School of Public Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia.
Seqirus (Australia) Pty Ltd, Parkville, Victoria 3052, Australia.
Vaccine. 2021 Jan 22;39(4):720-728. doi: 10.1016/j.vaccine.2020.12.025. Epub 2020 Dec 29.
Australia has a universal infant pneumococcal conjugate vaccination program and until recently a universal pneumococcal polysaccharide vaccine program for non-Indigenous adults aged ≥65 years and Indigenous adults aged ≥50 years. We documented the impacts of infant and adult vaccination programs on the epidemiology of invasive pneumococcal disease (IPD) in Indigenous and non-Indigenous adults. IPD notifications from the National Notifiable Disease Surveillance System were analysed from 2002 to 2017, grouped by age, vaccine serotype group and Indigenous status. Since the universal funding of infant and elderly pneumococcal vaccination programs in January 2005, total IPD decreased by 19% in non-Indigenous adults aged ≥65 years but doubled in Indigenous adults aged ≥50 years. Vaccine uptake was suboptimal in both groups but lower in Indigenous adults. IPD due to the serotypes contained in the pneumococcal conjugate vaccines (PCV) except for serotype 3 declined markedly over the study period but were replaced by non-PCV serotypes. Serotype 3 is currently the most common in older adults. In the populations eligible for the adult 23-valent pneumococcal polysaccharide vaccine (23vPPV) program, IPD rates due to its exclusive serotypes increased to a lower extent than non-vaccine types. In 2017, non-vaccine serotypes accounted for most IPD in the older population eligible for the 23vPPV program, while it's eleven exclusive serotypes accounted for the majority of IPD in younger adults. Infant and adult pneumococcal vaccination programs in Australia have shaped the serotype-specific epidemiology of IPD in older adults. IPD remains a significant health burden for the Indigenous population. Herd immunity impact is clear for PCV serotypes excluding serotype 3 and serotype replacement is evident for non-PCV serotypes. The adult 23vPPV immunisation program appears to have partially curbed replacement with IPD due to its eleven exclusive serotypes, highlighting a potential benefit of increasing adult 23vPPV coverage in Australia.
澳大利亚实行婴儿肺炎球菌结合疫苗接种计划和非土著成年人（≥ 65 岁）和土著成年人（≥ 50 岁）肺炎球菌多糖疫苗接种计划。我们记录了婴儿和成人疫苗接种计划对土著和非土著成年人侵袭性肺炎球菌病（IPD）的流行病学的影响。从 2002 年到 2017 年，我们对国家传染病监测系统的 IPD 通知进行了分析，按年龄、疫苗血清型组和土著身份进行分组。自 2005 年 1 月婴儿和老年肺炎球菌疫苗接种计划普遍供资以来，非土著成年人（≥ 65 岁）的总 IPD 下降了 19%，但土著成年人（≥ 50 岁）的 IPD 增加了一倍。两组人群的疫苗接种率均不理想，但土著成年人的接种率更低。在研究期间，除血清型 3 以外，包含在肺炎球菌结合疫苗（PCV）中的血清型导致的 IPD 显著下降，但被非 PCV 血清型取代。目前，血清型 3 是老年人中最常见的血清型。在有资格接种成人 23 价肺炎球菌多糖疫苗（23vPPV）的人群中，由于其独特血清型导致的 IPD 发病率增加程度低于非疫苗型。2017 年，在有资格接种 23vPPV 疫苗的老年人群中，非疫苗型血清型导致的 IPD 占大多数，而其 11 个独特血清型导致的 IPD 占年轻人的大多数。澳大利亚的婴儿和成人肺炎球菌疫苗接种计划塑造了老年人中特定血清型的 IPD 流行病学。IPD 仍然是土著人群的一个重大健康负担。除血清型 3 外，PCV 血清型的群体免疫效应明显，而非 PCV 血清型的血清型替代明显。成人 23vPPV 免疫接种计划似乎部分遏制了由于其 11 个独特血清型导致的 IPD 替代，突出了增加澳大利亚成人 23vPPV 覆盖率的潜在益处。
