Alicino Cristiano, Paganino Chiara, Orsi Andrea, Astengo Matteo, Trucchi Cecilia, Icardi Giancarlo, Ansaldi Filippo
Department of Health Sciences, University of Genoa, Italy.
Department of Health Sciences, University of Genoa, Italy.
Vaccine. 2017 Oct 13;35(43):5776-5785. doi: 10.1016/j.vaccine.2017.09.005. Epub 2017 Sep 11.
This systematic review and meta-analysis aimed at summarizing available data on the impact of PCV10 and PCV13 in reducing the incidence of CAP hospitalizations in children aged <5years.
A systematic search of the literature was conducted. We included time-series analyses and before-after studies, reporting the incidence of hospitalization for pneumonia in the periods before and after the introduction of PCV10 or PCV13 into the immunization program. Pooled estimates of Incidence Rate Ratio (IRR) were calculated by using a random-effects meta-analytic model. Results were stratified according to age-groups (<24months and 24-59months) and case definitions of pneumonia (clinically and radiologically confirmed pneumonia).
A total of 1533 potentially relevant articles were identified. Of these, 12 articles were included in the analysis. In children aged <24months, the meta-analysis showed a reduction of 17% (95%CI: 11-22%, p-value<0.001) an of 31% (95%CI: 26-35%, p-value<0.001) in the hospitalization rates respectively for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs. In children aged 24-59months, the meta-analysis showed a reduction of 9% (95%CI: 5-14%, p-value<0.001) and of 24% (95%CI: 12-33%, p-value<0.001) in the hospitalization rates for clinically and radiologically confirmed pneumonia, respectively, after the introduction of the novel PCVs. High heterogeneity was detected among studies evaluating the hospitalization rate for clinically and radiologically confirmed pneumonia.
The results of this study revealed a significant impact of PCV10 and PCV13 in reducing the hospitalizations for pneumonia, particularly in children aged <24months and for radiologically confirmed disease. Further appropriately designed studies, comparing the impact of PCV10 and PCV13, are needed in order to obtain solid data on which to establish future immunization strategies.
本系统评价和荟萃分析旨在总结关于10价肺炎球菌结合疫苗（PCV10）和13价肺炎球菌结合疫苗（PCV13）对降低5岁以下儿童社区获得性肺炎（CAP）住院率影响的现有数据。
对文献进行系统检索。我们纳入了时间序列分析和前后对照研究，这些研究报告了在免疫规划中引入PCV10或PCV13之前和之后各时期肺炎住院率。采用随机效应荟萃分析模型计算发病率比（IRR）的合并估计值。结果根据年龄组（<24个月和24 - 59个月）以及肺炎的病例定义（临床和放射学确诊的肺炎）进行分层。
共识别出1533篇潜在相关文章。其中，12篇文章纳入分析。在<24个月的儿童中，荟萃分析显示，引入新型肺炎球菌结合疫苗后，临床确诊肺炎和放射学确诊肺炎的住院率分别降低了17%（95%置信区间：11 - 22%，p值<0.001）和31%（95%置信区间：26 - 35%，p值<0.001）。在24 - 59个月的儿童中，荟萃分析显示，引入新型肺炎球菌结合疫苗后，临床确诊肺炎和放射学确诊肺炎的住院率分别降低了9%（95%置信区间：5 - 14%，p值<0.001）和24%（95%置信区间：12 - 33%，p值<0.001）。在评估临床和放射学确诊肺炎住院率的研究中检测到高度异质性。
本研究结果显示PCV10和PCV13对降低肺炎住院率有显著影响，尤其是在<24个月的儿童以及放射学确诊疾病方面。需要进一步开展设计合理的研究，比较PCV10和PCV13的影响，以获取可靠数据用于制定未来的免疫策略。
