Blyth Christopher C, Britton Kathryn J, Nguyen Cattram D, Sapura Joycelyn, Kave John, Nivio Birunu, Chan Jocelyn, Satzke Catherine, Ford Rebecca, Kirarock Wendy, Lehmann Deborah, Pomat William, Russell Fiona M
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, The University of Western Australia, Nedlands, WA, Australia.
Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia.
Lancet Reg Health West Pac. 2022 Mar 15;22:100432. doi: 10.1016/j.lanwpc.2022.100432. eCollection 2022 May.
Pneumonia is a leading cause of childhood mortality with a major contributor. Pneumococcal conjugate vaccines (PCVs) have been introduced into immunisation programs in many low- to middle-income countries (LMICs) yet there is a paucity of data evaluating the effectiveness in these settings. We assess the effectiveness of 13-valent PCV (13vPCV) against hypoxic pneumonia, hospitalisation and other clinical endpoints in children <5 years living in Eastern Highlands Province, Papua New Guinea (PNG).
Data from two consecutive prospective observational studies (2013-2019) enrolling children <60 months presenting with pneumonia were included. Hypoxic pneumonia was defined as oxygen saturations <90%. Outcomes included hospitalisation, severe clinical pneumonia and death. 13vPCV status was determined using written records. Logistic regression models were used to estimate the odds ratios of key outcomes by 13vPCV vaccination status adjusted for confounders using inverse probability of treatment weighting.
Data from 2067 children (median age; 9 months [IQR: 5-11]) were included. 739 children (36.1%) were hypoxic and 623 (30.4%) hospitalised. Twelve children (0.6% of total cohort) died in hospital. 670 children (32.7%) were fully 13vPCV-vaccinated. 13vPCV vaccination was associated with a 28.7% reduction (95% confidence interval [CI]: 9.9; 43.6%) in hypoxic pneumonia and a 57.4% reduction (38.0; 70.7%) in pneumonia hospitalisation.
13vPCV vaccination is effective against hypoxic pneumonia and pneumonia hospitalisation in PNG children. Strategies to improve access to and coverage of 13vPCV in PNG and other similar LMICs are urgently required.
Funded by Pfizer Global and the Bill & Melinda Gates Foundation.
肺炎是儿童死亡的主要原因之一，是一个主要促成因素。肺炎球菌结合疫苗（PCV）已被引入许多低收入和中等收入国家（LMICs）的免疫计划，但在这些环境中评估其有效性的数据很少。我们评估13价肺炎球菌结合疫苗（13vPCV）对巴布亚新几内亚（PNG）东部高地省5岁以下儿童低氧性肺炎、住院及其他临床终点的有效性。
纳入两项连续的前瞻性观察性研究（2013 - 2019年）的数据，研究对象为60个月以下患肺炎的儿童。低氧性肺炎定义为血氧饱和度<90%。结局包括住院、严重临床肺炎和死亡。通过书面记录确定13vPCV接种状态。使用逻辑回归模型，通过治疗权重的逆概率对混杂因素进行调整后，估计13vPCV接种状态对关键结局的比值比。
纳入了2067名儿童的数据（中位年龄；9个月[四分位间距：5 - 11]）。739名儿童（36.1%）为低氧血症，623名（30.4%）住院。12名儿童（占总队列的0.6%）在医院死亡。670名儿童（32.7%）完成了13vPCV全程接种。13vPCV接种与低氧性肺炎减少28.7%（95%置信区间[CI]：9.9；43.6%）以及肺炎住院减少57.4%（38.0；70.7%）相关。
13vPCV接种对PNG儿童的低氧性肺炎和肺炎住院有效。迫切需要采取策略，以改善PNG和其他类似低收入和中等收入国家获得13vPCV的机会及接种覆盖率。
由辉瑞全球公司和比尔及梅琳达·盖茨基金会资助。
