儿童结合疫苗对老年人侵袭性肺炎球菌病的间接影响。
Indirect effects of paediatric conjugate vaccines on invasive pneumococcal disease in older adults.
机构信息
Agència de Salut Pública de Catalunya, Generalitat de Catalunya, C/Roc Boronat, 81-95, 08005 Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/Monforte de Lemos, 3-5, 28029 Madrid, Spain.
Agència de Salut Pública de Catalunya, Generalitat de Catalunya, C/Roc Boronat, 81-95, 08005 Barcelona, Spain.
出版信息
Int J Infect Dis. 2019 Sep;86:122-130. doi: 10.1016/j.ijid.2019.06.030. Epub 2019 Jul 5.
OBJECTIVES
The aim of this study was to assess the indirect effect of paediatric 13-valent pneumococcal conjugate vaccine (PCV13) vaccination on people ≥65 years of age with invasive pneumococcal disease (IPD) in Catalonia and to determine factors predictive of mortality.
METHODS
During 2014-2016, 1285 IPD cases were reported to the Public Health Agency of Catalonia. The indirect effect of paediatric PCV13 vaccination was calculated by comparing the incidence rate (IR) in 2016 (PCV13 year) with that in 2009 (pre-PCV13). Predictors of mortality were determined using multivariate logistic regression.
RESULTS
Comparing 2016 and 2009, IPD decreased by 19% (IR 40.1 and 32.5 per 100 000 person-years, respectively). PCV13 serotypes decreased by 57% (IR 23.7 and 10.1), while non-PCV13 serotypes increased by 36% (IR 16.4 and 22.4). During 2014-2016, the mortality rate was 17.5%, and mortality was associated with age ≥85 years (adjusted odds ratio (aOR) 2.91, 95% confidence interval (CI) 1.89, 4.48), meningitis (aOR 2.29, 95% CI 1.25, 4.19), non-focal bacteraemia (aOR 3.73, 95% CI 2.00, 6.94), and ≥1 high-risk condition (aOR 1.89, 95% CI 1.08, 3.32). PPV23non13 serotypes were associated with lower mortality than PCV13 serotypes (aOR 0.54, 95% CI 0.34, 0.86).
CONCLUSIONS
The incidence of IPD in people ≥65 years of age decreased after the introduction of paediatric PCV13, and this was due to a reduction in PCV13 serotypes, although an increase in non-PCV13 serotypes was observed. Mortality was associated with age, meningitis, non-focal bacteraemia, ≥1 high-risk condition, and PCV13 serotypes.
目的
本研究旨在评估儿童 13 价肺炎球菌结合疫苗（PCV13）接种对加泰罗尼亚地区≥65 岁侵袭性肺炎球菌病（IPD）患者的间接影响，并确定与死亡率相关的预测因素。
方法
在 2014 年至 2016 年期间，向加泰罗尼亚公共卫生机构报告了 1285 例 IPD 病例。通过比较 2016 年（PCV13 年）与 2009 年（PCV13 前）的发病率（IR）来计算儿童 PCV13 疫苗接种的间接影响。使用多变量逻辑回归确定死亡率的预测因素。
结果
与 2009 年相比，2016 年 IPD 下降了 19%（IR 分别为 40.1 和 32.5/100000 人年）。PCV13 血清型下降了 57%（IR 分别为 23.7 和 10.1），而非 PCV13 血清型增加了 36%（IR 分别为 16.4 和 22.4）。在 2014 年至 2016 年期间，死亡率为 17.5%，死亡率与年龄≥85 岁（调整后的优势比（aOR）为 2.91，95%置信区间（CI）为 1.89，4.48）、脑膜炎（aOR 为 2.29，95%CI 为 1.25，4.19）、非局灶性菌血症（aOR 为 3.73，95%CI 为 2.00，6.94）和≥1 种高危情况（aOR 为 1.89，95%CI 为 1.08，3.32）相关。PPV23 非 13 血清型与 PCV13 血清型相比，死亡率较低（aOR 为 0.54，95%CI 为 0.34，0.86）。
结论
儿童 PCV13 疫苗接种后，≥65 岁人群的 IPD 发病率下降，这归因于 PCV13 血清型的减少，尽管观察到非 PCV13 血清型的增加。死亡率与年龄、脑膜炎、非局灶性菌血症、≥1 种高危情况和 PCV13 血清型有关。
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