10价和13价肺炎球菌结合疫苗对各年龄段肺炎球菌性脑膜炎的全球影响：PSERENADE项目
Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: The PSERENADE project.
作者信息
Yang Yangyupei, Knoll Maria Deloria, Herbert Carly, Bennett Julia C, Feikin Daniel R, Garcia Quesada Maria, Hetrich Marissa K, Zeger Scott L, Kagucia Eunice W, Xiao Melody, Cohen Adam L, van der Linden Mark, du Plessis Mignon, Yildirim Inci, Winje Brita A, Varon Emmanuelle, Valenzuela Maria Teresa, Valentiner-Branth Palle, Steens Anneke, Scott J Anthony, Savrasova Larisa, Sanz Juan Carlos, Khan Aalisha Sahu, Oishi Kazunori, Nzoyikorera Néhémie, Nuorti J Pekka, Mereckiene Jolita, McMahon Kimberley, McGeer Allison, Mackenzie Grant A, MacDonald Laura, Ladhani Shamez N, Kristinsson Karl G, Kleynhans Jackie, Kellner James D, Jayasinghe Sanjay, Ho Pak-Leung, Hilty Markus, Hammitt Laura L, Guevara Marcela, Gilkison Charlotte, Gierke Ryan, Desmet Stefanie, De Wals Philippe, Dagan Ron, Colzani Edoardo, Ciruela Pilar, Chuluunbat Urtnasan, Chan Guanhao, Camilli Romina, Bruce Michael G, Brandileone Maria-Cristina C, Ampofo Krow, O'Brien Katherine L, Hayford Kyla
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
UMass Chan Medical School, Worcester, MA 01655, United States.
出版信息
J Infect. 2025 Mar;90(3):106426. doi: 10.1016/j.jinf.2025.106426. Epub 2025 Jan 27.
BACKGROUND
Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.
METHODS
The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally. Site-specific meningitis incidence rate ratios (IRRs) comparing pre-PCV incidence to each year post-PCV10/13 were estimated by age (<5, 5-17 and ≥18 years) using Bayesian multi-level mixed effects Poisson regression, accounting for pre-PCV trends. All-site weighted average IRRs were estimated using linear mixed-effects regression stratified by age, product (PCV10 or PCV13) and prior PCV7 impact (none, moderate, or substantial). Changes in pneumococcal meningitis incidence were estimated overall and for product-specific vaccine-types and non-PCV13-types.
RESULTS
Analyses included 10,168 cases <5 y from PCV13 sites and 2849 from PCV10 sites, 3711 and 1549 for 5-17 y and 29,187 and 5653 for ≥18 y from 42 surveillance sites (30 PCV13, 12 PCV10, 2 PCV10/13) in 30 countries, primarily high-income (84%). Six years after PCV10/PCV13 introduction, pneumococcal meningitis declined 48-74% across products and PCV7 impact strata for children <5 y, 35-62% for 5-17 y and 0-36% for ≥18 y. Impact against PCV10-types at PCV10 sites, and PCV13-types at PCV13 sites was high for all age groups (<5 y: 96-100%; 5-17 y: 77-85%; ≥18 y: 73-85%). After switching from PCV7 to PCV10/13, increases in non-PCV13-types were generally low to none for all age groups.
CONCLUSION
Pneumococcal meningitis declined in all age groups following PCV10/PCV13 introduction. Plateaus in non-PCV13-type meningitis suggest less replacement than for all IPD. Data from meningitis belt and high-burden settings were limited.
背景
国家儿童免疫规划中引入的肺炎球菌结合疫苗（PCV）降低了疫苗型侵袭性肺炎球菌疾病（IPD），但在PCV10/13的随访期间，非疫苗型疾病持续存在。我们评估了PCV10/13对全球肺炎球菌脑膜炎发病率的影响。
方法
从全球监测点获取脑脊液中检测到的肺炎球菌血清型病例数和人口分母数据。使用贝叶斯多级混合效应泊松回归，按年龄（<5岁、5 - 17岁和≥18岁）估计特定地点的脑膜炎发病率比值（IRR），比较PCV接种前的发病率与PCV10/13接种后每年的发病率，并考虑PCV接种前的趋势。使用按年龄、产品（PCV10或PCV13）和先前PCV7影响（无、中等或显著）分层的线性混合效应回归估计所有地点的加权平均IRR。总体以及特定产品疫苗型和非PCV13型的肺炎球菌脑膜炎发病率变化进行了估计。
结果
分析纳入了来自PCV13监测点的10168例<5岁病例、来自PCV10监测点的2849例，42个监测点（30个PCV13、12个PCV10、2个PCV10/13）中5 - 17岁的3711例和1549例，以及≥18岁的29187例和5653例，这些监测点主要位于高收入国家（84%）。PCV10/PCV13引入6年后，<5岁儿童中肺炎球菌脑膜炎在各产品和PCV7影响分层中下降了48 - 74%，5 - 17岁儿童下降了35 - 62%，≥18岁儿童下降了0 - 36%。在PCV10监测点对PCV10型、在PCV13监测点对PCV13型的影响在所有年龄组中都很高（<5岁：96 - 100%；5 - 17岁：77 - 85%；≥18岁：7
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