Cohen Cheryl, von Mollendorf Claire, de Gouveia Linda, Naidoo Nireshni, Meiring Susan, Quan Vanessa, Nokeri Vusi, Fortuin-de Smit Melony, Malope-Kgokong Babatyi, Moore David, Reubenson Gary, Moshe Mamokgethi, Madhi Shabir A, Eley Brian, Hallbauer Ute, Kularatne Ranmini, Conklin Laura, O'Brien Katherine L, Zell Elizabeth R, Klugman Keith, Whitney Cynthia G, von Gottberg Anne
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service.
Clin Infect Dis. 2014 Sep 15;59(6):808-18. doi: 10.1093/cid/ciu431. Epub 2014 Jun 9.
South Africa introduced 7-valent pneumococcal conjugate vaccine (PCV7) in April 2009 using a 2 + 1 schedule (6 and 14 weeks and 9 months). We estimated the effectiveness of ≥2 PCV7 doses against invasive pneumococcal disease (IPD) in human immunodeficiency virus (HIV)-infected and -uninfected children.
IPD (pneumococcus identified from a normally sterile site) cases were identified through national laboratory-based surveillance. Specimens were serotyped by Quellung or polymerase chain reaction. Four controls, matched for age, HIV status, and hospital were sought for each case. Using conditional logistic regression, we calculated vaccine effectiveness (VE) as 1 minus the adjusted odds ratio for vaccination.
From March 2010 through November 2012, we enrolled 187 HIV-uninfected (48 [26%] vaccine serotype) and 109 HIV-infected (43 [39%] vaccine serotype) cases and 752 HIV-uninfected and 347 HIV-infected controls aged ≥16 weeks. Effectiveness of ≥2 PCV7 doses against vaccine-serotype IPD was 74% (95% confidence interval [CI], 25%-91%) among HIV-uninfected and -12% (95% CI, -449% to 77%) among HIV-infected children. Effectiveness of ≥3 doses against vaccine-serotype IPD was 90% (95% CI, 14%-99%) among HIV-uninfected and 57% (95% CI, -371% to 96%) among HIV-infected children. Among HIV-exposed but -uninfected children, effectiveness of ≥2 doses was 92% (95% CI, 47%-99%) against vaccine-serotype IPD. Effectiveness of ≥2 doses against all-serotype multidrug-resistant IPD was 96% (95% CI, 62%-100%) among HIV-uninfected children.
A 2 + 1 PCV7 schedule was effective in preventing vaccine-serotype IPD in HIV-uninfected and HIV-exposed, uninfected children. This finding supports the World Health Organization recommendation for this schedule as an alternative to a 3-dose primary series among HIV-uninfected individuals.
南非于2009年4月采用2+1免疫程序（6周、14周和9个月）引入7价肺炎球菌结合疫苗（PCV7）。我们评估了≥2剂PCV7对感染和未感染人类免疫缺陷病毒（HIV）儿童侵袭性肺炎球菌病（IPD）的有效性。
通过全国基于实验室的监测确定IPD（从正常无菌部位鉴定出肺炎球菌）病例。标本通过荚膜肿胀试验或聚合酶链反应进行血清分型。为每个病例寻找4名年龄、HIV状态和医院相匹配的对照。使用条件逻辑回归，我们将疫苗有效性（VE）计算为1减去接种疫苗的调整优势比。
从2010年3月至2012年11月，我们纳入了187例未感染HIV的儿童（48例[26%]为疫苗血清型）和109例感染HIV的儿童（43例[39%]为疫苗血清型），以及752例未感染HIV和347例感染HIV且年龄≥16周的对照。≥2剂PCV7对疫苗血清型IPD的有效性在未感染HIV的儿童中为74%（95%置信区间[CI]，25%-91%），在感染HIV的儿童中为-12%（95%CI，-449%至77%）。≥3剂对疫苗血清型IPD的有效性在未感染HIV的儿童中为90%（95%CI，14%-99%），在感染HIV的儿童中为57%（95%CI，-371%至96%）。在暴露于HIV但未感染的儿童中，≥2剂对疫苗血清型IPD的有效性为92%（95%CI，47%-99%）。≥2剂对所有血清型多重耐药IPD的有效性在未感染HIV的儿童中为96%（95%CI，62%-100%）。
2+1 PCV7免疫程序在预防未感染HIV以及暴露于HIV但未感染儿童的疫苗血清型IPD方面有效。这一发现支持世界卫生组织将该免疫程序作为未感染HIV个体3剂基础免疫程序替代方案的建议。
