Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China.
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
BMC Infect Dis. 2021 Jan 10;21(1):45. doi: 10.1186/s12879-020-05721-0.
The Taiwanese national 23-valent pneumococcal polysaccharide vaccine (PPV23) program in adults ≥75 years of age and the 13-valent pneumococcal conjugate vaccine (PCV13) program for children were implemented in 2008 and 2013, respectively. In this study we evaluated PPV23 vaccine effectiveness (PPV23VE) in the elderly, with regard to both direct protection from the vaccine itself and the indirect protection conferred by PCV13 immunization in children.
The incidence of invasive pneumococcal disease (IPD) in Taiwan from July 2008 to June 2016 was collected from IPD surveillance data. A comparison of IPD incidence with a nationwide vaccination registry allowed an estimation of PPV23VE by the screening and indirect cohort methods.
The incidence of IPD in adults ≥75 years of age ranged from 13.9 per 100,000 inhabitants during the period July 2008-June 2013 to 10.4 per 100,000 inhabitants between July 2013 and June 2016 (relative risk [RR]: 0.75; 95% confidence interval [95% CI]: 0.67-0.85). According to the screening method, PPV23VE against death within 30 days of IPD onset, all IPD, and PPV23-serotype IPD was 32.5% (95% CI: 17.5-44.7%), 33.9% (95% CI: 25.2-41.5%) and 43.4% (95% CI: 34.4-51.2%), respectively. PPV23VE with the indirect cohort method was 39.0% (95% CI: 15.5-55.9%) for all PPV23 serotypes and 71.5% (95% CI: 44.2-85.4%) for 11 serotypes included in PPV23 but not in PCV13. During the period July 2008-June 2012, PPV23VE against PPV23-serotype IPD was 55.1% (95% CI: 27.2-72.3%).
PPV23 is able to prevent IPD and 30-day fatality in adults 75 years of age and older due to a combination of direct effects from PPV23 and indirect effects from PCV13. It might confer higher protection against PPV23-serotype IPD before the introduction of PCV13 program in children.
2008 年和 2013 年分别在 75 岁及以上老年人中实施了 23 价肺炎球菌多糖疫苗（PPV23）计划和儿童 13 价肺炎球菌结合疫苗（PCV13）计划。本研究旨在评估老年人的 PPV23 疫苗效力（PPV23VE），同时考虑疫苗本身的直接保护作用以及儿童 PCV13 免疫的间接保护作用。
从 2008 年 7 月至 2016 年 6 月，从侵袭性肺炎球菌病（IPD）监测数据中收集了台湾的 IPD 发病率。通过比较 IPD 发病率与全国疫苗接种登记处的数据，可以通过筛选和间接队列方法估计 PPV23VE。
75 岁及以上成年人的 IPD 发病率在 2008 年 7 月至 2013 年 6 月期间为每 100,000 名居民 13.9 例，在 2013 年 7 月至 2016 年 6 月期间为每 100,000 名居民 10.4 例（相对风险 [RR]：0.75；95%置信区间 [95%CI]：0.67-0.85）。根据筛选方法，PPV23VE 对 IPD 发病后 30 天内的死亡、所有 IPD 和 PPV23 血清型 IPD 的保护率分别为 32.5%（95%CI：17.5-44.7%）、33.9%（95%CI：25.2-41.5%）和 43.4%（95%CI：34.4-51.2%）。间接队列方法的 PPV23VE 对所有 PPV23 血清型的保护率为 39.0%（95%CI：15.5-55.9%），对包括在 PPV23 但不包括在 PCV13 中的 11 种血清型的保护率为 71.5%（95%CI：44.2-85.4%）。在 2008 年 7 月至 2012 年 6 月期间，PPV23VE 对 PPV23 血清型 IPD 的保护率为 55.1%（95%CI：27.2-72.3%）。
PPV23 能够预防 75 岁及以上老年人的 IPD 和 30 天病死率，这是由于 PPV23 的直接作用和 PCV13 对儿童的间接作用的综合作用。在儿童中实施 PCV13 计划之前，它可能对 PPV23 血清型 IPD 具有更高的保护作用。
