Zhou Z, Deceuninck G, Lefebvre B, De Wals P
Quebec University Hospital Research Center, Quebec City, QC, Canada.
Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, QC, Canada.
Can J Infect Dis Med Microbiol. 2017;2017:4347206. doi: 10.1155/2017/4347206. Epub 2017 Jan 26.
In Canada, the current recommendation is to offer PPV23 to adults ≥ 65 years. PCV13 is now licensed for adults. Invasive pneumococcal disease (IPD) cases in adults 65-74 years of age in the Quebec notifiable diseases registry were classified into five serotype categories. Poisson regression models were fitted to monthly rates observed in 2000-2014 and predictions were made for 2015-2024, using theoretical assumptions regarding indirect effects of childhood vaccination and serotype replacement. IPD rates caused by PCV7 serotypes decreased markedly since PCV7 introduction for children in December 2004. This trend is also underway for additional PCV13 serotypes except serotype 3. Additional PPV23 serotypes and nonvaccine serotypes have been on rise since 2004 and this is expected to continue. A small decrease in overall IPD incidence in the next decade is predicted. The proportion of PCV13 serotypes represented 33% of IPD cases in 2014 and would be 20% (95% CI: 15% to 28%) in 2024. PPV23 coverage was 53% in 2014 and is expected to be 47% (95% CI: 26% to 85%) in 2024. The potential usefulness of a combined PCV13 + PPV23 program for elderly adults would decrease over time but PCV13 would be the only option to prevent serotype 3 IPD.
在加拿大，目前的建议是为65岁及以上的成年人接种23价肺炎球菌多糖疫苗（PPV23）。13价肺炎球菌结合疫苗（PCV13）现已获批用于成人。魁北克法定疾病登记处中65至74岁成年人的侵袭性肺炎球菌病（IPD）病例被分为五个血清型类别。使用关于儿童疫苗接种的间接影响和血清型替换的理论假设，对2000年至2014年观察到的月度发病率拟合泊松回归模型，并对2015年至2024年进行预测。自2004年12月开始为儿童接种PCV7以来，由PCV7血清型引起的IPD发病率显著下降。除血清型3外，其他PCV13血清型也呈现这种趋势。自2004年以来，PPV23的其他血清型和非疫苗血清型一直在上升，预计这种情况还将持续。预计未来十年IPD总体发病率将略有下降。PCV13血清型所占比例在2014年为IPD病例的33%，到2024年将为20%（95%置信区间：15%至28%）。2014年PPV23的覆盖率为53%，预计到2024年将为47%（95%置信区间：26%至85%）。联合使用PCV13 + PPV23方案对老年人的潜在效用会随着时间推移而降低，但PCV13将是预防血清型3 IPD的唯一选择。
