Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Emory University and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA.
Clin Infect Dis. 2020 Jun 10;70(12):2484-2492. doi: 10.1093/cid/ciz739.
The 13-valent pneumococcal vaccine (PCV13) was introduced for US children in 2010 and for immunocompromised adults ≥19 years old in series with the 23-valent polysaccharide vaccine (PPSV23) in 2012. We evaluated PCV13 indirect effects on invasive pneumococcal disease (IPD) among adults with and without PCV13 indications.
Using Active Bacterial Core surveillance and the National Health Survey, using Active Bacterial Core surveillance and the National Health Interview Survey, we estimated and compared IPD incidence in 2013-2014 and 2007-2008, by age and serotype group (PCV13, PPSV23-unique, or nonvaccine types [NVTs]), among adults with and without PCV13 indications.
IPD incidence declined among all adults. Among adults 19-64 years, PCV13-type IPD declined 57% (95% confidence interval [CI], -68% to -43%) in adults with immunocompromising conditions (indication for PCV13 use), 57% (95% CI, -62% to -52%) in immunocompetent adults with chronic medical conditions (CMCs, indications for PPSV23 use alone), and 74% (95% CI, -78% to -70%) in adults with neither vaccine indication. Among adults aged ≥65 years, PCV13-type IPD decreased 68% (95% CI, -76% to -60%) in those with immunocompromising conditions, 68% (95% CI, -72% to -63%) in those with CMCs, and 71% (95% CI, -77% to -64%) in healthy adults. PPSV23-unique types increased in adults 19‒64 years with CMCs, and NVTs did not change among adults with or without PCV13 indications. From 2013 to 2014, non-PCV13 serotypes accounted for 80% of IPD.
IPD incidence among US adults declined after PCV13 introduction in children. Similar reductions in PCV13-type IPD in those with and without PCV13 indications suggest that observed benefits are largely due to indirect effects from pediatric PCV13 use rather than direct use among adults.
2010 年美国儿童开始接种 13 价肺炎球菌结合疫苗（PCV13），2012 年免疫功能低下成人（19 岁及以上）开始与 23 价肺炎球菌多糖疫苗（PPSV23）联合接种。我们评估了 PCV13 对有和无 PCV13 接种指征的成人侵袭性肺炎球菌病（IPD）的间接影响。
利用主动细菌核心监测和国家健康调查，我们比较了 2013-2014 年和 2007-2008 年有和无 PCV13 接种指征的成人中不同年龄和血清型组（PCV13、PPSV23 特有或非疫苗型 [NVT]）的 IPD 发病率，按年龄和血清型组（PCV13、PPSV23 特有或非疫苗型 [NVT]）进行了比较。
所有成人的 IPD 发病率均下降。在 19-64 岁的成年人中，免疫功能低下的成年人（PCV13 使用指征）的 PCV13 型 IPD 下降了 57%（95%置信区间[CI]，-68%至-43%），患有慢性医学疾病（PPSV23 单独使用指征）的免疫功能正常成年人下降了 57%（95%CI，-62%至-52%），无疫苗接种指征的成年人下降了 74%（95%CI，-78%至-70%）。在 65 岁及以上的成年人中，免疫功能低下的成年人的 PCV13 型 IPD 下降了 68%（95%CI，-76%至-60%），患有慢性医学疾病（PPSV23 单独使用指征）的成年人下降了 68%（95%CI，-72%至-63%），健康成年人下降了 71%（95%CI，-77%至-64%）。19-64 岁患有慢性医学疾病的成年人中，PPSV23 特有型 IPD 增加，而有或无 PCV13 接种指征的成年人中 NVT 没有变化。从 2013 年到 2014 年，非 PCV13 血清型占 IPD 的 80%。
PCV13 应用于儿童后，美国成年人的 IPD 发病率下降。有和无 PCV13 接种指征的人群中 PCV13 型 IPD 相似的减少表明，观察到的益处主要归因于儿童接种 PCV13 的间接影响，而不是成年人的直接接种。
