Black Carla L, Williams Walter W, Warnock Rob, Pilishvili Tamara, Kim David, Kelman Jeffrey A
MMWR Morb Mortal Wkly Rep. 2017 Jul 14;66(27):728-733. doi: 10.15585/mmwr.mm6627a4.
On September 19, 2014, CDC published the Advisory Committee on Immunization Practices (ACIP) recommendation for the routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged ≥65 years, to be used in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23) (1). This replaced the previous recommendation that adults aged ≥65 years should be vaccinated with a single dose of PPSV23. As a proxy for estimating PCV13 and PPSV23 vaccination coverage among adults aged ≥65 years before and after implementation of these revised recommendations, CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS). Claims from any time during a beneficiary's enrollment in Medicare Parts A (hospital insurance) and B (medical insurance) since reaching age 65 years were assessed among beneficiaries continuously enrolled in Medicare Parts A and B during annual periods from September 19, 2009, through September 18, 2016. By September 18, 2016, 43.2% of Medicare beneficiaries aged ≥65 years had claims for at least 1 dose of PPSV23 (regardless of PCV13 status), 31.5% had claims for at least 1 dose of PCV13 (regardless of PPSV23 status), and 18.3% had claims for at least 1 dose each of PCV13 and PPSV23. Claims for either type of pneumococcal vaccine were highest among beneficiaries who were older, white, or with chronic and immunocompromising medical conditions than among healthy adults. Implementation of the National Vaccine Advisory Committee's standards for adult immunization practice to assess vaccination status at every patient encounter, recommend needed vaccines, and administer vaccination or refer to a vaccinating provider might help increase pneumococcal vaccination coverage and reduce the risk for pneumonia and invasive pneumococcal disease among older adults (2).
2014年9月19日，美国疾病控制与预防中心（CDC）发布了免疫实践咨询委员会（ACIP）的建议，即≥65岁成年人应常规接种13价肺炎球菌结合疫苗（PCV13），并与23价肺炎球菌多糖疫苗（PPSV23）系列接种（1）。这取代了之前≥65岁成年人应接种单剂PPSV23的建议。为了估算这些修订建议实施前后≥65岁成年人中PCV13和PPSV23的疫苗接种覆盖率，CDC分析了提交给医疗保险和医疗补助服务中心（CMS）报销的疫苗接种申请。在2009年9月19日至2016年9月18日各年度中持续参保医疗保险A部分（住院保险）和B部分（医疗保险）的受益人中，评估了自年满65岁起其参保医疗保险A、B部分期间任何时间的申请。到2016年9月18日，43.2%的≥65岁医疗保险受益人至少有一剂PPSV23的接种申请（无论PCV13接种情况如何），31.5%的受益人至少有一剂PCV13的接种申请（无论PPSV23接种情况如何），18.3%的受益人至少各有一剂PCV13和PPSV23的接种申请。与健康成年人相比，年龄较大、白人或患有慢性和免疫功能低下疾病的受益人中，两种肺炎球菌疫苗的接种申请率最高。实施国家疫苗咨询委员会关于成人免疫实践的标准，即在每次患者就诊时评估疫苗接种状况、推荐所需疫苗并进行疫苗接种或转介至疫苗接种提供者，可能有助于提高肺炎球菌疫苗接种覆盖率，并降低老年人患肺炎和侵袭性肺炎球菌疾病的风险（2）。
