Steens Anneke, Vestrheim Didrik F, de Blasio Birgitte Freiesleben
Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Sweden.
Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway.
Epidemics. 2015 Jun;11:24-31. doi: 10.1016/j.epidem.2015.01.001. Epub 2015 Jan 19.
Two different vaccines, a 23-valent polysaccharide vaccine (PPV23) and a 13-valent conjugate vaccine (PCV13), are available for prevention of invasive pneumococcal disease (IPD) in the population aged 65 years and older (65+). The IPD epidemiology in the 65+ is undergoing change due to indirect effects of childhood immunisation. Vaccine recommendations for the 65+ must take into account these trends in epidemiology. We therefore explored the preventive potential of vaccination strategies to prevent IPD in the 65+, including PPV23, PCV13 or PCV13 + PPV23 in 2014-2019. Quasi-Poisson regression models were fitted to 2004-2014 population-wide surveillance data and used to predict incidences for vaccine-type and non-vaccine type IPD. We determined the number of people needed to be vaccinated to prevent one case per season (NNV) for each strategy and estimated the public health impact on the IPD case counts from increasing the vaccine uptake to 28-45%. Our results indicate that PCV13-IPD will decrease by 71% from 58 (95% prediction interval 55-61) cases in 2014/15 to 17 (6-52) in 2018/19 and PPV23-IPD by 32% from 168 (162-175) to 115 (49-313) cases. The NNV will increase over time for all strategies because of a decreasing vaccine-type IPD incidence. In 2018/19, the PCV13-NNV will be 5.3 times higher than the PPV23-NNV. Increasing the vaccine uptake will lead to a larger public health impact for all scenarios. Combining PCV13 and PPV23 is most effective, but the additional effect of PCV13 will decrease and is only marginal in 2018/19. Our study demonstrates the importance of increasing PPV23 uptake and of developing vaccines that confer broader immunity.
有两种不同的疫苗可用于预防65岁及以上人群的侵袭性肺炎球菌疾病（IPD），即23价多糖疫苗（PPV23）和13价结合疫苗（PCV13）。由于儿童免疫接种的间接影响，65岁及以上人群的IPD流行病学正在发生变化。针对65岁及以上人群的疫苗接种建议必须考虑到这些流行病学趋势。因此，我们探讨了2014 - 2019年期间包括PPV23、PCV13或PCV13 + PPV23在内的疫苗接种策略预防65岁及以上人群IPD的潜在效果。将准泊松回归模型应用于2004 - 2014年全人群监测数据，并用于预测疫苗型和非疫苗型IPD的发病率。我们确定了每种策略每预防1例季节性病例所需接种的人数（NNV），并估计了将疫苗接种率提高到28% - 45%对IPD病例数的公共卫生影响。我们的结果表明，PCV13相关的IPD将从2014/15年的58例（95%预测区间55 - 61）降至2018/19年的17例（6 - 52），降幅为71%；PPV23相关的IPD将从168例（162 - 175）降至115例（49 - 313），降幅为32%。由于疫苗型IPD发病率下降，所有策略的NNV都会随时间增加。在2018/19年，PCV13的NNV将比PPV23的NNV高5.3倍。提高疫苗接种率在所有情况下都会带来更大的公共卫生影响。联合使用PCV13和PPV23最为有效，但PCV13的额外效果会降低，在2018/19年仅为边际效果。我们的研究证明了提高PPV23接种率以及研发具有更广泛免疫效果疫苗的重要性。
