MMWR Morb Mortal Wkly Rep. 2019 Nov 22;68(46):1069-1075. doi: 10.15585/mmwr.mm6846a5.
Two pneumococcal vaccines are currently licensed for use in adults in the United States: a 13-valent pneumococcal conjugate vaccine (PCV13 [Prevnar 13, Pfizer, Inc.]) and a 23-valent pneumococcal polysaccharide vaccine (PPSV23 [Pneumovax 23, Merck and Co., Inc.]). In 2014, the Advisory Committee on Immunization Practices (ACIP)* recommended routine use of PCV13 in series with PPSV23 for all adults aged ≥65 years based on demonstrated PCV13 safety and efficacy against PCV13-type pneumonia among adults aged ≥65 years (1). At that time, ACIP recognized that there would be a need to reevaluate this recommendation because it was anticipated that PCV13 use in children would continue to reduce disease burden among adults through reduced carriage and transmission of vaccine serotypes from vaccinated children (i.e., PCV13 indirect effects). On June 26, 2019, after having reviewed the evidence accrued during the preceding 3 years (https://www.cdc.gov/vaccines/acip/recs/grade/PCV13.html), ACIP voted to remove the recommendation for routine PCV13 use among adults aged ≥65 years and to recommend administration of PCV13 based on shared clinical decision-making for adults aged ≥65 years who do not have an immunocompromising condition, cerebrospinal fluid (CSF) leak, or cochlear implant, and who have not previously received PCV13. ACIP recognized that some adults aged ≥65 years are potentially at increased risk for exposure to PCV13 serotypes, such as persons residing in nursing homes or other long-term care facilities and persons residing in settings with low pediatric PCV13 uptake or traveling to settings with no pediatric PCV13 program, and might attain higher than average benefit from PCV13 vaccination. When patients and vaccine providers engage in shared clinical decision-making for PCV13 use to determine whether PCV13 is right for a particular person, considerations might include both the person's risk for exposure to PCV13 serotypes and their risk for developing pneumococcal disease as a result of underlying medical conditions. All adults aged ≥65 years should continue to receive 1 dose of PPSV23. If the decision is made to administer PCV13, it should be given at least 1 year before PPSV23. ACIP continues to recommend PCV13 in series with PPSV23 for adults aged ≥19 years with an immunocompromising condition, CSF leak, or cochlear implant (2).
两种肺炎球菌疫苗目前已获得美国许可，可用于成人：一种是 13 价肺炎球菌结合疫苗（PCV13 [沛儿 13，辉瑞公司]），另一种是 23 价肺炎球菌多糖疫苗（PPSV23 [纽莫法 23，默克公司]）。2014 年，免疫实践咨询委员会（ACIP）*建议所有≥65 岁的老年人连续接种 PCV13 和 PPSV23，依据是≥65 岁老年人中 PCV13 对 PCV13 型肺炎的安全性和有效性（1）。当时，ACIP 认识到需要重新评估这一建议，因为预计儿童中 PCV13 的使用将通过减少疫苗血清型从接种儿童的传播和携带来继续减轻成年人的疾病负担（即 PCV13 的间接效应）。2019 年 6 月 26 日，在回顾了过去 3 年中积累的证据（https://www.cdc.gov/vaccines/acip/recs/grade/PCV13.html）之后，ACIP 投票决定取消≥65 岁成年人常规使用 PCV13 的建议，并建议对没有免疫功能低下、脑脊液（CSF）漏或人工耳蜗植入且既往未接种过 PCV13 的≥65 岁成年人基于共同的临床决策来使用 PCV13。ACIP 认识到，一些≥65 岁的成年人可能面临更大的感染 PCV13 血清型的风险，例如居住在养老院或其他长期护理机构的人，以及居住在小儿 PCV13 接种率低或前往没有小儿 PCV13 计划的地区的人，他们可能从 PCV13 接种中获得更高的平均获益。当患者和疫苗提供者在是否接种 PCV13 方面进行共同的临床决策时，要确定 PCV13 是否适合特定人群，考虑因素可能包括该人群感染 PCV13 血清型的风险以及其因基础疾病而感染肺炎球菌病的风险。所有≥65 岁的成年人应继续接种 1 剂 PPSV23。如果决定接种 PCV13，则应在接种 PPSV23 之前至少 1 年接种。ACIP 继续建议对免疫功能低下、CSF 漏或人工耳蜗植入的≥19 岁成年人同时接种 PCV13 和 PPSV23（2）。
