Segal Niv, Greenberg David, Dagan Ron, Ben-Shimol Shalom
Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Vaccine. 2016 Aug 17;34(37):4371-7. doi: 10.1016/j.vaccine.2016.07.004. Epub 2016 Jul 18.
Invasive pneumococcal disease (IPD) and pneumonia are major causes of morbidity, especially in developing countries. While pneumococcal disease rates differences between various populations are well known, data are scarce regarding disparities in PCV impact on pneumococcal disease rates between populations living in the same country.
The aim of this systematic literature review was to describe disparities in PCV impact between different populations.
A systematic literature search was performed using the PubMed database. Studies evaluating pneumococcal disease rates at any age were included. The search was limited to articles written in English and published between 2000 and 2015. Independent extraction of articles was performed by two authors (NS, SB-S). Search terms included: pneumococcus, pneumococcal disease, IPD, pneumonia, PCV, pneumococcal vaccine, population, race, ethnicity, differences, and disparity. We defined resource-poor populations as African-Americans, Aboriginal, Alaska natives and Navajo native-Americans populations compared with the respective resource-rich populations, including White, non-Aboriginal, non-Alaska natives and general US population.
Eighteen articles meeting the selection criteria were identified; 17 regarding IPD and one regarding pneumonia. Nine articles compared IPD rates in African-Americans and Whites in the US, six compared Aboriginal and non-Aboriginal populations; two compared Alaska natives vs. non-native Alaskans in the US and one article compared Navajo native-Americans and general population in the US. Only minor difference where usually noted in the incidence rate ratios (IRRs) comparing pre- and post-PCV rates of IPD and pneumonia between resource rich and resource poor populations. In contrast, absolute rate reductions were higher in resource-poor compared with resource-rich populations.
While differences in IPD and pneumonia rates between resource-poor and resource-rich populations were decreased following PCV introduction, disparity is still apparent and is not fully eliminated in any of the studies. Younger (<2years) populations in resource-poor populations seem to benefit the most from PCV introduction.
侵袭性肺炎球菌病（IPD）和肺炎是发病的主要原因，尤其是在发展中国家。虽然不同人群之间肺炎球菌病发病率的差异众所周知，但关于同一国家内不同人群中肺炎球菌结合疫苗（PCV）对肺炎球菌病发病率影响的差异的数据却很少。
本系统文献综述的目的是描述不同人群中PCV影响的差异。
使用PubMed数据库进行系统文献检索。纳入评估任何年龄肺炎球菌病发病率的研究。检索仅限于2000年至2015年间发表的英文文章。由两位作者（NS，SB-S）独立提取文章。检索词包括：肺炎球菌、肺炎球菌病、IPD、肺炎、PCV、肺炎球菌疫苗、人群、种族、民族、差异和 disparity。我们将资源匮乏人群定义为非裔美国人、原住民、阿拉斯加原住民和纳瓦霍美国原住民人群，与之对应的资源丰富人群包括白人、非原住民、非阿拉斯加原住民和美国普通人群。
确定了18篇符合选择标准的文章；17篇关于IPD，1篇关于肺炎。9篇文章比较了美国非裔美国人和白人的IPD发病率，6篇比较了原住民和非原住民人群；2篇比较了美国阿拉斯加原住民与非阿拉斯加原住民，1篇文章比较了美国纳瓦霍美国原住民和普通人群。在比较资源丰富和资源匮乏人群中IPD和肺炎的PCV接种前后发病率比值（IRR）时，通常仅发现微小差异。相比之下，资源匮乏人群的绝对发病率降低幅度高于资源丰富人群。
虽然引入PCV后资源匮乏和资源丰富人群之间的IPD和肺炎发病率差异有所降低，但差异仍然明显，且在任何研究中都未完全消除。资源匮乏人群中较年轻（<2岁）的人群似乎从引入PCV中获益最大。
