高价型肺炎球菌疫苗血清型导致的门诊就诊和抗生素使用。

Outpatient Visits and Antibiotic Use Due to Higher-Valency Pneumococcal Vaccine Serotypes.

机构信息

School of Public Health, University of California, Berkeley, California, USA.

Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

J Infect Dis. 2024 Oct 16;230(4):821-831. doi: 10.1093/infdis/jiae142.

DOI:10.1093/infdis/jiae142

PMID:38498565

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11481348/

Abstract

BACKGROUND

In 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in US children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts.

METHODS

We estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national health care surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses.

RESULTS

Per 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval, 1.8-3.9) visits and 2.4 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 1.5%-3.0%) of pediatric outpatient antibiotic use.

CONCLUSIONS

Compared with PCV15-additional serotypes, PCV20-additional serotypes account for > 5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.

摘要

背景

2022-2023 年，推荐为婴儿接种 15 价和 20 价肺炎球菌结合疫苗（PCV15/PCV20）。我们旨在估计美国儿童（≤17 岁）在 2016-2019 年期间与 PCV15-和 PCV20-附加（非 PCV13）血清型相关的门诊就诊和抗生素处方的发生率，以量化 PCV15/20 的潜在影响。

方法

我们估计了 PCV15/20 附加血清型相关就诊和抗生素处方的发生率，方法是将源自国家卫生保健调查和 MarketScan 数据库的全因发生率与 PCV15/20 附加血清型相关比例相乘。我们使用改良疫苗探测方法估计了特定血清型的归因比例，该方法结合了 PCV13 后的发病率变化和 PCV13 与 PCV15/20 血清型频率的比值，这些比值是通过荟萃分析估计的。

结果

每年每 1000 名儿童中，PCV15 附加血清型导致估计有 2.7（95%置信区间，1.8-3.9）次就诊和 2.4（95%置信区间，1.6-3.4）次抗生素处方。PCV20 附加血清型导致每年每 1000 名儿童中出现 15.0（95%置信区间，11.2-20.4）次就诊和 13.2（95%置信区间，9.9-18.0）次抗生素处方。PCV15/20 附加血清型占儿科门诊抗生素使用的 0.4%（95%置信区间，0.2%-0.6%）和 2.1%（95%置信区间，1.5%-3.0%）。