Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: a population-based surveillance study
Effect of the introduction of pneumococcal conjugate vaccination on invasive pneumococcal disease in The Gambia: a population-based surveillance study
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DOI：
10.1016/s1473-3099(16)00054-2
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发表时间：
2016-06-01
影响因子：
56.3
通讯作者：
Corrah, Tumani
中科院分区：
文献类型：
--
作者：
Mackenzie, Grant A.;Hill, Philip C.;Corrah, Tumani
背景：关于肺炎球菌结合疫苗（PCV）在低收入国家的效果的信息很少。我们测量了这些疫苗对冈比亚侵袭性肺炎球菌疾病的影响，2009年8月引入了7价疫苗（PCV 7），5月引入了13价疫苗（PCV 13），2011.方法我们对Basse健康和人口监测系统（BHDSS）在冈比亚上游地区，使用标准化标准来识别和调查患者。2008年5月至2014年12月期间进行了监测。我们比较了基线（2008年5月12日至2010年5月11日）和PCV 13（2013年1月1日至2014年12月31日）引入后的侵袭性肺炎球菌疾病的发病率，调整了随时间推移的病例确定的变化结果我们调查了14650例患者，其中我们确定了320例侵袭性肺炎球菌疾病。与基线相比，在引入PCV计划后，2-23个月年龄组中侵袭性肺炎球菌疾病的发病率下降了55%（95%CI 30-71），从每10万人253例降至113例。这一下降是由于PCV 13疫苗覆盖的血清型减少了82%（95% CI 64-91）。在2-4岁年龄组中，侵袭性肺炎球菌疾病的发病率下降了56%（95% CI 25-75），从113例/100 000降至49例/100 000，PCV 13血清型减少了68%（95% CI 39-83）。2-59月龄儿童中非PCV 13血清型的发病率增加了47%（-21至275），从每10万人28例增加到41例，血清型范围广泛。非肺炎球菌菌血症的发病率随时间变化不大。解释冈比亚的PCV计划使2-59个月儿童的侵袭性肺炎球菌病发病率降低了约55%。需要进一步监测，以确定疫苗在2-4岁及以上年龄组中的最大效果，并监测血清型更换。引入PCV 13的低收入和中等收入国家预计侵袭性肺炎球菌疾病将大幅减少。
Background Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011.Methods We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008 May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013 Dec 31, 2014), adjusting for changes in case ascertainment over time.Findings We investigated 14650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30-71) in the 2-23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64-91) reduction in serotypes covered by the PCV13 vaccine. In the 2-4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25-75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39-83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2-59 months increased by 47% (-21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time.Interpretation The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2-59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2-4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease.