Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites
Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance Sites
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DOI：
10.1371/journal.pmed.1001517
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发表时间：
2013-09-01
期刊：
影响因子：
15.8
通讯作者：
Moore, Matthew R.
中科院分区：
文献类型：
--
作者：
Feikin, Daniel R.;Kagucia, Eunice W.;Moore, Matthew R.
工作背景：在国家免疫规划中引入7价肺炎球菌结合疫苗（PCV 7）后，疫苗血清型（VT）侵袭性肺炎球菌病（IPD）的发病率大幅下降。在一些地区，非疫苗血清型（NVT）IPD发生率增加，可能代表血清型替换。我们使用了一种标准化的方法来描述PCV 7 introduction.Methods和调查结果：32 IPD监测数据集收到后，多个站点之间的特定类型的IPD变化，我们确定了21个合格的数据库率数据>= 2年前，>= 1年后PCV 7介绍。使用PCV 7前发生率的泊松回归模型或PCV 7前发生率的平均值，通过外推法估计不存在PCV 7引入的IPD的预期年发生率。为了估计在引入PCV 7后发生率是否发生变化，我们通过将观察到的IPD率除以PCV 7后各年的预期IPD率来计算研究中心特定的比率。我们使用随机效应荟萃分析计算汇总率比（RR）。对于5岁儿童，PCV 7后第1年总体IPD下降（RR 0.55，95% CI 0.46-0.65），并在第7年保持相对稳定（RR 0.49，95% CI 0.35-0.68）。VT IPD的点估计值在第7年每年下降（RR 0？03，95% CI 0.01-0.10），而NVT IPD增加（第7年RR 2.81，95% CI 2.12-3.71）。在成人中，总体IPD也发生了下降，但与儿童相比，不同部位的IPD下降幅度更小，变化更大。在引入后第7年，观察到显著减少（18-49岁[RR 0.52，95% CI 0.29-0.91]，50-64岁[RR 0.84，95% CI 0.77-0.93]，≥ 65岁[RR 0.74，95% CI 0.58-0.95]）。儿童总体和VT IPD的一致和显著降低发生迅速，并在PCV 7引入后持续7年，支持PCV的使用。NVT IPD增加发生在大多数网站，具有可变的幅度。这些发现可能并不代表低收入国家的经验或引入较高效价PCV后的影响。随着越来越多的国家（包括低收入国家）引入PCV以及使用更高效价的PCV，需要对特定类型IPD率进行高质量、基于人群的监测，以监测疫苗的影响。
Background: Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccineserotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction.Methods and Findings: Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data >= 2 years before and >= 1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children,5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0.55, 95% CI 0.46-0.65) and remained relatively stable through year 7 (RR 0.49, 95% CI 0.35-0.68). Point estimates for VT IPD decreased annually through year 7 (RR 0? 03, 95% CI 0.01-0.10), while NVT IPD increased (year 7 RR 2.81, 95% CI 2.12-3.71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0.52, 95% CI 0.29-0.91], 50-64 year-olds [RR 0.84, 95% CI 0.77-0.93], and >= 65 year-olds [RR 0.74, 95% CI 0.58-0.95]).Conclusions: Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used.