Kraicer-Melamed Hannah, O'Donnell Shauna, Quach Caroline
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada; MUHC Vaccine Study Centre - Research Institute, McGill University Health Centre, Montreal, QC, Canada.
Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada; MUHC Vaccine Study Centre - Research Institute, McGill University Health Centre, Montreal, QC, Canada; Department of Pediatrics, Division of Infectious Diseases, McGill University, Montreal, QC, Canada; Quebec Institute of Public Health, Montreal, QC, Canada.
Vaccine. 2016 Mar 18;34(13):1540-1550. doi: 10.1016/j.vaccine.2016.02.024. Epub 2016 Feb 17.
Two pneumococcal vaccines currently exist and have been recommended for the prevention of pneumococcal infection in adults 65 years of age and older: the 23-valent polysaccharide (PPV23) and the conjugate 13-valent (PCV13) vaccine.
To evaluate and summarize the results from all studies reporting on the vaccine effectiveness of PPV23 in preventing invasive pneumococcal disease (IPD) and community-acquired pneumonia (CAP) in individuals over the age of 50.
Systematic database searches were completed in PubMed, Medline, Embase, CINAHL, Web of Science, and Cochrane. Google Scholar and hand searches of seminal articles and past systematic reviews were employed. Studies were included if they independently evaluated the effect of PPV23 on IPD and/or CAP in adults (50+). Data extraction and quality assessment were both completed independently by two researchers. Quality was assessed using the National Advisory Committee on Immunization methodology for quality assessment. All conflicts were resolved by consensus.
The vaccine effectiveness for PPV23 in preventing IPD was 50% (95% CI: 21%-69%) for cohort studies and 54% (95% CI: 32%-69%) for case-control studies. The VE estimates for CAP were 4% (95% CI: -26%-26%) for trials, 17% (95% CI: -26%-45%) for cohort studies, and 7% (95% CI: -10%-21%) for case-control studies.
The vaccine effectiveness of PPV23 in preventing IPD and all-cause CAP was consistent with past systematic reviews and similar to the estimates that were reported in the CAPiTA trial evaluating the vaccine effectiveness of PCV13. Consistent benefits were also reported across ecological studies and reports of surveillance data for the general population 50 years and older. The results suggests that the current practice of vaccinating the adults 65 years of age and older with PPV23 would have similar benefits to PCV13 in preventing potential cases of all-serotype IPD and all-cause CAP.
目前有两种肺炎球菌疫苗，并已被推荐用于预防65岁及以上成年人的肺炎球菌感染：23价多糖疫苗（PPV23）和13价结合疫苗（PCV13）。
评估并总结所有报告PPV23预防50岁以上人群侵袭性肺炎球菌病（IPD）和社区获得性肺炎（CAP）疫苗效力的研究结果。
在PubMed、Medline、Embase、CINAHL、Web of Science和Cochrane中完成系统的数据库检索。还利用了谷歌学术搜索以及对重要文章和以往系统评价的手工检索。如果研究独立评估了PPV23对成年人（50岁及以上）IPD和/或CAP的影响，则纳入研究。数据提取和质量评估均由两名研究人员独立完成。使用国家免疫咨询委员会的质量评估方法进行质量评估。所有分歧均通过协商解决。
队列研究中PPV23预防IPD的疫苗效力为50%（95%CI：21%-69%），病例对照研究中为54%（95%CI：32%-69%）。CAP的疫苗效力估计值在试验中为4%（95%CI：-26%-26%），队列研究中为17%（95%CI：-26%-45%），病例对照研究中为7%（95%CI：-10%-21%）。
PPV23预防IPD和全因性CAP的疫苗效力与以往的系统评价一致，且与评估PCV13疫苗效力的CAPiTA试验中报告的估计值相似。在生态研究以及50岁及以上普通人群的监测数据报告中也报告了一致的益处。结果表明，目前对65岁及以上成年人接种PPV23的做法在预防所有血清型IPD和全因性CAP的潜在病例方面将具有与PCV13相似的益处。
