Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: A case-control test-negative design study.
Effectiveness of the 23-valent pneumococcal polysaccharide vaccine against vaccine serotype pneumococcal pneumonia in adults: A case-control test-negative design study.
复制标题
DOI：
10.1371/journal.pmed.1003326
复制
发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Lim WS
中科院分区：
文献类型：
--
作者：
Lawrence H;Pick H;Baskaran V;Daniel P;Rodrigo C;Ashton D;Edwards-Pritchard RC;Sheppard C;Eletu SD;Litt D;Fry NK;Rose S;Trotter C;McKeever TM;Lim WS
23价肺炎球菌多糖疫苗（PPV23）在英国可用于65岁或以上的成年人和确定的临床危险群体。我们在一组因社区获得性肺炎（CAP）住院的成人队列中评估了PPV23对疫苗型肺炎球菌肺炎的疫苗有效性（VE）。采用病例对照阴性试验设计，对2013年9月至2018年8月在英国诺丁汉两所大学教学医院住院的成人（年龄≥16岁）CAP患者进行前瞻性队列研究的数据进行了二次分析。感兴趣的暴露是在指数入院前的任何时间点接种PPV23疫苗。1例被定义为PPV23血清型特异性肺炎球菌肺炎，对照组被定义为非PPV23血清型肺炎球菌肺炎或非肺炎球菌肺炎。使用多重免疫测定法从尿液样本或阳性血培养中确定肺炎球菌血清型。采用多变量logistic回归推导出接种疫苗和未接种疫苗个体之间病例状态的调整几率；VE估计值计算为（1−优势比）× 100%。在2357例患者中，有717例PPV23病例（接种了48%）和1640例对照（接种了54.5%）。PPV23血清型疾病的校正VE （aVE）估计值为24% （95% CI 5%-40%, p = 0.02）。在疫苗合格患者（n = 1,768, aVE 23%, 95% CI 1%-40%）和≥65岁患者（n = 1,407, aVE 20%, 95% CI - 5% - 40%）的分析中，估计相似，但≥75岁患者（n = 905, aVE 5%, 95% CI - 37% - 35%）的分析中，估计相似。与PPV23/非13价肺炎球菌结合疫苗（PCV13）血清型肺炎（n = 417例，接种疫苗的43.7%）相关的aVE估计为29% （95% CI 6%-46%）。本研究的主要局限性在于，由于疫苗接种率高，没有能力拒绝疫苗无效的原假设，而且该研究的规模不够大，无法在老年群体中进行稳健的亚组分析。在已建立的国家儿童PCV13疫苗接种规划的背景下，临床高危患者群体和年龄≥65岁的成年人接种PPV23疫苗可提供中等程度的长期保护，防止因PPV23血清型肺炎住院。这些发现表明，PPV23疫苗接种可能继续在成人肺炎球菌疫苗政策中发挥重要作用，包括老年人再次接种疫苗的可能性。Hannah Lawrence及其同事在建立儿童肺炎球菌疫苗计划的背景下评估PPV23在成人中的长期疫苗有效性。肺炎链球菌是引起社区获得性肺炎（CAP）的最常见细菌，在全世界有90多种不同的血清型。针对23种常见血清型的23价肺炎球菌多糖疫苗（PPV23）被推荐用于不同国家的成人，以预防肺炎球菌感染。在已建立的儿童肺炎球菌疫苗规划的背景下，PPV23对成人疫苗血清型肺炎球菌CAP的长期疫苗有效性（VE）尚不清楚。我们回顾性分析了来自英格兰诺丁汉的一组因CAP住院的成年人的数据，他们进行了诊断性血液或尿液检查，以确定(i)他们是否患有肺炎球菌疾病，（ii）如果患有肺炎球菌疾病，是否属于PPV23疫苗覆盖的血清型。我们通过计算接种疫苗和未接种疫苗的个体感染疫苗型肺炎球菌肺炎（病例）和其他原因肺炎（对照组）的几率来计算本队列中PPV23的VE。在我们的2357例患者（717例PPV23病例，1640例对照）中，平均接种时间为10年，我们估计PPV23对PPV23血清型肺炎的VE在调整患者因素后为24% （95% CI 5%-40%, p = 0.02）。PPV23疫苗接种可提供中等程度的长期保护，防止因PPV23血清型肺炎住院。PPV23疫苗接种可能继续在国家肺炎球菌免疫政策中发挥重要作用，包括老年人再次接种疫苗的可能性。
Vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is available in the United Kingdom to adults aged 65 years or older and those in defined clinical risk groups. We evaluated the vaccine effectiveness (VE) of PPV23 against vaccine-type pneumococcal pneumonia in a cohort of adults hospitalised with community-acquired pneumonia (CAP). Using a case-control test-negative design, a secondary analysis of data was conducted from a prospective cohort study of adults (aged ≥16 years) with CAP hospitalised at 2 university teaching hospitals in Nottingham, England, from September 2013 to August 2018. The exposure of interest was PPV23 vaccination at any time point prior to the index admission. A case was defined as PPV23 serotype-specific pneumococcal pneumonia and a control as non-PPV23 serotype pneumococcal pneumonia or nonpneumococcal pneumonia. Pneumococcal serotypes were identified from urine samples using a multiplex immunoassay or from positive blood cultures. Multivariable logistic regression was used to derive adjusted odds of case status between vaccinated and unvaccinated individuals; VE estimates were calculated as (1 − odds ratio) × 100%. Of 2,357 patients, there were 717 PPV23 cases (48% vaccinated) and 1,640 controls (54.5% vaccinated). The adjusted VE (aVE) estimate against PPV23 serotype disease was 24% (95% CI 5%–40%, p = 0.02). Estimates were similar in analyses restricted to vaccine-eligible patients (n = 1,768, aVE 23%, 95% CI 1%–40%) and patients aged ≥65 years (n = 1,407, aVE 20%, 95% CI −5% to 40%), but not in patients aged ≥75 years (n = 905, aVE 5%, 95% CI −37% to 35%). The aVE estimate in relation to PPV23/non-13-valent pneumococcal conjugate vaccine (PCV13) serotype pneumonia (n = 417 cases, 43.7% vaccinated) was 29% (95% CI 6%–46%). Key limitations of this study are that, due to high vaccination rates, there was a lack of power to reject the null hypothesis of no vaccine effect, and that the study was not large enough to allow robust subgroup analysis in the older age groups. In the setting of an established national childhood PCV13 vaccination programme, PPV23 vaccination of clinical at-risk patient groups and adults aged ≥65 years provided moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. These findings suggest that PPV23 vaccination may continue to have an important role in adult pneumococcal vaccine policy, including the possibility of revaccination of older adults. Hannah Lawrence and colleagues assess the long-term vaccine effectiveness of PPV23 in adults in the setting of an established childhood pneumococcal vaccine program. Streptococcus pneumoniae is the commonest bacterial cause of community-acquired pneumonia (CAP) worldwide with over 90 different serotypes. A 23-valent pneumococcal polysaccharide vaccine (PPV23) targeting 23 common serotypes is recommended for use in adults in various countries to protect against pneumococcal infection. The long-term vaccine effectiveness (VE) of PPV23 against vaccine serotype pneumococcal CAP in adults in the setting of an established childhood pneumococcal vaccine programme is not known. We retrospectively analysed data from a cohort of adults hospitalised with CAP in Nottingham, England, who had a diagnostic blood or urine test to determine (i) whether they had pneumococcal disease and (ii) if so, whether or not it was a serotype covered by the PPV23 vaccine. We calculated the VE of PPV23 in our cohort by calculating the odds of infection with vaccine-type pneumococcal pneumonia (cases) versus pneumonia of an alternate cause (controls) between vaccinated and unvaccinated individuals. In our group of 2,357 patients (717 PPV23 cases, 1,640 controls) with an average time of 10 years since PPV23 vaccination, we estimated the VE of PPV23 against PPV23 serotype pneumonia to be 24% after adjustment for patient factors (95% CI 5%–40%, p = 0.02). PPV23 vaccination provides moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. PPV23 vaccination may continue to have an important role in national pneumococcal immunisation policies, including the possibility of revaccination of older adults.
登录
查看更多内容
影响因子：
3.7
作者：
Said MA;Johnson HL;Nonyane BA;Deloria-Knoll M;O'Brien KL;AGEDD Adult Pneumococcal Burden Study Team;Andreo F;Beovic B;Blanco S;Boersma WG;Boulware DR;Butler JC;Carratalà J;Chang FY;Charles PG;Diaz AA;Domínguez J;Ehara N;Endeman H;Falcó V;Falguera M;Fukushima K;Garcia-Vidal C;Genne D;Guchev IA;Gutierrez F;Hernes SS;Hoepelman AI;Hohenthal U;Johansson N;Kolek V;Kozlov RS;Lauderdale TL;Mareković I;Masiá M;Matta MA;Miró Ò;Murdoch DR;Nuermberger E;Paolini R;Perelló R;Snijders D;Plečko V;Sordé R;Strålin K;van der Eerden MM;Vila-Corcoles A;Watt JP
通讯作者：
Watt JP
影响因子：
11.8
作者：
Haessler, Sarah;Lindenauer, Peter K.;Rothberg, Michael B.
通讯作者：
Rothberg, Michael B.
影响因子：
6.4
作者：
Sherwin, Robert L.;Gray, Sharon;File, Thomas M., Jr.
通讯作者：
File, Thomas M., Jr.
影响因子：
--
作者：
Eletu, Seyi D.;Sheppard, Carmen L.;Fry, Norman K.
通讯作者：
Fry, Norman K.
影响因子：
56.3
作者：
Ladhani, Shamez N.;Collins, Sarah;Ramsay, Mary E.
通讯作者：
Ramsay, Mary E.