13 价肺炎球菌结合疫苗对合并 HIV 的成人侵袭性肺炎球菌病的影响-美国，2008-2018 年。
Impact of 13-Valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease Among Adults With HIV-United States, 2008-2018.
机构信息
Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Weems Design Studio Inc, Decatur, GA.
出版信息
J Acquir Immune Defic Syndr. 2022 May 1;90(1):6-14. doi: 10.1097/QAI.0000000000002916.
BACKGROUND
People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older.
METHODS
We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs.
RESULTS
In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively.
CONCLUSIONS
Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.
背景
HIV 感染者（PWH）罹患侵袭性肺炎球菌病（IPD）的风险增加。2010 年，十三价肺炎球菌结合疫苗（PCV13）被推荐用于美国儿童，2012 年则被推荐用于 19 岁及以上的 PWH。我们评估了 PCV13 对 19 岁及以上 PWH 和非 PWH 的 IPD 人群水平的影响。
方法
我们通过主动细菌性核心监测平台确定了 2008 年至 2018 年的 IPD 病例。我们利用国家 HIV 监测系统和美国人口普查局的数据来估计 IPD 的发病率。我们衡量了 HIV 状态、年龄组和疫苗血清型组（包括最近获得许可的 15 价（PCV15）和 20 价（PCV20）PCV 中的血清型）的 IPD 发病率从 2008-2009 年到 2017-2018 年的百分比变化。
结果
在 2008-2009 年和 2017-2018 年，8.4%（552/6548）和 8.0%（416/5169）的成人 IPD 病例分别发生在 PWH 中。与非 PWH 相比，PWH 中 IPD 病例的更大比例发生在 19-64 岁的成年人中（94.7%-97.4%比 56.0%-60.1%）和非西班牙裔黑人（62.5%-73.0%比 16.7%-19.2%）。总体而言，PWH 中的 IPD 发病率和 PCV13 型 IPD 发病率分别下降了 40.3%（95%置信区间：-47.7 至-32.3）和 72.5%（95%置信区间：-78.8 至-65.6）。在 2017-2018 年，与非 PWH 相比，PWH 中的 IPD 发病率分别高 16.8 倍（总体）和 12.6 倍（PCV13 型）；PCV13、PCV15/非 PCV13 和 PCV20/非 PCV15 血清型分别占 PWH 中 IPD 的 21.5%、11.2%和 16.5%。
结论
尽管 PCV13 推出后有所减少，但 PWH 中的 IPD 发病率仍明显高于非 PWH。更高价的 PCV 为减少 PWH 中剩余的 IPD 负担提供了机会。
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