Regional variations in serotype distribution and vaccination status in children under six years of age with invasive pneumococcal disease in Germany
Regional variations in serotype distribution and vaccination status in children under six years of age with invasive pneumococcal disease in Germany
复制标题
DOI：
10.1371/journal.pone.0210278
复制
发表时间：
2019-01-09
期刊：
影响因子：
3.7
通讯作者：
van der Linden, Mark
中科院分区：
文献类型：
--
作者：
Perniciaro, Stephanie;Imoehl, Matthias;van der Linden, Mark
概述婴儿肺炎球菌结合疫苗（PCV）的保护作用可以在德国作为一个整体，并在较小的区域组中看到。德国人口标准化地理区域之间的比较显示，在项目实施后，血清型分布不同，特别是在非疫苗血清型中。前东德和前西德联邦各州之间儿童血清型分布的明显差异已经消失。6岁以下儿童仍然是一个脆弱的群体，但在正确接种PCV 13疫苗（使用三剂初级系列加一剂加强剂）的儿童中，疫苗型（VT）侵袭性肺炎球菌疾病（IPD）的发生率较低（374例中有9例，2.4%）。然而，在德国，只有18.4%的IPD儿童按照推荐的时间表正确接种了PCV 13疫苗。持续的监测和更好的时间表依从性对于确定最有效的PCV接种时间表至关重要。接种效果对于德国使用的所有PCV产品（PCV 7、PCV 10和PCV 13），疫苗接种状态是特定血清型感染的最常见统计学显著性预测因子：在PCV 7组中，年龄足以接受至少一剂疫苗的未接种儿童的几率显著较高（OR：6.84，95% CI：2.66-22.06，根据人均收入和居住地在东北部联邦州进行调整）。在PCV 10组中，VT IPD的OR为4.52（95% CI：1.60-15.62，经感染年份、家庭规模中位数和居住在南部联邦州调整），在未接种疫苗的儿童中，PCV 13组中，未接种疫苗的儿童继续具有较高的几率（OR：6.21，95% CI：3.45-11.36，经感染年份、儿童年龄、人均收入、居住在南部联邦州和使用公共日托的儿童百分比调整）。未接种疫苗是每个分析组中疫苗型血清型感染最常见的重要指标，而地理分组在预测德国儿童早期IPD感染血清型方面的潜力更有限。
OverviewThe protective effect of infant pneumococcal conjugate vaccine (PCV) recommendation can be seen in Germany as a whole and in smaller regional groups. Comparisons between population-normalized geographic regions of Germany show different serotype distributions after program implementation, particularly in non-vaccine serotypes. The prior distinct differences in serotype distribution in children between the former East and former West German federal states have vanished. Children under six remain a vulnerable group, but the occurrence of vaccine-type (VT) invasive pneumococcal disease (IPD) in children correctly vaccinated (using a three-dose primary series plus one booster dose) with PCV13 was low (9 out of 374 cases, 2.4%). However, only 18.4% of children in Germany with IPD were correctly vaccinated with PCV13 according to the recommended schedule. Continued surveillance and better schedule adherence are essential to definitively establish the most effective PCV administration schedule.Vaccination effectsFor all PCV products used in Germany (PCV7, PCV10, and PCV13), vaccination status was the most common statistically significant predictor of infection with a particular serotype: Unvaccinated children old enough to have received at least one dose of vaccine in the PCV7 group had significantly higher odds (OR: 6.84, 95% CI: 2.66-22.06, adjusted for per capita income and residence in the northeastern federal states) of contracting VT IPD. In the PCV10 group, VT IPD had an OR of 4.52 (95% CI: 1.60-15.62, adjusted for year of infection, median household size, and residence in the southern federal states) in unvaccinated children, and in the PCV13 group, unvaccinated children continued to have higher odds (OR: 6.21, 95% CI: 3.45-11.36, adjusted for year of infection, age of child, per capita income, residence in the southern federal states, and percentage of children using public daycare) of getting vaccine-type IPD. Being unvaccinated was the most frequent significant indicator for infection with vaccine-type serotypes for each analysis group, while geographic groupings showed more limited potential to predict serotype of infection in early childhood IPD in Germany.