García Gabarrot Gabriela, López Vega Mariana, Pérez Giffoni Gabriel, Hernández Silvia, Cardinal Pablo, Félix Viviana, Gabastou Jean Marc, Camou Teresa
Departamento de Laboratorios, Ministerio de Salud Pública, Montevideo, Uruguay.
Unidad de Terapia Intensiva, CASMU-IAMPP, Montevideo, Uruguay.
PLoS One. 2014 Nov 6;9(11):e112337. doi: 10.1371/journal.pone.0112337. eCollection 2014.
In 2008, a 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into the routine childhood immunization program in Uruguay, with a 2+1 schedule. In 2010, PCV13 replaced PCV7, and the same 2+1 schedule was used. The effect of these pneumococcal vaccines on the incidence of invasive pneumococcal infections (IPD) and on serotype distribution was analyzed retrospectively, based on passive national laboratory surveillance.
Data from 1,887 IPD isolates from 5 years before and 5 years after PCV7 introduction (7 before and 3 after PCV13 introduction) was examined to assess the incidence rate per 100,000 age-specific population of all IPD, PCV7-serotypes, and PCV13-serotypes associated IPD among children < 2 years and 2 to 4 years old, and patients ≥ 5 years old. Trends of frequency for each serotype were also analyzed.
Comparison of pre-vaccination (2003-2007) and post-vaccination (2008-2012) periods showed a significant decrease in IPD incidence among children < 2 years old (IR 68.7 to IR 29.6, p<0.001) and children 2 to 4 years (p < 0.04). IPD caused by serotypes in PCV7 was reduced by 95.6% and IPD caused by 6 serotypes added in PCV13 was reduced by 83.9% in children <5 years old. Indirect effects of both conjugate vaccines were observed among patients ≥ 5 years old one year after the introduction of each vaccine, in 2010 for PCV7 and in 2012 for PCV13. Nevertheless, for reasons that still need to be explained, perhaps due to ascertainment bias, total IPD in this group increased after 2007. In 2012, the relative frequency of vaccine serotypes among vaccinated and unvaccinated population declined, except for serotype 3. Non vaccine serotypes with increasing frequency were identified, in rank order: 12F, 8, 24F, 22F, 24A, 15C, 9N, 10A and 33.
Consecutive immunization with PCV7 and PCV13 has significantly reduced IPD in children < 5 years of age in Uruguay.
2008年，一种7价肺炎球菌结合疫苗（PCV7）被纳入乌拉圭儿童常规免疫计划，采用2+1接种程序。2010年，PCV13取代了PCV7，并采用相同的2+1接种程序。基于全国被动实验室监测，回顾性分析了这些肺炎球菌疫苗对侵袭性肺炎球菌感染（IPD）发病率和血清型分布的影响。
检查了PCV7引入前5年和引入后5年（PCV13引入前7年和引入后3年）的1887株IPD分离株的数据，以评估2岁以下、2至4岁儿童以及5岁及以上患者中每10万特定年龄人群的所有IPD、PCV7血清型和PCV13血清型相关IPD的发病率。还分析了每种血清型的频率趋势。
疫苗接种前（2003 - 2007年）和接种后（2008 - 2012年）时期的比较显示，2岁以下儿童（发病率从68.7降至29.6，p<0.001）和2至4岁儿童的IPD发病率显著下降（p < 0.04）。5岁以下儿童中由PCV7血清型引起的IPD减少了95.6%，由PCV13中新增的6种血清型引起的IPD减少了83.9%。在每种疫苗引入后的一年，即2010年的PCV7和2012年的PCV13，在5岁及以上患者中观察到了两种结合疫苗的间接效应。然而，由于仍需解释的原因，可能是由于确诊偏倚，该组中的总IPD在2007年后有所增加。2012年，除血清型3外，接种疫苗和未接种疫苗人群中疫苗血清型的相对频率下降。确定了频率增加的非疫苗血清型，按顺序排列为：12F、8、24F、22F、24A、15C、9N、10A和33。
在乌拉圭，连续接种PCV7和PCV13显著降低了5岁以下儿童的IPD发病率。
