Epidemiology Department, EpiConcept, Paris, France.
Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic.
Lancet Respir Med. 2017 Aug;5(8):648-656. doi: 10.1016/S2213-2600(17)30110-8. Epub 2017 Mar 27.
The Streptococcus pneumoniae Invasive Disease network (SpIDnet) actively monitors populations in nine sites in seven European countries for invasive pneumococcal disease. Five sites use 13-valent pneumococcal conjugate vaccine (PCV13) alone and four use the ten-valent PCV (PCV10) and PCV13. Vaccination uptake is greater than 90% in six sites and 67-78% in three sites. We measured the effects of introducing high-valency PCVs on the incidence of invasive pneumococcal disease in children younger than 5 years.
We compared the incidence of invasive pneumococcal disease in each of the 4 years after the introduction of PCV13 alone or PCV10 and PCV13 with the average incidence during the preceding period of heptavalent PCV (PCV7) use, overall and by serotype category. We calculated incidence rate ratios (IRRs) and 95% CIs for each year and pooled the values for all sites in a random effects meta-analysis.
4 years after the introduction of PCV13 alone or PCV10 and PCV13, the pooled IRR was 0·53 (95% CI 0·43-0·65) for invasive pneumococcal disease in children younger than 5 years caused by any serotype, 0·16 (0·07-0·40) for disease caused by PCV7 serotypes, 0·17 (0·07-0·42) for disease caused by 1, 5, and 7F serotypes, and 0·41 (0·25-0·69) for that caused by 3, 6A and 19A serotypes. We saw a similar pattern when we restricted the analysis to sites where only PCV13 was used. The pooled IRR for invasive pneumococcal disease caused by non-PCV13 serotypes was 1·62 (1·09-2·42).
The incidence of invasive pneumococcal disease caused by all serotypes decreased due to a decline in the incidence of vaccine serotypes. By contrast, that of invasive pneumococcal disease caused by non-PCV13 serotypes increased, which suggests serotype replacement. Long-term surveillance will be crucial to monitor the further effects of PCV10 and PCV13 vaccination programmes in young children.
European Centre for Disease Prevention and Control, Czech National Institute of Public Health, French National Agency for Public Health, Irish Health Services Executive, Norwegian Institute of Public Health, Public Health Agency of Catalonia, Public Health Department of Community of Madrid, Navarra Hospital Complex, Public Health Institute of Navarra, CIBER Epidemiology and Public Health, Institute of Health Carlos III, Public Health Agency of Sweden, and NHS Scotland.
肺炎球菌侵袭性疾病网络（SpIDnet）积极监测欧洲七个国家的九个地点的人群中侵袭性肺炎球菌病的发病情况。五个地点单独使用 13 价肺炎球菌结合疫苗（PCV13），四个地点使用 10 价 PCV（PCV10）和 PCV13。六个地点的疫苗接种率超过 90%，三个地点的疫苗接种率为 67-78%。我们测量了引入高价 PCV 对 5 岁以下儿童侵袭性肺炎球菌病发病率的影响。
我们比较了单独使用 PCV13 或 PCV10 和 PCV13 后 4 年期间侵袭性肺炎球菌病的发病率与使用七价 PCV（PCV7）之前的平均发病率，按血清型类别进行了比较。我们计算了每年的发病率比值（IRR）和 95%CI，并在随机效应荟萃分析中汇总了所有地点的值。
单独使用 PCV13 或 PCV10 和 PCV13 4 年后，5 岁以下儿童由任何血清型引起的侵袭性肺炎球菌病的汇总 IRR 为 0.53（95%CI 0.43-0.65），由 PCV7 血清型引起的疾病为 0.16（0.07-0.40），由 1、5 和 7F 血清型引起的疾病为 0.17（0.07-0.42），由 3、6A 和 19A 血清型引起的疾病为 0.41（0.25-0.69）。当我们将分析仅限于仅使用 PCV13 的地点时，我们看到了类似的模式。由非 PCV13 血清型引起的侵袭性肺炎球菌病的汇总 IRR 为 1.62（1.09-2.42）。
由于疫苗血清型发病率的下降，所有血清型引起的侵袭性肺炎球菌病的发病率下降。相比之下，由非 PCV13 血清型引起的侵袭性肺炎球菌病的发病率增加，这表明了血清型替代。长期监测对于监测小儿 PCV10 和 PCV13 疫苗接种计划的进一步影响至关重要。
欧洲疾病预防控制中心、捷克国家公共卫生研究所、法国国家公共卫生署、爱尔兰卫生服务执行局、挪威公共卫生研究所、加泰罗尼亚公共卫生局、马德里自治区公共卫生局、纳瓦拉医院综合体、纳瓦拉公共卫生研究所、CIBER 流行病学和公共卫生、卡洛斯三世健康研究所、瑞典公共卫生局和苏格兰国民健康保险制度。
