Department of Medical Microbiology, German National Reference Center for Streptococci, University Hospital (RWTH) Aachen, Germany.
Department of Medical Statistics, University Hospital (RWTH) Aachen, Germany.
PLoS One. 2019 Jan 9;14(1):e0210278. doi: 10.1371/journal.pone.0210278. eCollection 2019.
The protective effect of infant pneumococcal conjugate vaccine (PCV) recommendation can be seen in Germany as a whole and in smaller regional groups. Comparisons between population-normalized geographic regions of Germany show different serotype distributions after program implementation, particularly in non-vaccine serotypes. The prior distinct differences in serotype distribution in children between the former East and former West German federal states have vanished. Children under six remain a vulnerable group, but the occurrence of vaccine-type (VT) invasive pneumococcal disease (IPD) in children correctly vaccinated (using a three-dose primary series plus one booster dose) with PCV13 was low (9 out of 374 cases, 2.4%). However, only 18.4% of children in Germany with IPD were correctly vaccinated with PCV13 according to the recommended schedule. Continued surveillance and better schedule adherence are essential to definitively establish the most effective PCV administration schedule.
For all PCV products used in Germany (PCV7, PCV10, and PCV13), vaccination status was the most common statistically significant predictor of infection with a particular serotype: Unvaccinated children old enough to have received at least one dose of vaccine in the PCV7 group had significantly higher odds (OR: 6.84, 95%CI: 2.66-22.06, adjusted for per capita income and residence in the northeastern federal states) of contracting VT IPD. In the PCV10 group, VT IPD had an OR of 4.52 (95% CI: 1.60-15.62, adjusted for year of infection, median household size, and residence in the southern federal states) in unvaccinated children, and in the PCV13 group, unvaccinated children continued to have higher odds (OR: 6.21, 95%CI: 3.45-11.36, adjusted for year of infection, age of child, per capita income, residence in the southern federal states, and percentage of children using public daycare) of getting vaccine-type IPD. Being unvaccinated was the most frequent significant indicator for infection with vaccine-type serotypes for each analysis group, while geographic groupings showed more limited potential to predict serotype of infection in early childhood IPD in Germany.
在德国整体和较小的地区群体中，都可以看到婴儿肺炎球菌结合疫苗 (PCV) 推荐的保护作用。在实施计划后，对德国人口标准化地理区域进行比较，显示出不同的血清型分布，特别是在非疫苗血清型中。以前在前东德和前西德联邦州之间儿童的血清型分布明显不同的情况已经消失。6 岁以下儿童仍然是一个脆弱群体，但使用 PCV13 进行正确（三剂基础系列加一剂加强剂）接种的儿童中疫苗型（VT）侵袭性肺炎球菌病（IPD）的发生率较低（374 例中有 9 例，2.4%）。然而，根据推荐的时间表，德国只有 18.4%的 IPD 患儿使用 PCV13 进行了正确接种。持续监测和更好的接种计划依从性对于确定最有效的 PCV 接种方案至关重要。
对于在德国使用的所有 PCV 产品（PCV7、PCV10 和 PCV13），接种状态是感染特定血清型的最常见统计学显著预测因素：在 PCV7 组中，年龄足够大且已接受至少一剂疫苗接种的未接种儿童，感染 VT IPD 的可能性显著更高（OR：6.84，95%CI：2.66-22.06，根据人均收入和东北部联邦州的居住地进行调整）。在 PCV10 组中，未接种疫苗的儿童的 VT IPD 的 OR 为 4.52（95%CI：1.60-15.62，根据感染年份、家庭规模中位数和南部联邦州的居住地进行调整），而在 PCV13 组中，未接种疫苗的儿童的 OR 仍较高（OR：6.21，95%CI：3.45-11.36，根据感染年份、儿童年龄、人均收入、南部联邦州的居住地以及使用公共日托的儿童百分比进行调整）获得疫苗型 IPD。对于每个分析组，未接种疫苗是感染疫苗型血清型的最常见显著指标，而地理分组显示出对德国早期儿童 IPD 中感染血清型的预测能力有限。
