Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: a prospective national observational cohort study
Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: a prospective national observational cohort study
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DOI：
10.1016/s1473-3099(18)30052-5
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发表时间：
2018-04-01
影响因子：
56.3
通讯作者：
Ramsay, Mary E.
中科院分区：
文献类型：
--
作者：
Ladhani, Shamez N.;Collins, Sarah;Ramsay, Mary E.
背景肺炎球菌结合疫苗（PCV）已经大大降低了由疫苗血清型引起的侵袭性肺炎球菌疾病的发生率;然而，非PCV血清型引起的替代疾病仍然是一个问题。我们描述了7价和13价PCV（PCV 7和PCV 13）对England and Wales.Methods侵袭性肺炎球菌疾病的人群效应，使用2016/17年的国家侵袭性肺炎球菌疾病监测数据，我们比较了PCV 13（2008/092009/10）和PCV 7（2000/012005/06）前基线的发病率比（IRR）。我们还估计了自引入PCV以来预防的侵袭性肺炎球菌疾病病例数。结果在2016/17年度，侵袭性肺炎球菌疾病的总体发病率（每10万人9.87例; 5450例）低37%（IRR 0.63，95% CI 0.600.65）比PCV 7前的发生率（14.79/100 000; 8167例病例）低7%（0.93; 0.890.97），比PCV 13前的发生率（10.13/100 000; 5595例病例）低7%。到2016/17年度，所有年龄组的PCV 7型侵袭性肺炎球菌疾病发病率下降了97%（0.24/100 000; 0.03，0.020.04），而额外的PCV 13型侵袭性肺炎球菌疾病减少了64%（1.66/100 000; 0.36，0.320.40）自引入PCV 13以来。自引入PCV 7以来，非PCV 13血清型导致的侵袭性肺炎球菌疾病发病率翻了一番（7.97/10万; 1.97，1.862.09），自2013/14以来加速，特别是血清型8，12 F和9 N，到2016/17年，它们占侵袭性肺炎球菌疾病病例的40%以上。自2013/14年以来，5岁以下儿童的侵袭性肺炎球菌疾病发病率保持稳定，几乎所有替代疾病都发生在成人中。我们估计，自PCV 7引入以来的11年中，预防了38366例侵袭性肺炎球菌疾病病例。解释PCV 7和PCV 13在减轻英格兰和威尔士侵袭性肺炎球菌疾病负担方面发挥了重要作用;然而，一些非PCV 13血清型的快速增加正在损害该计划的益处。
Background Pneumococcal conjugate vaccines (PCVs) have substantially reduced the incidence of invasive pneumococcal disease caused by vaccine serotypes; however, replacement disease with non-PCV serotypes remains a concern. We describe the population effect of the seven-valent and 13-valent PCVs (PCV7 and PCV13) on invasive pneumococcal disease in England and Wales.Methods Using national invasive pneumococcal disease surveillance data for 2016/17, we compared incidence rate ratios (IRRs) against pre-PCV13 (2008/092009/10) and pre-PCV7 (2000/012005/06) baselines. We also estimated the number of invasive pneumococcal disease cases prevented since the introduction of PCVs.Findings In 2016/17, overall invasive pneumococcal disease incidence (9.87 cases per 100 000; 5450 cases) across all age groups was 37% lower (IRR 0.63, 95% CI 0.600.65) than pre-PCV7 incidence (14.79 per 100 000; 8167 cases) and 7% lower (0.93; 0.890.97) than pre-PCV13 incidence (10.13 per 100 000; 5595 cases). By 2016/17, PCV7-type invasive pneumococcal disease incidence across all age groups had decreased by 97% (0.24 per 100 000; 0.03, 0.020.04) compared with the pre-PCV7 period, whereas additional PCV13-type invasive pneumococcal disease decreased by 64% (1.66 per 100 000; 0.36, 0.320.40) since the introduction of PCV13. Invasive pneumococcal disease incidence due to non-PCV13 serotypes doubled (7.97 per 100 000; 1.97, 1.862.09) since the introduction of PCV7, and accelerated since 2013/14especially serotypes 8, 12F, and 9N, which were responsible for more than 40% of invasive pneumococcal disease cases by 2016/17. Invasive pneumococcal disease incidence in children younger than 5 years remained stable since 2013/14, with nearly all replacement disease occurring in adults. We estimated 38 366 invasive pneumococcal disease cases were prevented in the 11 years since the introduction of PCV7.Interpretation Both PCV7 and PCV13 have had a major effect in reducing the burden of invasive pneumococcal disease in England and Wales; however, rapid increases in some non-PCV13 serotypes are compromising the benefits of the programme.