加拿大魁北克省 2+1 型肺炎球菌结合疫苗计划的影响。
Impact of 2+1 pneumococcal conjugate vaccine program in the province of Quebec, Canada.
机构信息
Department of Social and Preventive Medicine, Laval University, Quebec City, Canada; Quebec National Public Health Institute (Institut national de Santé publique du Québec), Quebec City, Canada; Quebec University Hospital Research Centre, Quebec City, Canada.
Quebec Public Health Laboratory (Laboratoire de santé publique du Québec), Quebec National Public Health Institute (Institut national de Santé publique du Québec), Montreal, Canada.
出版信息
Vaccine. 2014 Mar 14;32(13):1501-6. doi: 10.1016/j.vaccine.2013.11.028. Epub 2014 Jan 31.
BACKGROUND
Quebec was the first jurisdiction in the world to recommend a 3-dose (2+1) pneumococcal conjugate vaccine (PCV) schedule. The program was implemented in December 2004 with a catch-up for children <5 years. PCV-7 was first used and replaced, respectively, by PCV-10 in 2009 and by PCV-13 in 2011.
METHODS
Cases of invasive pneumococcal disease (IPD) notified to public health authorities and isolates submitted to the provincial reference laboratory during the period 2000-2011 were analyzed.
RESULTS
IPD incidence in children <5 years was 67/100,000 in 2001-2004, and decreased to 32/100,000 in 2007-2009 following PCV-7 implementation (p<0.01). A further decrease to 24/100,000 was observed in 2010-2011 following PCV-10 introduction (p<0.01). PCV-7 serotypes represented 82% of the total IPD cases in 2000-2004 and elimination was achieved in 2011. Main emerging serotypes were 19A and 7F. Children exposed to the PCV-10 experienced lower IPD rates and all serotypes contributed to the decline, mainly 7F and 19A. In adults, a decrease of low magnitude was observed in 2005-2006 but rates in 2007-2009 were higher than in the prevaccination period.
CONCLUSIONS
A 3-dose PCV schedule with high uptake is highly effective and should be recommended worldwide. Serotype replacement eroded benefits especially in adults. PCV-10 introduction had an effect and the impact of PCV-13 use remains to be evaluated.
背景
魁北克是世界上第一个建议采用 3 剂（2+1）肺炎球菌结合疫苗（PCV）方案的管辖区。该计划于 2004 年 12 月实施，为 5 岁以下儿童进行了补种。PCV-7 于 2009 年分别被 PCV-10 和 2011 年的 PCV-13 取代。
方法
分析了 2000-2011 年期间向公共卫生当局报告的侵袭性肺炎球菌病（IPD）病例和向省级参考实验室提交的分离株。
结果
2001-2004 年，5 岁以下儿童 IPD 发病率为每 10 万人 67 例，PCV-7 实施后降至 2007-2009 年的每 10 万人 32 例（p<0.01）。2010-2011 年 PCV-10 推出后，发病率进一步降至每 10 万人 24 例（p<0.01）。2000-2004 年，PCV-7 血清型占总 IPD 病例的 82%，2011 年消除了该血清型。主要新出现的血清型为 19A 和 7F。接种 PCV-10 的儿童患 IPD 的风险较低，所有血清型均有助于降低发病率，主要是 7F 和 19A。在成年人中，2005-2006 年观察到发病率略有下降，但 2007-2009 年的发病率高于疫苗接种前。
结论
高接种率的 3 剂 PCV 方案非常有效，应在全球范围内推荐。血清型替代侵蚀了效益，特别是在成年人中。PCV-10 的引入产生了影响，PCV-13 的使用效果仍有待评估。
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