Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: a longitudinal surveillance study
Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: a longitudinal surveillance study
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DOI：
10.1016/s0140-6736(18)33005-8
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发表时间：
2019-05-25
期刊：
影响因子：
168.9
通讯作者：
Scott, J. Anthony G.
中科院分区：
文献类型：
--
作者：
Hammitt, Laura L.;Etyang, Anthony O.;Scott, J. Anthony G.
背景2011年1月，肯尼亚引入了在6、10和14周龄接种的十价肺炎球菌结合疫苗（PCV 10），同时在基利菲县为5岁以下儿童开展了一项追赶运动。2011年，2-11月龄儿童至少接种两剂PCV 10的覆盖率为80%，2016年为84%; 2011年，12-59月龄儿童至少接种一剂PCV 10的覆盖率为66%，2016年为87%。我们的目的是评估PCV 10对儿童和成人鼻咽部携带和侵袭性肺炎球菌病（IPD）在Kilifi County.Methods这项研究是在KEMRI-惠康信托基金会研究计划中完成的Kilifi健康和人口监测系统，肯尼亚海岸覆盖面积891公里（2）的农村社区的居民。我们将1999年至2016年肯尼亚Kilifi县医院所有年龄段住院患者的IPD临床和微生物监测与Kilifi健康和人口监测系统联系起来。我们计算了疫苗接种前（1999年1月1日至2010年12月31日）和疫苗接种后（2012年1月1日至2016年12月31日）的发病率比（IRR），调整了混杂因素，并报告了IPD降低的百分比为1减去IRR。从2009年到2016年进行了鼻咽携带的年度横断面调查。结果监测在3 211 403人-年的观察中发现了667例IPD。2011年，在引入疫苗后，5岁以下儿童的IPD年发病率急剧下降，并保持在较低水平（PCV 10型IPD：60 .在疫苗前时代，每10万人中有8例，而在疫苗前时代，每10万人中有3例。2/100 000在疫苗后时代[调整后的IRR 0。08，95% CI 0 . 03-0 . 22];任何血清型引起的IPD：81。每10万人中有6人对15人。每10万人中有3人[ 0 . 32，0。17-0 . 60]）。在未接种疫苗的年龄组中，PCV 10型IPD在接种后时代也有所下降（< 2个月[接种后时代无病例]，5-14岁[调整后IRR 0。26，95% CI 0。11-0 . 59]，和= 15年[ 0 . 19，0。07-0 . 51]）。非PCV 10型IPD的发生率在不同时期之间没有差异。在小于5岁的儿童中，PCV 10型携带率在不同时期之间下降（年龄标准化校正患病率为0。26，95% CI 0。19-0 . 35)和非PCV 10型车厢增加（1。71，1 . 47-1 . 99).在肯尼亚引入PCV 10，伴随着追赶运动，导致没有重大替代疾病的儿童和成人中PCV 10型IPD大幅减少。虽然追赶运动可能会提前几年带来好处，但研究表明，常规的婴儿PCV 10免疫接种计划将在热带非洲的低收入环境中提供实质性的直接和间接保护。资助Gavi，疫苗联盟和英国惠康信托基金。版权所有（c）2019作者。由Elsevier Ltd.出版。这是一篇开放获取文章，使用CC BY 4.0许可证。
Background Ten-valent pneumococcal conjugate vaccine (PCV10), delivered at 6, 10, and 14 weeks of age was introduced in Kenya in January, 2011, accompanied by a catch-up campaign in Kilifi County for children aged younger than 5 years. Coverage with at least two PCV10 doses in children aged 2-11 months was 80% in 2011 and 84% in 2016; coverage with at least one dose in children aged 12-59 months was 66% in 2011 and 87% in 2016. We aimed to assess PCV10 effect against nasopharyngeal carriage and invasive pneumococcal disease (IPD) in children and adults in Kilifi County.Methods This study was done at the KEMRI-Wellcome Trust Research Programme among residents of the Kilifi Health and Demographic Surveillance System, a rural community on the Kenyan coast covering an area of 891 km(2). We linked clinical and microbiological surveillance for IPD among admissions of all ages at Kilifi County Hospital, Kenya, which serves the community, to the Kilifi Health and Demographic Surveillance System from 1999 to 2016. We calculated the incidence rate ratio (IRR) comparing the prevaccine (Jan 1, 1999-Dec 31, 2010) and postvaccine (Jan 1, 2012-Dec 31, 2016) eras, adjusted for confounding, and reported percentage reduction in IPD as 1 minus IRR. Annual cross-sectional surveys of nasopharyngeal carriage were done from 2009 to 2016.Findings Surveillance identified 667 cases of IPD in 3 211 403 person-years of observation. Yearly IPD incidence in children younger than 5 years reduced sharply in 2011 following vaccine introduction and remained low (PCV10-type IPD: 60 . 8 cases per 100 000 in the prevaccine era vs 3 . 2 per 100 000 in the postvaccine era [ adjusted IRR 0 . 08, 95% CI 0 . 03-0 . 22]; IPD caused by any serotype: 81 . 6 per 100 000 vs 15 . 3 per 100 000 [ 0 . 32, 0 . 17-0 . 60]). PCV10-type IPD also declined in the post-vaccination era in unvaccinated age groups (< 2 months [ no cases in the postvaccine era], 5-14 years [ adjusted IRR 0 . 26, 95% CI 0 . 11-0 . 59], and = 15 years [ 0 . 19, 0 . 07-0 . 51]). Incidence of non-PCV10-type IPD did not differ between eras. In children younger than 5 years, PCV10-type carriage declined between eras (age-standardised adjusted prevalence ratio 0 . 26, 95% CI 0 . 19-0 . 35) and non-PCV10-type carriage increased (1 . 71, 1 . 47-1 . 99).Interpretation Introduction of PCV10 in Kenya, accompanied by a catch-up campaign, resulted in a substantial reduction in PCV10-type IPD in children and adults without significant replacement disease. Although the catch-up campaign is likely to have brought forward the benefits by several years, the study suggests that routine infant PCV10 immunisation programmes will provide substantial direct and indirect protection in low-income settings in tropical Africa. Funding Gavi, The Vaccine Alliance and The Wellcome Trust of Great Britain. Copyright (c) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.