Weaver Rupert, Nguyen Cattram D, Chan Jocelyn, Vilivong Keoudomphone, Lai Jana Y R, Lim Ruth, Satzke Catherine, Vongsakid Malisa, Newton Paul N, Mulholland Kim, Gray Amy, Dubot-Pérès Audrey, Dance David A B, Russell Fiona M
Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
Lancet Reg Health West Pac. 2020 Sep 6;2:100014. doi: 10.1016/j.lanwpc.2020.100014. eCollection 2020 Sep.
Pneumococcal pneumonia is a leading cause of childhood mortality. Pneumococcal conjugate vaccines (PCVs) have been shown to reduce hypoxic pneumonia in children. However, there are no studies from Asia examining the effectiveness of PCVs on hypoxic pneumonia. We describe a novel approach to determine the effectiveness of the 13-valent PCV (PCV13) against hypoxia in children admitted with pneumonia in the Lao People's Democratic Republic.
A prospective hospital-based, test-negative observational study of children aged up to 59 months admitted with pneumonia to a single tertiary hospital in Vientiane was undertaken over 54 months. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. Test-negative cases and controls were children with hypoxic and non-hypoxic pneumonia, respectively. PCV13 status was determined by written record. Vaccine effectiveness was calculated using logistic regression. Propensity score and multiple imputation analyses were used to handle confounding and missing data.
There were 826 children admitted with pneumonia, 285 had hypoxic pneumonia and 377 were PCV13-vaccinated. The unadjusted, propensity-score adjusted and multiple-imputation adjusted estimates of vaccine effectiveness against hypoxic pneumonia were 23% (95% confidence interval: -9, 46%; p=0•14); 37% (6, 57%; p=0•02) and 35% (7, 55%; p=0•02) respectively.
PCV13 is effective against hypoxic pneumonia in Asia, and should be prioritised for inclusion in national immunisation programs. This single hospital-based, test-negative approach can be used to assess vaccine effectiveness in other similar settings.
Funded by the Bill & Melinda Gates Foundation.
肺炎球菌肺炎是儿童死亡的主要原因。肺炎球菌结合疫苗（PCV）已被证明可降低儿童缺氧性肺炎的发生率。然而，亚洲尚无研究探讨PCV对缺氧性肺炎的有效性。我们描述了一种新方法，以确定13价肺炎球菌结合疫苗（PCV13）对老挝人民民主共和国因肺炎入院儿童缺氧情况的有效性。
在万象的一家单一三级医院对59个月及以下因肺炎入院的儿童进行了一项为期54个月的前瞻性医院基础测试阴性观察性研究。肺炎采用2013年世界卫生组织的定义。缺氧定义为在室内空气中氧饱和度<90%或住院期间需要吸氧。测试阴性病例和对照分别为患有缺氧性肺炎和非缺氧性肺炎的儿童。PCV13接种状况通过书面记录确定。使用逻辑回归计算疫苗有效性。倾向评分和多重插补分析用于处理混杂因素和缺失数据。
共有826名儿童因肺炎入院，其中285名患有缺氧性肺炎，377名接种了PCV13。PCV13对缺氧性肺炎疫苗有效性的未调整、倾向评分调整和多重插补调整估计值分别为23%（95%置信区间：-9，46%；p = 0.14）；37%（6，57%；p = 0.02）和35%（7，55%；p = 0.02）。
PCV13对亚洲的缺氧性肺炎有效，应优先纳入国家免疫规划。这种基于单一医院的测试阴性方法可用于评估其他类似环境中的疫苗有效性。
由比尔及梅琳达·盖茨基金会资助。
