Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2013 Mar;56(5):e59-67. doi: 10.1093/cid/cis971. Epub 2012 Nov 15.
Certain chronic diseases increase risk for invasive pneumococcal disease (IPD) and are indications for receipt of 23-valent pneumococcal polysaccharide vaccine (PPV23). Since the pediatric introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, incidence of IPD among adults has declined. The relative magnitude of these indirect effects among persons with and without PPV23 indications is unknown.
We evaluated IPD incidence among adults with and without PPV23 indications using population- and laboratory-based data collected during 1998-2009 and estimates of the denominator populations with PPV23 indications from the National Health Interview Survey. We compared rates before and after PCV7 use by age, race, PPV23 indication, and serotype.
The proportion of adult IPD cases with PPV23 indications increased from 51% before to 61% after PCV7 introduction (P < .0001). PCV7-serotype IPD declined among all race, age, and PPV23 indication strata, ranging from 82% to 97%. Overall IPD rates declined in most strata, by up to 65%. However, incidence remained highest among adults with PPV23 indications compared with those without (34.9 vs 8.8 cases per 100 000 population, respectively). Apart from age ≥65 years, diabetes is now the most common indication for PPV23 (20% of all cases vs 10% of cases in 1998-1999).
Although IPD rates have declined among adults, adults with underlying conditions remain at increased risk of IPD and comprise a larger proportion of adult IPD cases in 2009 compared with 2000. A continued increase in the prevalence of diabetes among US adults could lead to increased burden of pneumococcal disease.
某些慢性疾病会增加侵袭性肺炎球菌病（IPD）的风险，这也是 23 价肺炎球菌多糖疫苗（PPV23）接种的指征。自 2000 年儿童使用 7 价肺炎球菌结合疫苗（PCV7）以来，成年人中 IPD 的发病率有所下降。在有和没有 PPV23 接种指征的人群中，这些间接影响的相对程度尚不清楚。
我们利用 1998-2009 年期间收集的基于人群和实验室的数据以及来自国家健康访谈调查的 PPV23 接种指征人群的分母估计值，评估了有和没有 PPV23 接种指征的成年人的 IPD 发病率。我们比较了 PCV7 使用前后按年龄、种族、PPV23 接种指征和血清型划分的发病率。
具有 PPV23 接种指征的成年人 IPD 病例比例从 PCV7 引入前的 51%增加到引入后的 61%（P<0.0001）。PCV7 血清型 IPD 在所有种族、年龄和 PPV23 接种指征人群中均有下降，范围为 82%至 97%。大多数人群的总体 IPD 发病率下降，最高可达 65%。然而，与没有 PPV23 接种指征的成年人相比，具有该接种指征的成年人的发病率仍然最高（分别为每 100000 人口 34.9 例和 8.8 例）。除了年龄≥65 岁以外，糖尿病现在是最常见的 PPV23 接种指征（占所有病例的 20%，而在 1998-1999 年为 10%）。
尽管成年人的 IPD 发病率有所下降，但患有基础疾病的成年人仍然面临更高的 IPD 风险，并且在 2009 年与 2000 年相比，成年人 IPD 病例的比例更大。美国成年人中糖尿病患病率的持续增加可能会导致肺炎球菌疾病负担的增加。
