13价肺炎球菌结合疫苗对蒙古正规和非正规住区肺炎住院儿童肺炎球菌携带的直接和间接影响：一项观察性研究
Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study.
作者信息
Chan Jocelyn, Mungun Tuya, Batsaixan Purevsuren, Ulziibayar Mukhchuluun, Suuri Bujinlkham, Otgonbayar Dashpagam, Luvsantseren Dashtseren, Nguyen Cattram D, Narangarel Dorj, Dunne Eileen M, Fox Kimberley, Hinds Jason, Nation Monica L, Pell Casey L, Mulholland E Kim, Satzke Catherine, von Mollendorf Claire, Russell Fiona M
机构信息
Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Australia.
出版信息
Lancet Reg Health West Pac. 2021 Jul 30;15:100231. doi: 10.1016/j.lanwpc.2021.100231. eCollection 2021 Oct.
BACKGROUND
Within Ulaanbaatar, Mongolia, risk factors for pneumonia are concentrated among children living in informal settlements comprised of temporary shelters (gers). We used pneumococcal carriage surveillance among children from formal and informal settlements hospitalised with pneumonia to evaluate the direct and indirect effects of 13-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) pneumococcal carriage following a phased introduction of PCV13.
METHODS
We enrolled and collected nasopharyngeal swabs from children 2-59 months of age presenting to hospital. Pneumococci were detected using lytA qPCR and serotyped using microarray on a random monthly selection of swabs between November 2015 and March 2019 from two districts in Ulaanbaatar. PCV13 status was determined using written records. We quantified the associations between individual PCV13 status (direct effects) and district-level PCV13 coverage (indirect effects) and VT carriage using generalised estimating equations and explored interactions by settlement type.
FINDINGS
A total of 1 292 swabs from 6 046 participants were tested for pneumococci. Receipt of PCV13 and increasing PCV13 coverage independently reduced the risk of VT carriage. For each percent increase in PCV13 coverage, the adjusted odds of VT carriage decreased by 1•0% (OR 95% CI 0•983-0•996; p=0•001), with a predicted decrease in VT carriage rate from 29•1% to 13•1% as coverage reached 100%. There was a trend towards a slower decline within informal settlements (p=0•100). Adjusted PCV13 vaccine effectiveness against VT carriage was 39•1% (95% CI 11•4-58•1%, p=0•009).
INTERPRETATION
Substantial indirect effects were observed following PCV13 introduction, including among children living within informal settlements.
FUNDING
Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance.
背景
在蒙古国乌兰巴托，肺炎的危险因素集中在居住在由临时住所（蒙古包）组成的非正式定居点的儿童中。我们对因肺炎住院的来自正式和非正式定居点的儿童进行了肺炎球菌携带情况监测，以评估在分阶段引入13价肺炎球菌结合疫苗（PCV13）后，该疫苗对疫苗型（VT）肺炎球菌携带的直接和间接影响。
方法
我们招募了2至59个月大到医院就诊的儿童并收集其鼻咽拭子。在2015年11月至2019年3月期间，从乌兰巴托的两个区每月随机选取拭子，使用lytA定量聚合酶链反应（qPCR）检测肺炎球菌，并使用微阵列进行血清分型。通过书面记录确定PCV13接种情况。我们使用广义估计方程量化个体PCV13接种情况（直接影响）和地区层面PCV13覆盖率（间接影响）与VT携带之间的关联，并按定居点类型探索相互作用。
结果
共对6046名参与者的1292份拭子进行了肺炎球菌检测。接种PCV13以及PCV13覆盖率的提高独立降低了VT携带风险。PCV13覆盖率每增加1% , VT携带的校正比值比下降1.0%（比值比95%置信区间0.983 - 0.996；p = 0.001），随着覆盖率达到100%，预计VT携带率将从29.1%降至13.1%。非正式定居点内下降趋势较慢（p = 0.100）。PCV13针对VT携带的校正疫苗效力为39.1%（95%置信区间11.4 - 58.1%，p = 0.009）。
解读
引入PCV13后观察到了显著的间接影响，包括在居住于非正式定居点的儿童中。
资助
比尔及梅琳达·盖茨基金会；全球疫苗免疫联盟。
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