10价和13价肺炎球菌结合疫苗对拉丁美洲国家5岁以下儿童住院率和死亡率的影响及效果：一项系统评价
Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review.
作者信息
de Oliveira Lucia Helena, Camacho Luiz Antonio B, Coutinho Evandro S F, Martinez-Silveira Martha S, Carvalho Ana Flavia, Ruiz-Matus Cuauhtemoc, Toscano Cristiana M
机构信息
Immunization Unit/FGL, Pan American Health Organization, World Health Organization (PAHO), Washington DC, United States of America.
Department of Epidemiology and Quantitative Methods in Health, National Public Health School (ENSP), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil.
出版信息
PLoS One. 2016 Dec 12;11(12):e0166736. doi: 10.1371/journal.pone.0166736. eCollection 2016.
BACKGROUND
Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.
OBJECTIVES
We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.
METHODS
We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.
RESULTS
We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8-37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4-20.6% for clinical pneumonia, and 13.3-87.7% for meningitis hospitalizations, and 56-83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.
CONCLUSIONS
Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.
背景
几个拉丁美洲和加勒比地区（LAC）国家已将肺炎球菌结合疫苗（PCV - 10或PCV - 13）纳入其国家常规免疫规划。
目的
我们旨在总结PCV对LAC地区5岁以下儿童的影响及有效性的证据。
方法
我们对有关PCV对侵袭性肺炎球菌疾病（IPD）、肺炎、脑膜炎和败血症所致死亡或住院的影响或有效性的文献进行了系统综述。我们检索了2009年至2016年1月以任何语言发表的Medline、WoS、Lilacs、Scopus、Central及灰色文献。我们纳入了针对目标年龄组儿童的感兴趣结局的研究，研究设计如下：随机试验、队列或病例对照研究、干预前后至少有三个数据点的中断时间序列研究以及前后对照研究。根据在PROSPERO上注册的研究方案，由独立评审员对文献筛选、数据提取和偏倚风险评估进行了重复操作。进行了有效性测量的描述性分析和敏感性分析。对于病例对照或队列/临床试验，有效性报告为1 - OR或1 - RR，对于前后对照研究，有效性报告为疾病发病率的百分比变化。
结果
我们共识别出1085篇文献，其中892篇来自数据库，193篇来自其他来源。其中，22篇文献进行了进一步分析。这些研究来自巴西、智利、乌拉圭、阿根廷、秘鲁和尼加拉瓜。因X线确诊肺炎住院的有效性为8.8% - 37.8%，临床肺炎为7.4% - 20.6%，脑膜炎住院为13.3% - 87.7%，IPD住院为56% - 83.3%，因年龄、结局定义、疫苗类型和研究设计而异。
结论
目前可得的证据表明，PCV - 10和PCV - 13对所研究的结局均有显著影响，没有证据表明在降低5岁以下儿童肺炎、IPD或脑膜炎住院率方面一种疫苗优于另一种疫苗。
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