Nicholls Thomas Rodger, Leach Amanda Jane, Morris Peter Stanley
Menzies School of Health Research, Charles Darwin University, John Matthews Building (58), Royal Darwin Hospital Campus, Darwin 0810, NT, Australia.
Menzies School of Health Research, Charles Darwin University, John Matthews Building (58), Royal Darwin Hospital Campus, Darwin 0810, NT, Australia.
Vaccine. 2016 Feb 3;34(6):703-13. doi: 10.1016/j.vaccine.2015.12.048. Epub 2015 Dec 29.
Early onset of persistent otitis media is a priority issue for Australian Indigenous populations. The objective is to determine the direct and short-term impact of one, two and three doses of any pneumococcal conjugate vaccine (PCV) formulation on nasopharyngeal (NP) carriage of Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi), the otopathogens targeted by current PCVs.
We searched MEDLINE (PubMed) and CENTRAL (Cochrane Library) to 29 September 2015. We also scanned reference lists of recent reviews and contacted authors. We included randomised controlled trials (RCTs) with a PCV schedule commencing ≤3 months of age that reported controlled non-cumulative group-specific prevalence data for carriage of Spn or NTHi at age<12 months. We performed a standard risk of bias assessment. We estimated the pooled relative risk (RR) and 95% confidence interval (95%CI) for each vaccine dose on NP carriage by meta-analysis.
We included 16 RCTs involving 14,776 participants. The PCVs were conjugated to diphtheria toxin CRM197, diphtheria toxoid, tetanus toxoid or NTHi protein D and varied in valency (4-13). Controls were non-PCVs, placebo or no vaccine. The earliest carriage outcome was from 2 to 9 months of age. Compared to controls, there were no significant differences between one or two doses of PCV on vaccine-type (VT) pneumococcal carriage at ∼4 and ∼6 months respectively. However, VT carriage was significantly lower at ∼7 months RR 0.67 95%CI 0.56-0.81 from 9 studies and 7613 infants and non-vaccine type (NVT) carriage was higher RR 1.23 95%CI 1.09-1.40 from 8 studies and 5861 infants. No impact on overall pneumococcal or NTHi carriage was found.
The primary PCV schedule had no significant short-term impact on overall pneumococcal or NTHi NP carriage and a limited impact on VT pneumococcal carriage before the third dose.
持续性中耳炎的早发是澳大利亚原住民的一个优先问题。目的是确定单剂、两剂和三剂任何肺炎球菌结合疫苗（PCV）制剂对肺炎链球菌（Spn）和不可分型流感嗜血杆菌（NTHi）的鼻咽（NP）携带的直接和短期影响，这两种病原体是目前PCV所针对的耳病原体。
我们检索了截至2015年9月29日的MEDLINE（PubMed）和CENTRAL（Cochrane图书馆）。我们还浏览了近期综述的参考文献列表并联系了作者。我们纳入了PCV接种计划始于≤3月龄的随机对照试验（RCT），这些试验报告了12月龄以下Spn或NTHi携带的对照非累积组特异性流行率数据。我们进行了标准的偏倚风险评估。我们通过荟萃分析估计了每种疫苗剂量对NP携带的合并相对风险（RR）和95%置信区间（95%CI）。
我们纳入了16项RCT，涉及14776名参与者。PCV与白喉毒素CRM197、白喉类毒素、破伤风类毒素或NTHi蛋白D结合，血清型（4 - 13）各不相同。对照为非PCV、安慰剂或无疫苗。最早的携带结果来自2至9月龄。与对照相比，单剂或两剂PCV在约4个月和约6个月时分别对疫苗型（VT）肺炎球菌携带无显著差异。然而，在约7个月时，来自9项研究和7613名婴儿的VT携带显著降低，RR为0.67，95%CI为0.56 - 0.81，而非疫苗型（NVT）携带增加，RR为1.23，95%CI为1.09 - 1.40，来自8项研究和5861名婴儿。未发现对总体肺炎球菌或NTHi携带的影响。
主要的PCV接种计划对总体肺炎球菌或NTHi的NP携带无显著短期影响，对第三剂之前VT肺炎球菌携带的影响有限。
