From the *Center for Health Research-Southeast, Kaiser Permanente; †Rollins School of Public Health; and ‡Emory Vaccine Center, Emory University, Atlanta GA.
Pediatr Infect Dis J. 2013 Nov;32(11):1180-4. doi: 10.1097/INF.0b013e3182a26752.
Influenza virus infection can predispose patients to secondary pneumococcal infections. Children are at greatest risk for pneumococcal infection in the first year of life and are not considered fully protected by pneumococcal conjugate vaccine (PCV) until their third dose at 6 months of age. Infants less than 6 months cannot receive influenza vaccination, though maternal influenza vaccination can protect infants.
We conducted a retrospective cohort study of 9807 mother-infant pairs enrolled in a managed care organization for infants born June 1, 2002, to December 31, 2009. Exposure was assessed for receipt of infant PCV only and the combination of PCV and maternal influenza vaccine (trivalent inactivated vaccine). Outcomes of interest were acute otitis media and medically attended acute respiratory infection in the first year of life. We estimated the adjusted incidence of illness, incidence rate ratios and vaccine effectiveness using the ratio of incidence rate ratios between the periods of noncirculating influenza and that of at least local influenza circulation.
For medically attended acute respiratory infection, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 39.6% (95% confidence interval [CI]: 31.6%-46.7%) and for PCV only was 29.8% (95% CI: 11.4%-44.3%). For acute otitis media, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 47.9% (95% CI: 42%-53.3%) and for PCV only was 37.6% (95% CI: 23.1%-49.4%).
In infants, the combination of maternal influenza vaccine and infant pneumococcal conjugate vaccination confers greater protection from acute otitis media infections and medically attended acute respiratory infections than does PCV alone.
流感病毒感染可使患者易患肺炎球菌继发感染。儿童在生命的第一年患肺炎球菌感染的风险最大，并且在 6 个月大时接种第三剂肺炎球菌结合疫苗（PCV）之前，不能被 PCV 完全保护。6 个月以下的婴儿不能接种流感疫苗，但母亲接种流感疫苗可以保护婴儿。
我们对 2002 年 6 月 1 日至 2009 年 12 月 31 日期间在一家管理式医疗组织中登记的 9807 对母婴进行了回顾性队列研究。评估了婴儿仅接受 PCV 和 PCV 与母亲流感疫苗（三价灭活疫苗）联合接种的情况。研究的主要转归为婴儿生命第一年的急性中耳炎和需要医疗干预的急性呼吸道感染。我们使用非流行期和至少当地流感流行期的发病率比值的比值来估计疾病的调整发病率、发病率比值比和疫苗效力。
对于需要医疗干预的急性呼吸道感染，三价灭活疫苗联合 PCV 的疫苗效力为 39.6%（95%置信区间[CI]：31.6%-46.7%），仅 PCV 的疫苗效力为 29.8%（95% CI：11.4%-44.3%）。对于急性中耳炎，三价灭活疫苗联合 PCV 的疫苗效力为 47.9%（95% CI：42%-53.3%），仅 PCV 的疫苗效力为 37.6%（95% CI：23.1%-49.4%）。
在婴儿中，母亲流感疫苗联合婴儿肺炎球菌结合疫苗接种比单独使用 PCV 能更有效地预防急性中耳炎感染和需要医疗干预的急性呼吸道感染。
