肺炎球菌结合疫苗对儿童疫苗血清型肺炎链球菌所致社区获得性肺泡性肺炎的有效性。
Effectiveness of Pneumococcal Conjugate Vaccines Against Community-acquired Alveolar Pneumonia Attributable to Vaccine-serotype Streptococcus pneumoniae Among Children.
机构信息
Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA.
Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, USA.
出版信息
Clin Infect Dis. 2021 Oct 5;73(7):e1423-e1433. doi: 10.1093/cid/ciaa1860.
INTRODUCTION
Streptococcus pneumoniae is a leading cause of pneumonia among children. However, owing to diagnostic limitations, the protection conferred by pneumococcal conjugate vaccines (PCVs) against pediatric pneumonia attributable to vaccine-serotype pneumococci remains unknown.
METHODS
We analyzed data on vaccination and nasopharyngeal pneumococcal detection among children <5 years old with community-acquired alveolar pneumonia (CAAP; "cases") and those without respiratory symptoms ("controls"), who were enrolled in population-based prospective surveillance studies in southern Israel between 2009 and 2018. We measured PCV-conferred protection against carriage of vaccine-serotype pneumococci via the relative risk of detecting these serotypes among vaccinated versus unvaccinated controls. We measured protection against progression of vaccine serotypes from carriage to CAAP via the relative association of vaccine-serotype detection in the nasopharynx with CAAP case status, among vaccinated and unvaccinated children. We measured PCV-conferred protection against CAAP attributable to vaccine-serotype pneumococci via the joint reduction in risks of carriage and disease progression.
RESULTS
Our analyses included 1032 CAAP cases and 7743 controls. At ages 12-35 months, a PCV13 schedule containing 2 primary doses and 1 booster dose provided 87.2% (95% confidence interval: 8.1-100.0%) protection against CAAP attributable to PCV13-serotype pneumococci, and 92.3% (-0.9%, 100.0%) protection against CAAP attributable to PCV7-serotype pneumococci. Protection against PCV13-serotype and PCV7-serotype CAAP was 67.0% (-424.3%, 100.0%) and 67.7% (-1962.9%, 100.0%), respectively, at ages 36-59 months. At ages 4-11 months, 2 PCV13 doses provided 98.9% (-309.8%, 100.0%) and 91.4% (-191.4%, 100.0%) against PCV13-serotype and PCV7-serotype CAAP.
CONCLUSIONS
Among children, PCV-conferred protection against CAAP attributable to vaccine-targeted pneumococcal serotypes resembles protection against vaccine-serotype invasive pneumococcal disease.
简介
肺炎链球菌是导致儿童肺炎的主要原因。然而，由于诊断上的限制，肺炎球菌结合疫苗（PCV）对疫苗血清型肺炎球菌引起的小儿肺炎的保护作用仍不清楚。
方法
我们分析了 2009 年至 2018 年期间在以色列南部进行的基于人群的前瞻性监测研究中，患有社区获得性肺泡性肺炎（CAAP；“病例”）的<5 岁儿童和无呼吸道症状的儿童（“对照”）的疫苗接种和鼻咽部肺炎球菌检测数据。我们通过比较接种疫苗和未接种疫苗的对照组中检测到这些血清型的相对风险，来衡量 PCV 对疫苗血清型肺炎球菌携带的保护作用。我们通过比较接种疫苗和未接种疫苗儿童的鼻咽部检测到疫苗血清型与 CAAP 病例状态之间的相对关联，来衡量疫苗血清型从携带到 CAAP 的进展的保护作用。我们通过联合降低疫苗血清型携带和疾病进展的风险来衡量 PCV 对疫苗血清型肺炎球菌引起的 CAAP 的保护作用。
结果
我们的分析包括 1032 例 CAAP 病例和 7743 例对照。在 12-35 月龄时，含有 2 剂基础免疫和 1 剂加强免疫的 PCV13 方案对 PCV13 血清型肺炎球菌引起的 CAAP 的保护率为 87.2%（95%置信区间：8.1-100.0%），对 PCV7 血清型肺炎球菌引起的 CAAP 的保护率为 92.3%（-0.9%，100.0%）。对 PCV13 血清型和 PCV7 血清型 CAAP 的保护率分别为 67.0%（-424.3%，100.0%）和 67.7%（-1962.9%，100.0%），年龄为 36-59 月龄。在 4-11 月龄时，2 剂 PCV13 对 PCV13 血清型和 PCV7 血清型 CAAP 的保护率分别为 98.9%（-309.8%，100.0%）和 91.4%（-191.4%，100.0%）。
结论
在儿童中，PCV 对疫苗针对的血清型肺炎球菌引起的 CAAP 的保护作用类似于对疫苗血清型侵袭性肺炎球菌病的保护作用。
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