From the *Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; †Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA; ‡International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §Westat Inc., Rockville, MD; 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):S152-60. doi: 10.1097/INF.0000000000000083.
Pneumococcal conjugate vaccines (PCV) reduce nasopharyngeal carriage of vaccine type (VT) pneumococci, an important driver of vaccine programs' overall benefits. The dosing schedule that best reduces carriage is unclear.
We performed a systematic review of English language publications from 1994 to 2010 (supplemented post hoc with studies from 2011) reporting PCV effects on VT carriage to assess variability in effect by dosing schedule.
We identified 32 relevant studies (36 citations) from 12,980 citations reviewed. Twenty-one (66%) evaluated PCV7; none used PCV10 or PCV13. Five studies evaluated 2 primary doses and 13 three primary doses. After the first year of life, 14 evaluated 3-dose primary series with PCV booster (3+1), seven 3 doses plus 23-valent polysaccharide booster "3+1PPV23," five "3+0," four "2+1," three "2+1PPV23" and two "2+0." Four studies directly compared schedules. From these, 3 primary doses reduced VT carriage more than 2 doses at 1-7 months following the series (1 study significant; 2 borderline). In a study, the 2+1 schedule reduced VT carriage more than 2+0 at 18, but not at 24 months of age. One study of a 23-valent pneumococcal polysaccharide vaccine booster showed no effect. All 16 clinical trials with unvaccinated controls and 11 observational studies with before-after designs showed reduction in VT carriage.
The available literature demonstrates VT-carriage reduction for 2+0, 2+1, 3+0 and 3+1 PCV schedules, but not for 23-valent pneumococcal polysaccharide vaccine booster. Comparisons between schedules show that 3 primary doses and a 2+1 schedule may reduce carriage more than 2 primary doses and a 2+0 schedule, respectively.
肺炎球菌结合疫苗（PCV）可降低疫苗型（VT）肺炎球菌的鼻咽携带率，这是疫苗计划总体效益的重要驱动因素。最佳的剂量方案尚不清楚。
我们对 1994 年至 2010 年期间的英文文献进行了系统评价（事后补充了 2011 年的研究），报告了 PCV 对 VT 携带的影响，以评估剂量方案对效果的差异。
我们从审查的 12980 篇文献中确定了 32 项相关研究（36 篇文献）。其中 21 项（66%）评估了 PCV7；没有使用 PCV10 或 PCV13。五项研究评估了两剂主要剂量和 13 剂三剂主要剂量。在生命的第一年之后，14 项研究评估了 3 剂主要系列加 PCV 加强剂（3+1），7 项研究评估了 3 剂加 23 价多糖加强剂（3+1PPV23），5 项研究评估了 3 剂加 0 剂，4 项研究评估了 2 剂加 1 剂，3 项研究评估了 2 剂加 1PPV23 剂，2 项研究评估了 2 剂加 0 剂。四项研究直接比较了方案。其中，3 剂主要剂量比 1-7 个月后的两剂剂量更能降低 VT 携带率（1 项研究有统计学意义；2 项研究接近统计学意义）。在一项研究中，2+1 方案在 18 个月时比 2+0 方案降低了 VT 携带率，但在 24 个月时没有差异。一项关于 23 价肺炎球菌多糖疫苗加强剂的研究显示无效果。所有 16 项有未接种对照的临床试验和 11 项有前后设计的观察性研究均显示 VT 携带率降低。
现有文献表明 2+0、2+1、3+0 和 3+1 PCV 方案可降低 VT 携带率，但 23 价肺炎球菌多糖疫苗加强剂无效果。方案之间的比较表明，3 剂主要剂量和 2+1 方案可能比 2 剂主要剂量和 2+0 方案分别更能降低携带率。
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