Tsaban Gal, 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.
Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Vaccine. 2017 May 19;35(22):2882-2891. doi: 10.1016/j.vaccine.2017.04.032. Epub 2017 Apr 24.
Pneumococcal diseases are major causes of morbidity among adults, especially those over 50years of age. While pneumococcal conjugated vaccines (PCV's) impact on pneumococcal disease rates among children is well established, the extent of its impact on adult pneumococcal related illness remains unclear. The aim of this systematic literature review was to describe the impact of PCV introduction to childhood national immunization programs worldwide on PCV-naive adult population.
A systematic literature search was performed using the PubMed database. The search was limited to articles written in English and published between January 2000 and February 2016. Studies evaluating pneumococcal disease rates in individuals over 5years of age were included. Independent extraction of articles was performed by the two authors. Search terms included: Pneumococcal conjugated vaccine, herd, indirect, adults, and pneumonia.
Forty-nine articles meeting the selection criteria were identified, 39 regarding invasive pneumococcal disease (IPD, one on meningitis only), 8 regarding pneumonia, and 2 on both IPD and pneumonia. The majority of reports were from the US, UK and Canada. Considerable variability in the data sources, quality and completeness was observed. While most studies reported either statistically significant reduction or insignificant changes in IPD and pneumonia disease rates in adults following PCV nationwide implementation, few studies reported statistically significant increase in pneumococcal disease rates, these were mainly from countries with low PCV coverage rates and/or inadequate surveillance.
Invasive pneumococcal diseases and pneumonia rates among the adult population decreased in most countries following PCV introduction into the NIP. This indirect effect on older population seems to be dependent on PCV coverage rates and time from PCV nationwide implementation. Adults >65years old seem to benefit the most from PCV introduction.
肺炎球菌疾病是成人发病的主要原因，尤其是50岁以上的成年人。虽然肺炎球菌结合疫苗（PCV）对儿童肺炎球菌疾病发病率的影响已得到充分证实，但其对成人肺炎球菌相关疾病的影响程度仍不清楚。本系统文献综述的目的是描述在全球儿童国家免疫规划中引入PCV对未接种PCV的成年人群的影响。
使用PubMed数据库进行系统文献检索。检索仅限于2000年1月至2016年2月期间发表的英文文章。纳入评估5岁以上个体肺炎球菌疾病发病率的研究。由两位作者独立提取文章。检索词包括：肺炎球菌结合疫苗、群体、间接、成人和肺炎。
确定了49篇符合选择标准的文章，39篇关于侵袭性肺炎球菌疾病（IPD，仅1篇关于脑膜炎），8篇关于肺炎，2篇关于IPD和肺炎。大多数报告来自美国、英国和加拿大。观察到数据来源、质量和完整性存在相当大的差异。虽然大多数研究报告称，在全国范围内实施PCV后，成人IPD和肺炎疾病发病率有统计学显著下降或无显著变化，但很少有研究报告肺炎球菌疾病发病率有统计学显著上升，这些主要来自PCV覆盖率低和/或监测不足的国家。
在国家免疫规划中引入PCV后，大多数国家成年人群中的侵袭性肺炎球菌疾病和肺炎发病率有所下降。这种对老年人群的间接影响似乎取决于PCV覆盖率和从全国实施PCV开始的时间。65岁以上的成年人似乎从引入PCV中受益最大。
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