Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Vaccine. 2019 May 9;37(21):2797-2804. doi: 10.1016/j.vaccine.2019.04.017. Epub 2019 Apr 17.
While herd effects and serotype replacement by childhood pneumococcal protein conjugated vaccines (PCVs) continues to accumulate worldwide, direct effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumococcal diseases in the elderly has been challenged. We estimated the direct effectiveness of PPV23 in the elderly population.
For a hospital-based case-control study, cases of invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) (adults ≥ 65 years) were identified in 14 hospitals participated in the pneumococcal surveillance program from March 2013 to October 2015, following implementation of PPV23 national immunization program (NIP) for the elderly in the Republic of Korea. Controls matched by age, sex, and hospital were selected at ratios of 1:2 (IPD) or 1:1 (NBPP). Clinical data and vaccination records were collected. Vaccine effectiveness was calculated as (1-adjusted odds ratio) × 100.
We enrolled 148 IPD and 557 NBPP cases, and 295 IPD and 557 NBPP controls for analyses. Overall effectiveness of PPV23 against IPD was 28.5% [95% confidence interval (CI) -5.8%-51.6%] and against NBPP was 10.2% (-15.1-30.6) in all patients ≥ 65 years. However, in subgroup analysis of patients aged 65-74 years, PPV23 was protective against IPD [effectiveness 57.4% (19.4-77.5)] and against NBPP [effectiveness 35.0% (2.3-56.7)]. Furthermore, serotype-specific effectiveness of PPV23 against IPD was 90.6% (27.6-98.8) for PPV23-unique serotypes and 81.3% (38.6-94.3) for PPV23 serotypes excluding serotype 3.
This study indicates that PPV23 with broad serotype coverage might be beneficial in preventing IPD and NBPP due to non-PCV13 serotypes in the young-elderly, with potentially increasing effectiveness in the setting of childhood PCV NIP.
虽然人群效应和儿童肺炎球菌结合疫苗（PCV）血清型替代现象在全球范围内仍在持续，但 23 价肺炎球菌多糖疫苗（PPV23）对老年人肺炎球菌病的直接效果一直受到挑战。我们评估了老年人中 PPV23 的直接效果。
对于一项基于医院的病例对照研究，我们在韩国实施了老年人 PPV23 国家免疫计划（NIP）之后，于 2013 年 3 月至 2015 年 10 月在 14 家参与肺炎球菌监测计划的医院中确定了侵袭性肺炎球菌病（IPD）和非菌血症性肺炎球菌肺炎（NBPP）（年龄≥65 岁）病例。按年龄、性别和医院以 1:2（IPD）或 1:1（NBPP）的比例匹配对照。收集临床数据和疫苗接种记录。疫苗效力计算为（1-调整后比值比）×100。
我们共纳入了 148 例 IPD 和 557 例 NBPP 病例，以及 295 例 IPD 和 557 例 NBPP 对照进行分析。所有年龄≥65 岁的患者中，PPV23 对 IPD 的总体效力为 28.5%（95%置信区间[CI]：-5.8%至 51.6%），对 NBPP 的效力为 10.2%（-15.1%至 30.6%）。然而，在 65-74 岁患者的亚组分析中，PPV23 对 IPD 有保护作用[效力为 57.4%（19.4%至 77.5%）]和对 NBPP[效力为 35.0%（2.3%至 56.7%）]。此外，PPV23 对 IPD 的血清型特异性效力为 90.6%（27.6%至 98.8%）针对 PPV23 独特血清型，81.3%（38.6%至 94.3%）针对 PPV23 血清型（不包括血清型 3）。
本研究表明，由于年轻老年人中存在非 PCV13 血清型，具有广泛血清型覆盖范围的 PPV23 可能有益于预防 IPD 和 NBPP，并且在儿童 PCV NIP 环境中可能会增加效果。
