Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
Vaccine. 2018 Jan 25;36(4):572-577. doi: 10.1016/j.vaccine.2017.11.085. Epub 2017 Dec 16.
To identify a potential nadir of the impact of pneumococcal conjugate vaccination (PCV) in infancy on invasive pneumococcal diseases (IPD) in children under 16 in Germany.
Active surveillance on IPD based on two independent data sources with capture-recapture correction for underreporting. Annual incidence rates by age group, serotypes, site of infection, and relative incidence reduction compared to pre-vaccination period (1997-2001) at nadir and for the most recent season are reported. We calculated vaccine coverage at the age of 24 months using health insurance claims data.
96-97% of children had received at least two doses of PCV since 2009. The maximum impact on overall IPD incidence was achieved in 2012/13 (-48% [95% CI: -55%; -39%]) with a rebound to -26% [95% CI: -36%; -16%] in 2015/16. Non-PCV13 serotypes accounted for 84.1% of the IPD cases in 2015/16. The most frequent non-PCV serotypes in IPD in 2014/15 and 2015/16 were 10A, 24F, 15C, 12F, 38, 22F, 23B, and 15B. The impact at nadir was highest in children 0-1 years of age both in meningitis and non-meningitis cases, whereas the impact for other age groups was higher for meningitis cases. The rebound mainly pertained to non-meningitis cases.
The maximum impact of pneumococcal conjugate vaccination has been attained and signs of a rebound are apparent. Sustained surveillance for IPD in children is warranted to assess whether these trends will continue. There may be a need for vaccines using antigens common to all serotypes.
确定德国 16 岁以下儿童侵袭性肺炎球菌病（IPD）中肺炎球菌结合疫苗（PCV）接种影响的潜在最低点。
基于两个独立数据来源的主动监测，采用捕获-再捕获校正方法纠正漏报。按年龄组、血清型、感染部位以及与疫苗接种前时期（1997-2001 年）相比的相对发病率降低报告发病率。我们使用健康保险索赔数据计算了 24 个月龄时的疫苗覆盖率。
自 2009 年以来，96-97%的儿童至少接受了两剂 PCV 接种。2012/13 年总体 IPD 发病率达到最大影响（-48%[95%CI：-55%；-39%]），2015/16 年反弹至-26%[95%CI：-36%；-16%]。非 PCV13 血清型在 2015/16 年占 IPD 病例的 84.1%。2014/15 年和 2015/16 年 IPD 中最常见的非 PCV 血清型为 10A、24F、15C、12F、38、22F、23B 和 15B。0-1 岁儿童的脑膜炎和非脑膜炎病例中，疫苗接种影响的最低点最高，而其他年龄组的脑膜炎病例的影响更高。反弹主要与非脑膜炎病例有关。
肺炎球菌结合疫苗的最大影响已经达到，并且出现反弹迹象。需要对儿童 IPD 进行持续监测，以评估这些趋势是否会继续。可能需要使用针对所有血清型共同抗原的疫苗。
