Division of Epidemiology, School of Public Health, University of California -Berkeley, Berkeley, California, USA.
Division of Infectious Diseases & Vaccinology, School of Public Health, University of California -Berkeley, California, USA.
Clin Infect Dis. 2023 Nov 11;77(9):1340-1352. doi: 10.1093/cid/ciad355.
Updated recommendations of the US Advisory Committee on Immunization Practices indicate that all adults aged ≥65 years and adults aged <65 years with comorbid conditions should receive 15- and 20-valent pneumococcal conjugate vaccines (PCV15/20). We aimed to assess the potential impact of these recommendations on the burden of lower respiratory tract infections (LRTIs) among adults.
We estimated the incidence of LRTI cases and associated hospital admissions among enrollees of Kaiser Permanente Southern California from 2016 through 2019. We used a counterfactual inference framework to estimate excess LRTI-associated risk of death up to 180 days after diagnosis. We used prior estimates of PCV13 effectiveness against LRTI to model potential direct effects of PCV15/20 by age group and risk status.
Use of PCV15 and PCV20, respectively, could prevent 89.3 (95% confidence interval, 41.3-131.8) and 108.6 (50.4-159.1) medically attended LRTI cases; 21.9 (10.1-32.0) and 26.6 (12.4-38.7) hospitalized LRTI cases; and 7.1 (3.3-10.5) and 8.7 (4.0-12.7) excess LRTI-associated deaths, each per 10 000 person-years. Among at-risk adults aged <65 years, use of PCV15 and PCV20 could prevent 85.7 (39.6-131.5) and 102.7 (47.8-156.7) medically attended LRTI cases per 10 000 person-years; 5.1 (2.4-8.6) and 6.2 (2.8-10.2) LRTI hospitalizations per 10 000 person-years, and 0.9 (0.4-1.4) and 1.1 (0.5-1.7) excess LRTI-associated deaths per 10 000 person-years.
Our findings suggest recent recommendations, including PCV15/20 within adult pneumococcal vaccine series, may substantially reduce LRTI burden.
美国免疫实践咨询委员会的最新建议表明，所有年龄≥65 岁的成年人和年龄<65 岁且患有合并症的成年人都应接种 15 价和 20 价肺炎球菌结合疫苗（PCV15/20）。我们旨在评估这些建议对成年人下呼吸道感染（LRTI）负担的潜在影响。
我们估计了 2016 年至 2019 年期间凯撒永久南加州会员的 LRTI 病例和相关住院人数。我们使用反事实推理框架估计了诊断后 180 天内与 LRTI 相关的超额死亡风险。我们使用之前对 PCV13 预防 LRTI 的有效性的估计来按年龄组和风险状况对 PCV15/20 的潜在直接影响进行建模。
使用 PCV15 和 PCV20 可分别预防 89.3（95%置信区间，41.3-131.8）和 108.6（50.4-159.1）例经医学证实的 LRTI 病例；21.9（10.1-32.0）和 26.6（12.4-38.7）例住院 LRTI 病例；以及 7.1（3.3-10.5）和 8.7（4.0-12.7）例与 LRTI 相关的超额死亡，每 10000 人年分别为一例。在<65 岁的高危成年人中，使用 PCV15 和 PCV20 可预防 85.7（39.6-131.5）和 102.7（47.8-156.7）例经医学证实的 LRTI 病例，每 10000 人年；5.1（2.4-8.6）和 6.2（2.8-10.2）例 LRTI 住院病例，每 10000 人年；以及 0.9（0.4-1.4）和 1.1（0.5-1.7）例与 LRTI 相关的超额死亡，每 10000 人年。
我们的研究结果表明，最近的建议，包括成人肺炎球菌疫苗系列中的 PCV15/20，可能会大大降低 LRTI 负担。
