From the *International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Biostatistics Consulting, Chicago, IL; ‡Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; §Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; and ¶Institute of Child Health, University College London, London, United Kingdom.
Pediatr Infect Dis J. 2014 Jan;33 Suppl 2(Suppl 2 Optimum Dosing of Pneumococcal Conjugate Vaccine For Infants 0 A Landscape Analysis of Evidence Supportin g Different Schedules):S130-9. doi: 10.1097/INF.0000000000000081.
BACKGROUND: Antipneumococcal capsular polysaccharide antibody concentrations are used as predictors of vaccine efficacy against vaccine serotype (ST) pneumococcal disease among infants. While pneumococcal conjugate vaccines (PCV) are recommended globally, factors associated with optimal PCV immune response are not well described. We aimed to systematically assess local setting factors, beyond dosing schedule, which may affect PCV antibody levels. METHODS: We conducted a literature review of PCV immunogenicity, abstracting data from published reports, unpublished sources, and conference abstracts from 1994 to 2010 (and ad hoc 2011 reports). Studies included in this analysis evaluated ≥ 2 primary doses of PCV before 6 months of age in non-high-risk populations, used 7-valent or higher PCV products (excluding Aventis-Pasteur and Merck products) and provided information on geometric mean concentration (GMC) for STs 1, 5, 6B, 14, 19F or 23F. Using random effects meta-regression, we assessed the impact of geographic region, coadministered vaccines and PCV product on postprimary GMC, adjusting for dosing schedule and ELISA laboratory method. RESULTS: Of 12,980 citations reviewed, we identified 103 vaccine study arms for this analysis. Children in studies from Asia, Africa and Latin America had significantly higher GMC responses compared with those in studies from Europe and North America. Coadministration with acellular pertussis DTP compared with whole-cell DTP had no effect on PCV immunogenicity except for ST14, where GMCs were higher when coadministered with acellular pertussis DTP. Vaccine product, number of PCV doses, dosing interval, age at first dose and ELISA laboratory method also affected the GMC. CONCLUSIONS: PCV immunogenicity is associated with geographic region and vaccine product; however, the associations and magnitude varied by ST. Consideration of these factors is essential when comparing PCV immunogenicity results between groups and should be included in the evidence base when selecting optimal PCV vaccine schedules in specific settings.
背景：抗肺炎球菌荚膜多糖抗体浓度可用作预测婴幼儿疫苗血清型（ST）肺炎球菌疾病疫苗疗效的指标。虽然全球范围内推荐使用肺炎球菌结合疫苗（PCV），但针对影响 PCV 免疫应答的最佳因素还没有很好的描述。我们旨在系统评估除了剂量方案之外，可能影响 PCV 抗体水平的局部设定因素。
方法：我们对 PCV 免疫原性进行了文献综述，从 1994 年至 2010 年（以及临时 2011 年报告）的已发表报告、未发表来源和会议摘要中提取数据。本分析中纳入的研究评估了在非高危人群中，6 个月龄前接种≥2 剂 PCV，使用 7 价或更高价 PCV 产品（不包括 Aventis-Pasteur 和 Merck 产品），并提供了 ST1、5、6B、14、19F 或 23F 血清型几何平均浓度（GMC）的信息。使用随机效应荟萃回归，我们评估了地理位置、共同接种疫苗和 PCV 产品对主要剂量后 GMC 的影响，同时调整了剂量方案和 ELISA 实验室方法。
结果：在审查的 12980 条引文中，我们确定了 103 个疫苗研究臂进行此分析。与来自欧洲和北美的研究相比，来自亚洲、非洲和拉丁美洲的研究中的儿童 GMC 反应明显更高。与全细胞 DTP 相比，与无细胞百日咳 DTP 联合使用对 PCV 免疫原性没有影响，除了 ST14 外，当与无细胞百日咳 DTP 联合使用时，GMC 更高。疫苗产品、PCV 剂量数、剂量间隔、首次剂量年龄和 ELISA 实验室方法也影响 GMC。
结论：PCV 免疫原性与地理位置和疫苗产品有关；然而，ST 之间的关联和幅度不同。在比较不同组别之间的 PCV 免疫原性结果时，考虑这些因素至关重要，并且在特定环境中选择最佳 PCV 疫苗方案时，应将这些因素纳入证据基础。
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