2007 - 2022年加拿大安大略省引入13价肺炎球菌结合疫苗后的侵袭性肺炎球菌疾病流行病学及血清型替代情况
Invasive Pneumococcal Disease Epidemiology and Serotype Replacement After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Ontario, Canada, 2007-2022.
作者信息
Grewal Ramandip, Hillier Kelty, Deeks Shelley L, Yeung Allison H, Wilson Sarah E, Wijayasri Shinthuja, Harris Tara M, Buchan Sarah A
机构信息
Health Protection, Public Health Ontario, Toronto, Ontario, Canada.
Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada.
出版信息
Open Forum Infect Dis. 2024 May 15;11(6):ofae275. doi: 10.1093/ofid/ofae275. eCollection 2024 Jun.
BACKGROUND
New vaccine products were recently authorized for protection against invasive pneumococcal disease (IPD) in Canada. Our aim was to determine age- and serotype-specific trends in IPD incidence and severity in Canada's largest province, Ontario.
METHODS
We included all confirmed IPD cases reported in Ontario and defined the pre-pneumococcal 13-valent conjugate vaccine (PCV13) era (01/2007 to 12/2010), post-PCV13 era (01/2011 to 12/2019), and coronavirus disease 2019 (COVID-19) pandemic era (01/2020 to 12/2022). We estimated incidence, hospitalization, and case fatality rate (CFR) by age. We grouped IPD cases by vaccine-specific serotypes (PCV13; PCV15-non-PCV13; PCV20-non-PCV13; PCV20-non-PCV15; polysaccharide 23-valent vaccine-non-PCV20; and non-vaccine-preventable [NVP]). We then compared incidence rates by age and serotype group in the pre- and post-PCV13 eras by calculating rate ratios (RRs) and their 95% CIs.
RESULTS
Incidence and hospitalizations declined from the pre- to post-PCV13 era in children aged <5 years (RR, 0.7; 95% CI, 0.6-0.8; and RR, 0.8; 95% CI, 0.7-0.9, respectively), but the CFR increased (1.4% to 2.3%). Other age groups saw smaller declines or more stable incidence rates across the years; hospitalizations increased in adults aged 50-64 years (RR, 1.2; 95% CI, 1.1-1.4) and ≥65 years (RR, 1.1; 95% CI, 1.0-1.1). For all ages, IPD cases and hospitalizations attributable to PCV13 serotypes declined, and those attributable to PCV15-non-PCV13, PCV20-non-PCV13, and NVP serotypes increased. IPD incidence declined during the COVID-19 era.
CONCLUSIONS
IPD incidence and hospitalizations due to PCV13 serotypes decreased after PCV13 introduction but increased for other serotypes. Continued surveillance is required to evaluate changes to pneumococcal vaccination programs and ongoing changes to the distribution of IPD-causing serotypes.
背景
加拿大最近批准了新的疫苗产品用于预防侵袭性肺炎球菌病（IPD）。我们的目的是确定加拿大最大的省份安大略省IPD发病率和严重程度的年龄及血清型特异性趋势。
方法
我们纳入了安大略省报告的所有确诊IPD病例，并定义了13价肺炎球菌结合疫苗（PCV13）引入前时代（2007年1月至2010年12月）、PCV13引入后时代（2011年1月至2019年12月）以及2019冠状病毒病（COVID-19）大流行时代（2020年1月至2022年12月）。我们按年龄估计发病率、住院率和病死率（CFR）。我们将IPD病例按疫苗特异性血清型分组（PCV13；PCV15 - 非PCV13；PCV20 - 非PCV13；PCV20 - 非PCV15；23价多糖疫苗 - 非PCV20；以及非疫苗可预防[NVP]）。然后，我们通过计算率比（RRs）及其95%置信区间（CIs），比较PCV13引入前后年龄和血清型组的发病率。
结果
在<5岁儿童中，从PCV13引入前到引入后时代，发病率和住院率下降（RR分别为0.7；95%CI为0.6 - 0.8；以及RR为0.8；95%CI为0.7 - 0.9），但病死率增加（从1.4%增至2.3%）。其他年龄组在这些年中下降幅度较小或发病率更稳定；50 - 64岁成年人（RR为1.2；95%CI为1.1 - 1.4）和≥65岁成年人（RR为1.1；95%CI为1.0 - 1.1）的住院率增加。对于所有年龄，归因于PCV13血清型的IPD病例和住院率下降，而归因于PCV15 - 非PCV13、PCV20 - 非PCV13和NVP血清型的病例和住院率增加。在COVID - 19时代，IPD发病率下降。
结论
引入PCV13后，PCV13血清型导致的IPD发病率和住院率下降，但其他血清型的发病率增加。需要持续监测以评估肺炎球菌疫苗接种计划的变化以及引起IPD的血清型分布的持续变化。
Zotero 插件