Boston University Schools of Medicine and Public Health, Massachusetts.
Boston Medical Center, Massachusetts.
Clin Infect Dis. 2019 May 17;68(11):1831-1838. doi: 10.1093/cid/ciy800.
Following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in the United States, epidemiology of pneumococcal disease shifted such that disease incidence in the elderly exceeded that in children. We evaluated the impact of replacing PCV7 with PCV13 on disease burden in adults and identified age/risk-specific subgroups with the highest remaining disease burden.
A retrospective design and data from two US healthcare claims repositories were used. Study population included adults aged ≥18 years and was stratified by age (18-49, 50-64, 65-74, ≥75) and risk profile (healthy, at-risk, high-risk). Rate ratios comparing invasive pneumococcal disease (IPD), all-cause hospitalized pneumonia (ACHP), and pneumococcal pneumonia requiring hospitalization among at-risk and high-risk adults vs healthy counterparts were estimated for 2007-2010 (pre-PCV13), 2011-2012 (peri-PCV13), and 2013-2015 (post-PCV13).
Across study periods, IPD and ACHP rates increased with age (2-27 times higher in persons ≥75 vs 18-49) and comorbidity (4-20 times higher in high-risk vs healthy). From pre- to post-PCV13 period, IPD rates declined 5%-48% and ACHP rates declined 4%-19% across age and risk groups (ACHP did not decline in persons ≥75). Decline in IPD and ACHP was attenuated among older adults and those with comorbidities. Accordingly, rate ratios among at-risk and high-risk persons (vs healthy counterparts) increased during the peri- and post-PCV13 periods compared with the pre-PCV13 period.
The switch to PCV13 was associated with large declines in pneumococcal disease among US adults. However, the decline was attenuated with increasing age (and, for ACHP, was absent in persons ≥75) and in those with comorbidities.
在美国引入 7 价肺炎球菌结合疫苗（PCV7）后，肺炎球菌疾病的流行病学发生了变化，导致老年人的疾病发病率超过了儿童。我们评估了用 PCV13 替代 PCV7 对成年人疾病负担的影响，并确定了剩余疾病负担最高的年龄/风险特定亚组。
采用回顾性设计和来自两个美国医疗保健索赔数据库的数据。研究人群包括年龄≥18 岁的成年人，并按年龄（18-49、50-64、65-74、≥75）和风险状况（健康、有风险、高风险）分层。在 2007-2010 年（PCV13 前）、2011-2012 年（PCV13 期间）和 2013-2015 年（PCV13 后），比较有风险和高风险成年人与健康成年人相比，侵袭性肺炎球菌病（IPD）、所有原因住院性肺炎（ACHP）和需要住院治疗的肺炎球菌肺炎的发病率比。
在整个研究期间，随着年龄的增长（≥75 岁的人群比 18-49 岁的人群高 2-27 倍）和合并症的增加（高风险人群比健康人群高 4-20 倍），IPD 和 ACHP 的发病率也随之增加。从 PCV13 前到 PCV13 后，各年龄组和风险组的 IPD 发病率下降了 5%-48%，ACHP 发病率下降了 4%-19%（≥75 岁的人群中 ACHP 发病率没有下降）。在老年患者和合并症患者中，IPD 和 ACHP 的下降幅度较小。因此，与 PCV13 前相比，在 PCV13 期间和之后，有风险和高风险人群（与健康人群相比）的发病率比增加。
在美国成年人中，改用 PCV13 与肺炎球菌疾病的大幅下降有关。然而，随着年龄的增长（对于 ACHP，≥75 岁的人群中不存在这种情况）和合并症的增加，这种下降趋势减弱了。
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