From the Clinical and Population Perinatal Health Research, Kolling Institute, Northern Sydney Local Health District, St Leonards.
The University of Sydney Northern Clinical School.
Pediatr Infect Dis J. 2019 Aug;38(8):860-865. doi: 10.1097/INF.0000000000002314.
Finnish studies have shown a significant impact of 10-valent pneumococcal conjugate vaccine (PCV10) on nonnotified clinically suspected invasive pneumococcal disease (IPD). We used a similar vaccine probe design to estimate PCV7 and PCV13 impact in Australian children.
Season and age-matched pre-PCV7 cohorts (born in 2002-2004) were compared with PCV7-early and PCV7-late, and PCV13-eligible cohorts. Using linked notification and hospitalization data, we calculated relative rate reductions (RRRs) and absolute rate reductions (ARRs) for notified IPD, and nonnotified clinically suspected IPD or unspecified sepsis (first hospitalization with an International Classification of Diseases 10th Revision-Australian Modification code: A40.3/G00.1/M00.1 or A40.9/A41.9/A49.9/G00/I30.1/M00, respectively).
Significant reductions in all outcomes were observed comparing PCV7-early and PCV7-late and PCV13-eligible to pre-PCV7 cohorts. RRRs were high for both notified and nonnotified clinically suspected IPD (range 71%-91%), but ARRs were lower for nonnotified (5-6/100,000 person-years) than for notified cases (59-70/100,000 person-years). RRRs for the combined outcome of nonnotified clinically suspected IPD or unspecified sepsis were lower at 21%-24% for PCV7-eligible cohorts and 36% for the PCV13-eligible cohort, but ARRs were considerable due to the high pre-PCV7 rates (ARR 37-31/100,000 person-years for PCV7-early and PCV7-late cohorts and 54/100,000 person-years for PCV13).
This study provides a quantitative estimate of the total burden of IPD preventable by PCV7 and PCV13 vaccination programs in Australia. ARRs (compared with prevaccination) were significant but smaller than in Finland (122/100,000 for the combined outcome) and longer-term follow-up is required to determine the additional impact of PCV13 above that seen for PCV7. Country-specific studies are needed to accurately estimate the burden of pneumococcal disease preventable by vaccination and cost-effectiveness of PCV vaccination programs.
芬兰的研究表明，10 价肺炎球菌结合疫苗（PCV10）对未报告的临床疑似侵袭性肺炎球菌病（IPD）有显著影响。我们使用类似的疫苗探针设计来估计澳大利亚儿童中 PCV7 和 PCV13 的影响。
与 PCV7-早期和 PCV7-晚期以及 PCV13 合格的队列相比，比较了季节和年龄匹配的 PCV7 前队列（出生于 2002-2004 年）。利用相关的报告和住院数据，我们计算了报告的 IPD、未报告的临床疑似 IPD 或未指定的败血症（首次住院时采用国际疾病分类第 10 次修订版-澳大利亚修改版代码：A40.3/G00.1/M00.1 或 A40.9/A41.9/A49.9/G00/I30.1/M00）的相对减少率（RRR）和绝对减少率（ARR）。
与 PCV7-早期和 PCV7-晚期以及 PCV13 合格的队列相比，所有结果均观察到显著减少。报告和未报告的临床疑似 IPD 的 RRR 均较高（范围为 71%-91%），但未报告的 ARR 较低（每 10 万人年 5-6 例），低于报告的病例（每 10 万人年 59-70 例）。对于未报告的临床疑似 IPD 或未指定的败血症的联合结果，PCV7 合格队列的 RRR 较低，为 21%-24%，而 PCV13 合格队列的 RRR 为 36%，但由于 PCV7 前的高发病率，ARR 相当可观（PCV7-早期和 PCV7-晚期队列为每 10 万人年 37-31 例，PCV13 为每 10 万人年 54 例）。
本研究提供了定量估计澳大利亚 PCV7 和 PCV13 疫苗接种计划可预防 IPD 总负担的方法。ARR（与疫苗接种前相比）虽有显著意义，但小于芬兰（联合结果为每 10 万人年 122 例），需要进行更长期的随访以确定 PCV13 在 PCV7 基础上的额外影响。需要开展国家特异性研究，以准确估计疫苗可预防的肺炎球菌病负担和 PCV 疫苗接种计划的成本效益。
