV specific serotypes (IRR 1.58, 95% CI, 0.78-3.21) and non-13vPCV serotypes (IRR 1.80, 95% CI, 0.45-7.21). Among adults aged ≥65 years, overall there was a 27% reduction in IPD caused by all serotypes following introduction of the 7vPCV program (IRR 0.73, 95% CI, 0.58-0.93). However, the rate of IPD increased in the last 2 years of the study period. The initial decrease was a result of a 74% reduction in the rate of IPD due to 7vPCV serotypes (IRR 0.26, 95% CI, 0.17-0.40). At the same time, the rate of IPD increased for 13vPCV specific serotypes (IRR 1.55, 95% CI, 0.94-2.54), 23vPPV specific serotypes (IRR 1.91, 95% CI, 0.99-3.71) and particularly non-23vPPV serotypes (IRR 5.3, 95% CI, 1.83-15.34).
There has been a large direct and sustained benefit from the universal 7vPCV program in children, particularly those aged <2 years, with some evidence for serotype replacement. There is also good evidence that the childhood program has provided indirect benefits to adults aged ≥65 years, although serotype replacement has reduced the initial benefits.
在澳大利亚普遍推广儿童 7 价肺炎球菌结合疫苗（7vPCV）计划之前的 4 年和之后的 5 年，对南澳大利亚侵袭性肺炎球菌病（IPD）的年龄特异性和血清型特异性发病率趋势进行了研究。
通过常规强化监测确定 IPD 病例。根据 7vPCV 覆盖的血清型、13 价肺炎球菌结合疫苗（13vPCV）特有的 6 种血清型、23 价肺炎球菌多糖疫苗（23vPPV）特有的 11 种血清型以及非 13vPCV 和非 23vPPV 组对 IPD 血清型进行分组。使用泊松回归计算比较普遍儿童 7vPCV 前（2002-2004 年）和后（2007-2009 年）时期的年龄特异性和血清型特异性发病率比值（IRR）。
在引入 7vPCV 计划后，2 岁以下儿童所有血清型的 IPD 发病率下降了 81%（IRR 0.19，95%CI，0.13-0.28），7vPCV 血清型下降了 98%（IRR 0.02，95%CI，0.007-0.07）。与此同时，13vPCV 特定血清型（IRR 1.58，95%CI，0.78-3.21）和非 13vPCV 血清型（IRR 1.80，95%CI，0.45-7.21）导致的 IPD 也有一定的证据表明有所增加。对于 65 岁及以上的成年人，在引入 7vPCV 计划后，所有血清型的 IPD 总体下降了 27%（IRR 0.73，95%CI，0.58-0.93）。然而，在研究期间的最后 2 年，IPD 发病率有所上升。最初的下降是由于 7vPCV 血清型导致的 IPD 率下降了 74%（IRR 0.26，95%CI，0.17-0.40）。与此同时，13vPCV 特定血清型（IRR 1.55，95%CI，0.94-2.54）、23vPPV 特定血清型（IRR 1.91，95%CI，0.99-3.71）和非 23vPPV 血清型（IRR 5.3，95%CI，1.83-15.34）的 IPD 率有所增加。
普遍推广儿童 7vPCV 计划带来了巨大的直接和持续的益处，尤其是对<2 岁的儿童，并且有证据表明血清型已经发生了替代。也有很好的证据表明，儿童计划为≥65 岁的成年人提供了间接益处，尽管血清型替代已经减少了最初的益处。
