National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.
National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
Clin Infect Dis. 2020 Jun 10;70(12):2607-2615. doi: 10.1093/cid/ciz731.
Universal pneumococcal conjugate vaccine (PCV) programs began in Indigenous Australian children in 2001 and all children in 2005, changing to 13-valent PCV (PCV13) in 2011. We used laboratory data for invasive pneumococcal disease (IPD) and coded hospitalizations for noninvasive pneumococcal community-acquired pneumonia (PnCAP) to evaluate long-term impact.
Annual incidence (per 100 000 population) was calculated for age-specific total IPD, PCV13 non-7-valent PCV (PCV7) serotypes, and PnCAP by Indigenous status. Incidence in the pre-universal PCV7 (2002-2004), early PCV7 (2005-2007), pre-PCV13 (2008 to mid-2011), and post-PCV13 (mid-2011 to 2016) periods was used to calculate incidence rate ratios (IRRs).
In the total population, all-age incidence of IPD declined from 11.8 pre-PCV7 to 7.1 post-PCV13 (IRR, 0.61 [95% confidence interval {CI}, .59-.63]) but for PnCAP declined among ages <1 year (IRR, 0.34 [95% CI, .25-.45]) and 1-4 years (IRR, 0.50 [95% CI, .43-.57]) but increased significantly among age ≥5 years (IRRs, 1.08-1.14). In Indigenous people, baseline PCV13 non-PCV7 IPD incidence was 3-fold higher, amplified by a serotype 1 epidemic in 2011. By 2015-2016, although incidence of IPD and PnCAP in children aged <5 years decreased by 38%, neither decreased in people aged ≥5 years.
Fifteen years post-PCV and 5 years post-PCV13, direct and indirect impact on IPD and PnCAP differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.Fifteen years after pneumococcal conjugate vaccine (PCV) introduction and 5 years post-PCV13, direct and indirect impact on invasive pneumococcal disease and pneumococcal community-acquired pneumonia differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.
2001 年，通用型肺炎球菌结合疫苗（PCV）项目在澳大利亚原住民儿童中开始实施，2005 年在所有儿童中开始实施，并于 2011 年改为 13 价 PCV（PCV13）。我们使用实验室检测数据评估了侵袭性肺炎球菌病（IPD）和编码的非侵袭性社区获得性肺炎（PnCAP）住院数据，以评估长期影响。
根据原住民身份，计算了特定年龄组的总 IPD、PCV13 非 7 价 PCV（PCV7）血清型和 PnCAP 的发病率（每 100000 人口）。在普及 PCV7 之前（2002-2004 年）、早期 PCV7（2005-2007 年）、普及 PCV13 之前（2008 年至 2011 年年中）和普及 PCV13 之后（2011 年年中至 2016 年），计算发病率比值比（IRR）。
在总人口中，所有年龄段的 IPD 发病率从 PCV7 普及前的 11.8 例下降到 PCV13 普及后的 7.1 例（IRR，0.61 [95%置信区间 {CI}，0.61-0.63]），但在年龄 <1 岁（IRR，0.34 [95% CI，0.25-0.45]）和 1-4 岁（IRR，0.50 [95% CI，0.43-0.57]）的儿童中，PnCAP 的发病率下降，但年龄≥5 岁的儿童中 PnCAP 的发病率显著增加（IRRs，1.08-1.14）。在原住民中，PCV13 非 PCV7 IPD 的基线发病率是三倍高，并因 2011 年的血清型 1 流行而放大。到 2015-2016 年，尽管<5 岁儿童的 IPD 和 PnCAP 发病率下降了 38%，但≥5 岁人群的发病率没有下降。
PCV 普及 15 年后和 PCV13 普及 5 年后，IPD 和 PnCAP 的直接和间接影响因年龄和原住民与非原住民人群而异，这可能对类似环境中的长期 PCV 影响产生影响。
