Pfizer Inc, Collegeville, PA, USA.
School of Medicine & Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia.
Vaccine. 2023 Aug 31;41(38):5662-5669. doi: 10.1016/j.vaccine.2023.08.001. Epub 2023 Aug 5.
Neither indirect protection through use of 13-valent and 10-valent pneumococcal conjugate vaccines (PCV13 and PCV10) in pediatric National Immunization Programs (NIPs) nor direct vaccination with the 23-valent polysaccharide vaccine have eliminated vaccine serotype invasive pneumococcal disease (IPD) in older adults. Vaccinating older adults with higher-valency PCV15 and PCV20 could address remaining IPD due to pediatric PCV serotypes plus additional IPD due to serotypes included in these vaccines.
We collected serotype-specific IPD data in older adults (≥65 years in most countries), from national or regional surveillance systems or hospital networks of 33 high-income countries. Data were from official government websites, online databases, surveillance system reports, published literature, and personal communication with in-country investigators. Average percentages of IPD serotypes were calculated.
Among 52,905 cases of IPD with a serotype identified, PCV13 serotypes accounted for 33.7% of IPD (55.8% and 30.6% for countries with PCV10 and PCV13 in the pediatric NIP), most commonly serotypes 3 (14.9%) and 19A (7.0%). PCV15 and PCV20 would cover an additional 10.4% and 32.9% of older adult IPD beyond PCV13 serotypes (PCV10 countries: 7.7% and 23.3%; PCV13 countries: 10.6% and 34.6%). The most common of these additional serotypes were 8 (9.9%), 22F (7.9%), 12F (4.6%), and 11A (3.3%). PPSV23 policies for older adults were not correlated with lower IPD percentages due to PPSV23 serotypes.
Vaccinating older adults with higher-valency PCVs, especially PCV20, could substantially reduce the remaining IPD burden in high-income countries, regardless of current PCV use in pediatric NIPs and adult PPSV23 policies.
在国家免疫计划（NIP）中使用 13 价和 10 价肺炎球菌结合疫苗（PCV13 和 PCV10）进行间接保护，或直接使用 23 价多糖疫苗对老年人进行疫苗接种，都不能消除疫苗血清型侵袭性肺炎球菌病（IPD）。对老年人使用更高价 PCV15 和 PCV20 进行疫苗接种，可以解决因小儿 PCV 血清型引起的剩余 IPD 问题，以及这些疫苗中包含的其他血清型引起的 IPD 问题。
我们从 33 个高收入国家的国家或地区监测系统或医院网络中收集了老年人（大多数国家≥65 岁）的血清型特异性 IPD 数据。数据来自官方政府网站、在线数据库、监测系统报告、已发表的文献以及与国内调查人员的个人交流。计算了 IPD 血清型的平均百分比。
在 52905 例有血清型鉴定的 IPD 病例中，PCV13 血清型占 IPD 的 33.7%（PCV10 和 PCV13 纳入国家儿科 NIP 中的比例分别为 55.8%和 30.6%），最常见的血清型为 3 型（14.9%）和 19A 型（7.0%）。PCV15 和 PCV20 将在 PCV13 血清型之外，再覆盖 10.4%和 32.9%的老年 IPD（PCV10 国家：7.7%和 23.3%；PCV13 国家：10.6%和 34.6%）。这些额外血清型中最常见的是 8 型（9.9%）、22F 型（7.9%）、12F 型（4.6%）和 11A 型（3.3%）。老年人使用 PPSV23 政策与 PPSV23 血清型导致的 IPD 百分比较低无关。
无论目前在国家免疫计划（NIP）中使用小儿 PCV 和成人 PPSV23 政策如何，对老年人使用更高价 PCV 进行疫苗接种，尤其是 PCV20，可以大大降低高收入国家的剩余 IPD 负担。
