National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, NSW, Australia.
Centre for Disease Control, Department of Health, Darwin, NT, Australia.
Med J Aust. 2014 Feb 3;200(2):112-5. doi: 10.5694/mja12.11759.
To evaluate the impact and effectiveness of the 23-valent polysaccharide pneumococcal vaccine (23vPPV) in ≥ 65-year-old Australians in the context of concurrent 7-valent pneumococcal conjugate vaccine (7vPCV) use in infants.
DESIGN, PATIENTS AND SETTING: Ecological analysis of trends in invasive pneumococcal disease (IPD) notification rates and vaccine effectiveness estimation using the screening method, using data on Australians aged ≥ 65 years (23vPPV funded) and 50-64 years (23vPPV not funded).
National 23vPPV program for people aged ≥ 65 years and national 7vPCV program for infants, both commencing in 2005.
IPD incidence rate ratios, 2002-2004 to 2010-2011, and 23vPPV effectiveness against 23vPPV-type IPD.
The proportion of people aged ≥ 65 years who were vaccinated within the previous 5 years in jurisdictions excluding Victoria ranged from 41% to 64% over the study period, with no clear trend over time. Incidence rate ratios in the ≥ 65-year age group were 0.11 (95% CI, 0.09-0.14) for 7vPCV serotypes, 1.64 (95% CI, 1.41-1.91) for 23vPPV-non-7vPCV serotypes and 2.07 (95% CI, 1.67-2.57) for non-23vPPV serotypes. The incidence rate ratio for total IPD was 0.65 (95% CI, 0.59-0.71) for people aged ≥ 65 years, and 0.80 (0.71-0.90) for people aged 50-64 years. The estimate of 23vPPV effectiveness was 61.1% (95% CI, 55.1%-66.9%).
The greater reduction in IPD among ≥ 65-year-olds compared with 50-64-year-olds did not reach statistical significance. However, vaccine effectiveness was significant. Greater reductions in IPD in ≥ 65-year-olds would be expected from the indirect effects of using 13-valent pneumococcal conjugate vaccine in infants (introduced for Australian infants in 2011) and an increase in 23vPPV coverage.
评估 23 价多糖肺炎球菌疫苗（23vPPV）在同时使用 7 价肺炎球菌结合疫苗（7vPCV）的情况下对 65 岁以上澳大利亚人产生的影响和效果。
设计、患者和设置：使用筛查方法，对澳大利亚≥ 65 岁（23vPPV 资助）和 50-64 岁（23vPPV 未资助）人群的侵袭性肺炎球菌病（IPD）报告率和疫苗效果估计趋势进行生态分析。
65 岁以上人群的国家 23vPPV 计划和婴儿的国家 7vPCV 计划，均于 2005 年开始实施。
2002-2004 年至 2010-2011 年 IPD 发病率比值，以及 23vPPV 对 23vPPV 型 IPD 的效果。
在研究期间，维多利亚州以外的司法管辖区≥ 65 岁人群中，在过去 5 年内接种疫苗的比例在 41%至 64%之间，没有明显的时间趋势。≥ 65 岁年龄组的 7vPCV 血清型发病率比值为 0.11（95%CI，0.09-0.14），23vPPV-非 7vPCV 血清型为 1.64（95%CI，1.41-1.91），非 23vPPV 血清型为 2.07（95%CI，1.67-2.57）。≥ 65 岁人群的总 IPD 发病率比值为 0.65（95%CI，0.59-0.71），50-64 岁人群为 0.80（0.71-0.90）。23vPPV 效果的估计值为 61.1%（95%CI，55.1%-66.9%）。
与 50-64 岁人群相比，≥ 65 岁人群的 IPD 减少幅度虽未达到统计学意义，但疫苗效果显著。预计 13 价肺炎球菌结合疫苗（2011 年在澳大利亚用于婴儿）的间接影响和 23vPPV 覆盖率的增加，将使≥ 65 岁人群的 IPD 进一步减少。
