奥地利国家免疫计划引入 10 价肺炎球菌结合疫苗前后儿童和成人侵袭性肺炎球菌病。
Invasive pneumococcal diseases in children and adults before and after introduction of the 10-valent pneumococcal conjugate vaccine into the Austrian national immunization program.
机构信息
Department of Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, Vienna, Austria.
Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
出版信息
PLoS One. 2019 Jan 10;14(1):e0210081. doi: 10.1371/journal.pone.0210081. eCollection 2019.
BACKGROUND
In February 2012 the ten-valent pneumococcal conjugate vaccine (PCV10) with a 2+1 doses schedule (3, 5, 12 or 14 months of age) without catch-up vaccination was introduced in Austria. We assessed direct and indirect vaccine effects on invasive pneumococcal disease (IPD) by a population-based intervention study.
METHODS
The study period was divided into pre- (2009-2011) and post-period (2013-2017, February), regarding 2012 as transition year. Outcomes were defined as PCV10 ST-IPD, the PCV10-related ST 6A and 19A IPD and non-PCV10 excluding ST 6A-/19A-IPD (NVT-IPD). We used national surveillance data and compared average monthly incidence rate (IR) between pre- and post-period among <5, 5-49 and ≥50 years old. Additionally, for the 5-49 and ≥50 years old, and the 50-59 and ≥60 years old, we analyzed monthly incidence data of the pre-, post-period, and estimated trend and level changes by using a segmented time-series regression.
RESULTS
The PCV-10 IPD was reduced by 58% (95% CI: 30%; 74%) and 67% (95% CI: 32%; 84%) among <5 and ≥50 years old; the reduction in ≥60 years was 71% (95% CI: 36%; 88%). There were no significant changes in the pre-post-rate or incidence trend of NVT-IPD in the <5 and ≥50 years old. ST-specific analyses revealed no ST 6A- and ST 19A IPD decline in any age-group, and a ST 8 IPD increase among ≥50 years old (IR ratio: 3.5; 95% CI: 1.7; 7.2). We found no vaccine effects among 5-49 years old.
CONCLUSIONS
Our study adds to the evidence on direct and indirect protection of a childhood PCV10 vaccine program. Elderlies seem to benefit the most. Findings did not support PCV 10 cross-protection, but indicate replacement at least for ST 8 among the ≥50 years old. Follow-up analyses of IPD surveillance data are needed to fully characterize the magnitude of serotype replacement and further vaccine-attributable IPD reduction with time.
背景
2012 年 2 月，奥地利推出了十价肺炎球菌结合疫苗（PCV10），采用 2+1 剂免疫程序（3、5、12 或 14 个月龄），不进行补种。我们通过基于人群的干预研究评估了疫苗对侵袭性肺炎球菌病（IPD）的直接和间接影响。
方法
研究期间分为前（2009-2011 年）和后（2013-2017 年，2 月）两个阶段，2012 年为过渡期。结果定义为 PCV10 ST-IPD、PCV10 相关 ST6A 和 19A IPD 和非 PCV10 型 IPD（不包括 ST6A-/19A-IPD）。我们使用国家监测数据，比较了 5 岁以下、5-49 岁和≥50 岁人群在前后两个阶段的平均每月发病率（IR）。此外，对于 5-49 岁和≥50 岁人群，以及 50-59 岁和≥60 岁人群，我们分析了前、后两个阶段的每月发病率数据，并通过分段时间序列回归估计趋势和水平变化。
结果
PCV-10 IPD 在 5 岁以下和≥50 岁人群中的降幅分别为 58%（95%CI：30%；74%）和 67%（95%CI：32%；84%）；≥60 岁人群的降幅为 71%（95%CI：36%；88%）。在 5 岁以下和≥50 岁人群中，前后两个阶段的发病率或发病率趋势均无显著变化。特定血清型分析显示，任何年龄组的 ST6A 和 ST19A IPD 均未下降，≥50 岁人群的 ST8 IPD 增加（IR 比：3.5；95%CI：1.7；7.2）。我们在 5-49 岁人群中未发现疫苗效果。
结论
本研究进一步证明了儿童 PCV10 疫苗计划的直接和间接保护作用。老年人似乎受益最大。研究结果不支持 PCV10 的交叉保护作用，但表明≥50 岁人群中 ST8 至少存在替代作用。需要对 IPD 监测数据进行随访分析，以充分描述血清型替代的程度以及随着时间的推移进一步减少疫苗相关的 IPD。
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