英国接种 13 价肺炎球菌结合疫苗 5 年后，疫苗血清型持续循环和血清型替换。
Persistent Circulation of Vaccine Serotypes and Serotype Replacement After 5 Years of Infant Immunization With 13-Valent Pneumococcal Conjugate Vaccine in the United Kingdom.
机构信息
Oxford Vaccine Group, Department of Paediatrics, University of Oxford.
National Institute for Health Research Oxford Biomedical Research Centre, Oxford.
出版信息
J Infect Dis. 2020 Mar 28;221(8):1361-1370. doi: 10.1093/infdis/jiz178.
BACKGROUND
Following programmatic introduction of the 13-valent pneumococcal conjugate vaccine (PCV13), there is residual carriage and disease due to PCV13-covered serotypes.
METHODS
PCV13-immunized children aged 13-48 months, N = 988, were enrolled between February 2014 and August 2015 ("late PCV13"), and had nasopharyngeal pneumococcal carriage compared with 7-valent pneumococcal conjugate vaccine (PCV7) immunized children, N = 567, enrolled between November 2010 and September 2011 ("early PCV13"). Nasopharyngeal pneumococci were molecular-serotyped by microarray. Invasive pneumococcal disease (IPD) cases were identified through enhanced national surveillance.
RESULTS
Compared with PCV7-immunized children, carriage among PCV13-immunized children was significantly lower for serotypes 19A (odds ratio [OR], 0.08 [95% confidence interval {CI}, .02-.25]), 6C (OR, 0.11 [95% CI, .03-.32]), and 7F (8 vs 0 cases). IPD incidence in children <5 years was significantly lower for serotypes 1 (incidence rate ratio [IRR], 0.03 [95% CI, 0-.19]) and 7F (IRR, 0.13 [95% CI, .05-.36]) but not 19A (IRR, 0.6 [95% CI, .3-1.12]) or serotype 3 (IRR, 2.3 [95% CI, .86-6.15]) in the late PCV13 period than in the early PCV13 period. The most significant rises in IPD incidence were for serotypes 8, 12F, and 24F.
CONCLUSIONS
PCV13 has reduced serotype 19A carriage among vaccinated children. We found no impact of PCV13 on serotype 3 carriage or disease, and emergence of non-PCV13-serotype disease.
背景
在推行 13 价肺炎球菌结合疫苗（PCV13）计划后，仍有因 PCV13 涵盖的血清型而导致的带菌和疾病。
方法
2014 年 2 月至 2015 年 8 月期间，招募了 988 名 13-48 月龄的 PCV13 免疫儿童（“晚期 PCV13”），并与 2010 年 11 月至 2011 年 9 月期间招募的 7 价肺炎球菌结合疫苗（PCV7）免疫儿童（“早期 PCV13”）进行了鼻咽部肺炎球菌带菌情况的比较。通过微阵列对鼻咽部肺炎球菌进行分子血清分型。通过强化国家监测识别侵袭性肺炎球菌病（IPD）病例。
结果
与 PCV7 免疫儿童相比，PCV13 免疫儿童的血清型 19A（比值比 [OR]，0.08 [95%置信区间 {CI}，0.02-0.25]）、6C（OR，0.11 [95% CI，0.03-0.32]）和 7F（8 例与 0 例）的带菌率显著降低。5 岁以下儿童的 IPD 发病率在血清型 1（发病率比 [IRR]，0.03 [95% CI，0-0.19]）和 7F（IRR，0.13 [95% CI，0.05-0.36]）较低，但血清型 19A（IRR，0.6 [95% CI，0.3-1.12]）或血清型 3（IRR，2.3 [95% CI，0.86-6.15]）在晚期 PCV13 期间并未降低。IPD 发病率上升最显著的血清型是 8、12F 和 24F。
结论
PCV13 降低了接种儿童中血清型 19A 的带菌率。我们发现 PCV13 对血清型 3 的带菌或疾病没有影响，也没有出现非 PCV13 血清型疾病。
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