能否利用肺炎球菌性脑膜炎监测来评估肺炎球菌结合疫苗对全人群侵袭性肺炎球菌病的影响？来自南非 2005-2016 年的一项病例研究。
Can pneumococcal meningitis surveillance be used to assess the impact of pneumococcal conjugate vaccine on total invasive pneumococcal disease? A case-study from South Africa, 2005-2016.
机构信息
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; South African Field Epidemiology Training Programme, NICD of the NHLS, Johannesburg, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Vaccine. 2019 Sep 10;37(38):5724-5730. doi: 10.1016/j.vaccine.2019.04.090. Epub 2019 May 7.
INTRODUCTION
South Africa introduced seven-valent pneumococcal conjugate vaccine (PCV7) in 2009 and PCV13 in 2011. We aimed to compare the estimated impact of PCV on pneumococcal meningitis (PM) to impact of PCV on total invasive pneumococcal disease (tIPD) based on risk reduction after PCV introduction.
METHODS
We conducted national, laboratory-based surveillance for tIPD during 2005-2016. We estimated and compared rates of PCV13 and non-PCV13 serotype disease among tIPD and PM in individuals aged <5 years and ≥5 years, and compared these rates between the 2005-2008 pre-PCV introduction period and two time points after PCV introduction, 2012 and 2016.
RESULTS
We enrolled 45,853 tIPD cases; 17,251 (38%) were PM. By 2016, IPD caused by all serotypes decreased 55% (95%CI -57% to -53%) for tIPD, and 54% for PM (95%CI -58% to -51%), 0.7% difference between estimates (p = 0.7). No significant differences were observed between PCV7-serotype disease reduction in tIPD and PM in both age groups or the additional 6 serotypes included in PCV13 in <5 year olds in 2012 and 2016. In 2012 there was a significant difference between increases in non-PCV13 serotype disease in those ≥5 years for tIPD and PM (32% greater increase in PM, p < 0.001), but this difference was absent by 2016. There was a significant difference between the estimated decrease in additional PCV13 type disease in 2016 between tIPD and PM for those aged ≥5 years (28% greater reduction in PM, p = 0.008).
CONCLUSION
PM showed similar reductions to tIPD seven years after PCV introduction in vaccine serotype disease in those <5 years, and increases in non-vaccine serotype disease in all ages.
简介
南非于 2009 年引入了 7 价肺炎球菌结合疫苗（PCV7），并于 2011 年引入了 13 价肺炎球菌结合疫苗（PCV13）。我们旨在根据 PCV 引入后风险降低的情况，比较 PCV 对肺炎球菌性脑膜炎（PM）和总侵袭性肺炎球菌病（tIPD）的估计影响。
方法
我们在 2005 年至 2016 年期间进行了全国性的实验室为基础的 tIPD 监测。我们在年龄<5 岁和≥5 岁的 tIPD 和 PM 患者中，估计和比较了 PCV13 和非 PCV13 血清型疾病的发生率，并比较了这两个时间点之间的发生率，即 PCV 引入前的 2005-2008 年和 PCV 引入后的 2012 年和 2016 年。
结果
我们纳入了 45853 例 tIPD 病例；17251 例（38%）为 PM。到 2016 年，所有血清型引起的 IPD 下降了 55%（95%CI-57%至-53%），PM 下降了 54%（95%CI-58%至-51%），估计值之间的差异为 0.7%（p=0.7）。在 2012 年和 2016 年，年龄组中<5 岁儿童中 PCV7 血清型疾病减少与 PM 之间，以及 PCV13 中包含的另外 6 种血清型之间，在 tIPD 和 PM 中均未观察到明显差异。在 2012 年，对于≥5 岁的人群，tIPD 和 PM 中非 PCV13 血清型疾病的增加之间存在显著差异（PM 增加 32%，p<0.001），但到 2016 年这一差异已不复存在。在 2016 年，对于≥5 岁的人群，tIPD 和 PM 之间估计的额外 PCV13 型疾病减少之间存在显著差异（PM 减少 28%，p=0.008）。
结论
在 PCV 引入后 7 年，在年龄<5 岁的儿童中，PM 在疫苗血清型疾病方面与 tIPD 表现出相似的减少，而在所有年龄组中，非疫苗血清型疾病增加。
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