Tsai Ying-Huang, Hsieh Meng-Jer, Chang Chee-Jen, Wen Yu-Wen, Hu Han-Chung, Chao Yen-Nan, Huang Yhu-Chering, Yang Cheng-Ta, Huang Chung-Chi
Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan; Department of Respiratory Therapy, Chang-Gung University, Taoyuan City, Taiwan.
Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Puzi City, Taiwan; Department of Respiratory Therapy, Chang-Gung University, Taoyuan City, Taiwan.
Vaccine. 2015 Jun 9;33(25):2897-902. doi: 10.1016/j.vaccine.2015.04.068. Epub 2015 Apr 30.
Pneumococcal infection is a serious cause of mortality and morbidity in the elderly. A nationwide pneumococcal polysaccharide vaccine (PPV) program for elderly adults aged 75 years and older was conducted in Taiwan in 2008. The efficacy of the PPV in this very elderly population was evaluated.
The data were analyzed using the Taiwan National Health Insurance Research Database (NHIRD), the cause-of-death registration database and the invasive pneumococcal disease (IPD) notification database of Taiwan's Ministry of Health and Welfare. The efficacy of PPV administration in this very elderly population was evaluated using multivariate logistic regression after propensity score matching (PSM). The rates of IPD, death from IPD, pneumonia hospitalization, death from pneumonia, and all-cause mortality were compared for those who did and did not receive the PPV.
Among the 1078,955 eligible people, 318,257 (29.5%) received the PPV, and 760,698 (70.5%) were not vaccinated. Using PSM to adjust for confounding factors, including age, gender, influenza vaccination status, associated chronic diseases and health care utilization, those who received the PPV had significantly lower odds ratios (ORs) for IPD (OR=0.24, 95% CI=0.123-0.461, p<0.001), death from IPD (OR=0.09, 95% CI=0.011-0.704, p<0.022, p<0.001), pneumonia hospitalization (OR=0.40, 95% CI=0.395-0.415, p<0.001), death from pneumonia (OR=0.07, 95% CI=0.059-0.082, p<0.001), and all-cause mortality (OR=0.07, 95% CI=0.069-0.072, p<0.001) compared with those who were not vaccinated.
PPV vaccination in the previous year was associated with a 60% reduction in pneumonia hospitalization, a 76% reduction in IPD, and a greater than 90% reduction in death from pneumonia, IPD and all causes among people over 75 years old in Taiwan. Data from subsequent years in Taiwan and similar populations elsewhere are needed to evaluate the contribution of underlying variations in the mortality rate and the confounding effects of prior disease severity to these findings.
肺炎球菌感染是老年人死亡和发病的一个重要原因。2008年台湾针对75岁及以上老年人开展了一项全国性肺炎球菌多糖疫苗（PPV）接种计划。对该疫苗在这一高龄人群中的效果进行了评估。
使用台湾国民健康保险研究数据库（NHIRD）、死因登记数据库以及台湾卫生福利部的侵袭性肺炎球菌疾病（IPD）通报数据库对数据进行分析。在倾向得分匹配（PSM）后，使用多因素逻辑回归评估PPV接种在这一高龄人群中的效果。比较了接种和未接种PPV者的IPD发病率、IPD死亡、肺炎住院、肺炎死亡以及全因死亡率。
在1078955名符合条件的人群中，318257人（29.5%）接种了PPV，760698人（70.5%）未接种。通过PSM调整包括年龄、性别、流感疫苗接种状况、相关慢性病和医疗保健利用等混杂因素后，接种PPV者的IPD（比值比[OR]=0.24，95%置信区间[CI]=0.123 - 0.461，p<0.001）、IPD死亡（OR=0.09，95%CI=0.011 - 0.704，p<0.022，p<0.001）、肺炎住院（OR=0.40，95%CI=0.395 - 0.415，p<0.001）、肺炎死亡（OR=0.07，95%CI=0.059 - 0.082，p<0.001）以及全因死亡率（OR=0.07，95%CI=0.069 - 0.072，p<0.001）的比值比均显著低于未接种者。
前一年接种PPV与台湾75岁以上人群的肺炎住院率降低60%、IPD发病率降低76%以及肺炎、IPD和全因死亡降低90%以上相关。需要台湾后续年份的数据以及其他地区类似人群的数据来评估死亡率的潜在差异以及既往疾病严重程度的混杂效应对这些结果的影响。
