Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal.
PLoS One. 2019 Jan 16;14(1):e0209428. doi: 10.1371/journal.pone.0209428. eCollection 2019.
Pneumonia is one of the leading causes of mortality and has a high burden in morbidity. In Portugal, 7-valent pneumococcal conjugated vaccine (PCV) was used since 2001 and PCV10/13 since 2009, being the last introduced into the National Immunization Program in 2015.
We conducted an ecological study to evaluate the impact of PCV7 and PCV13 on pneumococcal pneumonia (PP) hospitalizations in adults aged 65 years or more in Portugal. National hospital discharge registry data from 1998/99 to 2015/16 were used, and PP hospitalization was defined as any hospitalization coded in primary diagnosis as 481 (ICD-9-CM) or J18 (ICD-10-CM). Poisson regression models adjusted for seasonality, influenza-like illness and allowing for overdispersion was used to estimate annual average change of PP hospitalization rate. To assess PP hospitalization trends before and after PCV7 and PCV13 introduction interrupted time series analysis was performed.
In 1998/99 PP hospitalization rate was 7.0 per 10,000 inhabitants, varying between 3.2 (females, 65-74 years) to 20.7 (males, +85 years), and annually increasing by 16% during the pre-PCV7 period. Statistically significant reduction of 14% per year in PP hospitalization rate was observed after PCV7 introduction. Between 2004/05 and 2009/10 PP hospitalization rate decreased annually by 4% and after PCV13 introduction by 11% per year. In 2015/16 we found an overall reduction of 2.9 (CI 95%: 2.7; 3.1) PP hospitalizations per 10,000 inhabitants (598 hospitalizations) attributable to PCV13, varying from 2.2 (CI 95%: 1.3; 3.1) (female, 65-74 years) to 5.6 (CI 95%: 3.8; 7.5) (female, +85 years).
Our results suggest that introduction of both PCV7 and PCV13 vaccines resulted in the reduction of PP hospitalizations rates among older adults.
肺炎是导致死亡的主要原因之一，发病率也很高。在葡萄牙，自 2001 年起使用 7 价肺炎球菌结合疫苗（PCV），自 2009 年起使用 10 价和 13 价肺炎球菌结合疫苗（PCV10/13），而最后一种疫苗于 2015 年被纳入国家免疫计划。
我们进行了一项生态学研究，以评估 7 价肺炎球菌结合疫苗（PCV7）和 10 价肺炎球菌结合疫苗（PCV10/13）对葡萄牙 65 岁及以上老年人因肺炎球菌性肺炎（PP）住院的影响。我们使用了 1998/99 年至 2015/16 年全国住院登记数据，将肺炎球菌性肺炎住院定义为主要诊断编码为 481（ICD-9-CM）或 J18（ICD-10-CM）的任何住院。我们采用泊松回归模型进行调整，模型中包括季节性、流感样疾病，并允许过度分散，以估计 PP 住院率的年平均变化。为了评估 PCV7 和 PCV13 引入前后 PP 住院趋势，我们进行了中断时间序列分析。
1998/99 年，PP 住院率为每 10000 名居民 7.0 例，范围为 3.2（女性，65-74 岁）至 20.7（男性，+85 岁），在 PCV7 引入前每年增加 16%。在 PCV7 引入后，PP 住院率每年显著下降 14%。在 2004/05 年至 2009/10 年期间，PP 住院率每年下降 4%，在 PCV13 引入后每年下降 11%。在 2015/16 年，我们发现每 10000 名居民（598 例住院）因 PCV13 而导致的 PP 住院人数总体减少 2.9（95%CI：2.7；3.1），范围为 2.2（95%CI：1.3；3.1）（女性，65-74 岁）至 5.6（95%CI：3.8；7.5）（女性，+85 岁）。
我们的研究结果表明，两种 PCV 疫苗的引入都导致了老年人因肺炎球菌性肺炎住院率的下降。
