澳大利亚 2002-2014 年 7 价和 13 价肺炎球菌结合疫苗“3+0”免疫程序对侵袭性肺炎球菌病的长期影响
Long-term Impact of a "3 + 0" Schedule for 7- and 13-Valent Pneumococcal Conjugate Vaccines on Invasive Pneumococcal Disease in Australia, 2002-2014.
机构信息
National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead;
Discipline of Child and Adolescent Health, University of Sydney, and.
出版信息
Clin Infect Dis. 2017 Jan 15;64(2):175-183. doi: 10.1093/cid/ciw720. Epub 2016 Oct 21.
BACKGROUND
Australia introduced universal 7-valent pneumococcal conjugate vaccine (PCV7) from 2005, replaced by 13-valent PCV (PCV13) in 2011, uniquely among high-income countries giving doses at 2, 4, and 6 months (3 + 0 schedule). Data on impact of a timely 3 + 0 PCV schedule with high coverage are sparse, with none for PCV13.
METHODS
We used national surveillance of invasive pneumococcal disease (IPD) from 2002 for baseline and appropriate later comparison periods to calculate incidence rate ratios (IRRs) by serotype and age using a Poisson model. PCV coverage was assessed from the Australian Childhood Immunisation Register.
RESULTS
After 9 years of timely 3-dose PCV coverage of >92%, all-age IPD in Australia almost halved (IRR, 0.53; 95% confidence interval [CI], .50-.57), but differed by PCV era. Reductions in IPD due to vaccine serotypes from PCV7 (IRR, 0.20; CI, .17-.22) were about 2-fold greater than for IPD due to extra serotypes in PCV13 (13v-non7v) in a similar period (IRR, 0.58; CI, .51-.66). Post-PCV13 declines in serotype 19A IPD in persons aged <2 years (IRR, 0.23; CI, .13-.35) and ≥2 years (IRR, 0.35; CI, .28-.44) differed from other 13v-non7v IPD (IRR, 0.73; CI, .35-1.48 for those aged <2 years and IRR, 0.96; CI, .81-1.15 for those ≥2 years). Meningitis due to vaccine serotypes nearly disappeared in children eligible for 3 PCV13 doses. IPD due to non-PCV13 serotypes increased by 30% compared with 76% for non-PCV7 serotypes in equivalent period of vaccine use.
CONCLUSIONS
Reductions in vaccine-type IPD post-PCV13 were inferior to Australian experience with PCV7 and reports from high-income countries giving a PCV booster dose. Applicability of findings to other settings would depend on age of IPD onset, serotype profile, and timeliness of vaccination.
背景
澳大利亚于 2005 年开始推广使用通用 7 价肺炎球菌结合疫苗（PCV7），并于 2011 年用 13 价 PCV（PCV13）取代，这在高收入国家中是独一无二的，其接种时间为 2、4 和 6 个月（3+0 方案）。在高覆盖率的情况下，及时使用 3+0 PCV 方案的影响的数据很少，而关于 PCV13 的则更少。
方法
我们使用了 2002 年国家侵袭性肺炎球菌病（IPD）监测数据作为基线，并在适当的后期比较期内，使用泊松模型根据血清型和年龄计算发病率比值（IRR）。通过澳大利亚儿童免疫登记处评估 PCV 覆盖率。
结果
在及时进行了 9 年的 3 剂 PCV 接种，覆盖率>92%之后，澳大利亚所有年龄段的 IPD 几乎减半（IRR，0.53；95%置信区间[CI]，0.50-0.57），但不同时期的 PCV 时代有所不同。PCV7 疫苗血清型导致的 IPD 减少（IRR，0.20；CI，0.17-0.22）是 PCV13 中额外血清型（13v-非 7v）所致 IPD 减少的两倍多（IRR，0.58；CI，0.51-0.66）。PCV13 之后，2 岁以下（IRR，0.23；CI，0.13-0.35）和≥2 岁（IRR，0.35；CI，0.28-0.44）人群血清型 19A IPD 的下降情况与其他 13v-非 7v IPD 不同（2 岁以下人群的 IRR，0.73；CI，0.35-1.48；≥2 岁人群的 IRR，0.96；CI，0.81-1.15）。可接种 3 剂 PCV13 的儿童中，疫苗血清型引起的脑膜炎几乎消失。PCV13 疫苗使用同期，非 PCV13 血清型导致的 IPD 增加了 30%，而非 PCV7 血清型则增加了 76%。
结论
PCV13 之后疫苗血清型 IPD 的减少低于澳大利亚使用 PCV7 的经验和高收入国家使用 PCV 加强针的报告。这些发现对其他环境的适用性将取决于 IPD 发病年龄、血清型谱和疫苗接种的及时性。
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