Département de médecine sociale et préventive, Université Laval, Quebec City, Canada; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Quebec City, Canada; Centre de recherche du Centre hospitalier universitaire de Québec, Quebec City, Canada.
Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Canada.
Vaccine. 2018 Jan 8;36(3):421-426. doi: 10.1016/j.vaccine.2017.11.054. Epub 2017 Dec 7.
In Quebec, 7-valent (PCV7), 10-valent (PCV10) and 13-valent (PCV13) pneumococcal conjugate vaccines were successively used for the immunization of children according to a 2+1 doses schedule.
Our aim was to assess the impact of this program on the epidemiology of invasive pneumococcal disease (IPD) in children and adults.
Notification and laboratory surveillance data were analyzed and the immunization status of IPD cases in children was checked.
In children < 5 years, the IPD rate decreased from 69/100,000 in 2003 to 12/100,000 in 2016 (83% reduction). Following PCV7 introduction in 2004, there has been a rapid decline in PCV7-type IPD cases and 6A. 7F and 19A serotypes emerged but their incidence decreased following PCV10 introduction in 2009 and PCV13 in 2011, whereas decrease in serotype 3 IPD was modest. Non-PCV13 types increased and represented 79% of cases in 2016. The same pattern was seen in adults but replacement was complete and there was no decrease in overall IPD rate. In those 65 years and over, PCV13 serotypes represented 28% of cases in 2016 and 62% were serotypes included in the 23-valent polysaccharide vaccine. Out of 10 IPD cases caused by serotype 3 in children vaccinated with PCV13 in 2011-2016, 6 occurred more than one year following the booster dose, which suggests short-term protection. Out of 31 breakthrough 19A cases, 19 occurred in children aged between 8 and 14 months who had received the 2 primary PCV13 doses but not the toddler booster dose, which suggests a window of susceptibility in a 2+1 schedule.
PCVs had a major impact on the IPD rate in children but not in adults. Among elderly adults, the proportion of cases caused by serotypes included in PCV13 is diminishing year after year but a majority of cases remains covered by the 23-valent polysaccharide vaccine.
在魁北克，7 价（PCV7）、10 价（PCV10）和 13 价（PCV13）肺炎球菌结合疫苗根据 2+1 剂次方案相继用于儿童免疫接种。
我们旨在评估该计划对儿童和成人侵袭性肺炎球菌病（IPD）流行病学的影响。
分析了通知和实验室监测数据，并检查了儿童 IPD 病例的免疫接种状况。
在<5 岁的儿童中，IPD 发病率从 2003 年的 69/100,000 下降到 2016 年的 12/100,000（83%的下降）。继 2004 年 PCV7 引入后，PCV7 型 IPD 病例和 6A、7F 和 19A 血清型迅速减少，但在 2009 年引入 PCV10 和 2011 年引入 PCV13 后，其发病率下降，而血清型 3 IPD 的下降幅度较小。非 PCV13 型增加，在 2016 年占病例的 79%。在成年人中也出现了同样的模式，但完全替代且总体 IPD 率没有下降。在 65 岁及以上人群中，2016 年 PCV13 血清型占病例的 28%，62%为 23 价多糖疫苗包含的血清型。在 2011-2016 年接受 PCV13 疫苗接种的儿童中，有 10 例由血清型 3 引起的 IPD 病例，其中 6 例发生在加强剂次接种后一年以上，这表明短期保护作用。在 31 例突破性 19A 病例中，有 19 例发生在 8 至 14 个月大的儿童中，他们已接受了 2 剂 PCV13 基础疫苗接种，但未接受幼儿加强剂次接种，这表明在 2+1 方案中有易感窗口期。
PCV 对儿童 IPD 发病率有重大影响，但对成年人没有影响。在老年人群中，由 PCV13 包含的血清型引起的病例比例逐年下降，但大多数病例仍由 23 价多糖疫苗覆盖。
