肺炎球菌多糖疫苗的效力。对当前建议的评估。

Pneumococcal polysaccharide vaccine efficacy. An evaluation of current recommendations.

作者信息

Butler J C, Breiman R F, Campbell J F, Lipman H B, Broome C V, Facklam R R

机构信息

Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333.

出版信息

JAMA. 1993 Oct 20;270(15):1826-31.

PMID:8411526

Abstract

OBJECTIVE

To determine pneumococcal polysaccharide vaccine efficacy in selected populations at risk for serious pneumococcal infection for whom vaccination is currently recommended and to assess duration of protection after vaccination.

DESIGN

Vaccine efficacy was estimated using indirect cohort analysis to compare the proportion of pneumococcal infections caused by serotypes included in the vaccines of vaccinated and unvaccinated persons who were identified during 14 years of national surveillance.

SETTING

Hospital laboratories in the United States that submitted pneumococcal isolates to the Centers for Disease Control and Prevention between May 1978 and April 1992.

PARTICIPANTS

A total of 2837 persons older than 5 years who had pneumococcus isolated from blood or cerebrospinal fluid.

RESULTS

Overall efficacy for preventing infection caused by serotypes included in the vaccine was 57% (95% confidence interval [CI], 45% to 66%). Efficacy among persons with diabetes mellitus was 84% (95% CI, 50% to 95%); with coronary vascular disease, 73% (95% CI, 23% to 90%); with congestive heart failure, 69% (95% CI, 17% to 88%); with chronic pulmonary diseases, 65% (95% CI, 26% to 83%); and with anatomic asplenia, 77% (95% CI, 14% to 95%). Efficacy was not documented for patients with alcoholism or cirrhosis, sickle cell disease, chronic renal failure, lymphoma, leukemia, or multiple myeloma, although sample sizes were small for these groups. Efficacy for immunocompetent persons older than 65 years was 75% (95% CI, 57% to 85%). Efficacy did not decline with increasing interval after vaccination: 5 to 8 years after vaccination it was 71% (95% CI, 24% to 89%), and 9 years or more after vaccination it was 80% (95% CI, 16% to 95%).

CONCLUSIONS

Intensified efforts to improve pneumococcal vaccine coverage among certain populations for whom vaccination is currently recommended is indicated, but universal revaccination is not warranted at this time.

摘要

目的

确定肺炎球菌多糖疫苗对目前推荐接种疫苗的特定严重肺炎球菌感染高危人群的疗效，并评估接种疫苗后的保护持续时间。

设计

采用间接队列分析估计疫苗效力，比较在14年全国监测期间确定的接种疫苗者和未接种疫苗者中由疫苗中包含的血清型引起的肺炎球菌感染比例。

地点

1978年5月至1992年4月间向疾病控制和预防中心提交肺炎球菌分离株的美国医院实验室。

参与者

共有2837名5岁以上从血液或脑脊液中分离出肺炎球菌的人。

结果

预防疫苗中包含的血清型引起的感染的总体效力为57%（95%置信区间[CI]，45%至66%）。糖尿病患者中的效力为84%（95%CI，50%至95%）；冠心病患者中为73%（95%CI，23%至90%）；充血性心力衰竭患者中为69%（95%CI，17%至88%）；慢性肺部疾病患者中为65%（95%CI，26%至83%）；解剖性无脾患者中为77%（95%CI，14%至95%）。酗酒或肝硬化、镰状细胞病、慢性肾功能衰竭、淋巴瘤、白血病或多发性骨髓瘤患者的效力未得到证实，尽管这些组的样本量较小。65岁以上免疫功能正常者的效力为75%（95%CI，57%至85%）。效力不会随着接种疫苗后间隔时间的增加而下降：接种疫苗后5至8年为71%（95%CI，24%至89%），接种疫苗后9年或更长时间为80%（95%CI，16%至95%）。