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23 价肺炎球菌多糖疫苗对 60 岁以上普通人群社区获得性肺炎的有效性：CAPAMIS 研究 3 年随访结果。

Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against community-acquired pneumonia in the general population aged ≥ 60 years: 3 years of follow-up in the CAPAMIS study.

机构信息

Primary Care Service Camp de Tarragona, Institut Catala de la Salut, Tarragona.

出版信息

Clin Infect Dis. 2014 Apr;58(7):909-17. doi: 10.1093/cid/ciu002. Epub 2014 Feb 13.

DOI:10.1093/cid/ciu002

PMID:24532544

Abstract

BACKGROUND

The benefits of using the 23-valent pneumococcal polysaccharide vaccine (PPV23) are controversial. This study assessed clinical effectiveness of PPV23 in preventing community-acquired pneumonia (CAP) among the general population aged ≥ 60 years.

METHODS

This was a population-based cohort study involving 27 204 individuals aged ≥ 60 years in Tarragona, Spain, who were prospectively followed from 1 December 2008 until 30 November 2011. Primary outcomes were hospitalization for pneumococcal CAP (bacteremic and nonbacteremic cases) and all-cause CAP. All CAP cases were radiographically confirmed and validated by checking clinical records. Cox regression was used to evaluate the association between pneumococcal vaccination and the risk of each outcome.

RESULTS

Cohort members were followed for a total of 76 033 person-years (29 065 person-years for vaccinated subjects). Incidence rates (per 1000 person-years) were 0.21 for bacteremic pneumococcal CAP (0.14 vs 0.26 among vaccinated and unvaccinated subjects, respectively), 1.45 for nonbacteremic pneumococcal CAP (1.46 vs 1.44), and 7.51 for all-cause CAP (7.19 vs 7.71). In primary analyses including all cohort members, PPV23 did not appear to be effective against any analyzed outcome. However, a beneficial effect emerged in sensitive and stratified analyses. After multivariable adjustments, as compared with those never vaccinated, recent vaccination with PPV23 (<5 years ago) was associated with reduced risks of bacteremic pneumococcal CAP (hazard ratio [HR], 0.38; 95% confidence interval [CI], .09-1.68), nonbacteremic pneumococcal CAP (HR, 0.52; 95% CI, .29-.92), overall pneumococcal CAP (HR, 0.49; 95% CI, .29-.84), and all-cause CAP (HR, 0.75; 95% CI, .58-.98).

CONCLUSIONS

Our data support a protective effect of recent PPV23 vaccination (within previous 5 years) against both pneumococcal and all-cause CAP.

摘要

背景

使用 23 价肺炎球菌多糖疫苗（PPV23）的益处存在争议。本研究评估了 23 价肺炎球菌多糖疫苗在预防西班牙塔拉戈纳≥60 岁一般人群社区获得性肺炎（CAP）中的临床效果。

方法

这是一项基于人群的队列研究，涉及 27204 名≥60 岁的个体，他们于 2008 年 12 月 1 日至 2011 年 11 月 30 日进行前瞻性随访。主要结局为因肺炎球菌性 CAP（菌血症和非菌血症病例）和所有原因 CAP 而住院。所有 CAP 病例均经影像学证实，并通过检查临床记录进行验证。Cox 回归用于评估肺炎球菌疫苗接种与每种结局风险之间的关联。

结果

队列成员共随访 76033 人年（接种疫苗者随访 29065 人年）。发病率（每 1000 人年）为菌血症性肺炎球菌性 CAP0.21（接种疫苗和未接种疫苗者分别为 0.14 比 0.26），非菌血症性肺炎球菌性 CAP1.45（1.46 比 1.44），以及所有原因 CAP7.51（7.19 比 7.71）。在包括所有队列成员的主要分析中，PPV23 似乎对任何分析的结果均无效果。然而，在敏感和分层分析中出现了有益的效果。经过多变量调整后，与从未接种疫苗者相比，最近（<5 年前）接种 PPV23 与菌血症性肺炎球菌性 CAP（风险比 [HR]，0.38；95%置信区间 [CI]，0.09-1.68）、非菌血症性肺炎球菌性 CAP（HR，0.52；95%CI，0.29-0.92）、总肺炎球菌性 CAP（HR，0.49；95%CI，0.29-0.84）和所有原因 CAP（HR，0.75；95%CI，0.58-0.98）的风险降低相关。