Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States.
Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States.
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DOI：
10.1128/mbio.00309-10
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发表时间：
2011-01-25
期刊：
影响因子：
6.4
通讯作者：
Klugman KP
中科院分区：
文献类型：
--
作者：
Simonsen L;Taylor RJ;Young-Xu Y;Haber M;May L;Klugman KP
2000年在美国引入的一种七价肺炎球菌结合疫苗（PCV 7）已被证明可以通过诱导群体免疫减少接种疫苗的儿童和成人的侵袭性肺炎球菌疾病（IPD）。我们使用1996年至2006年来自10个州的卫生保健利用项目州住院患者数据库（SID）评估了婴儿免疫接种对所有年龄组肺炎球菌肺炎住院和死亡率的影响; SID包含选定州的ICD 9编码住院数据的100%样本。与1996-1997年至1998-1999年的基线相比，到2005-2006年季节，所有年龄组的IPD和肺炎球菌肺炎住院和死亡人数均大幅下降，其中47%（95%置信区间[CI]，非菌血症性肺炎球菌肺炎减少38%至54%（ICD 9编码481，无编码指示IPD），≥65岁成人降低54%（CI，53 - 56%）。为计算2000年至2006年美国婴儿PCV 7疫苗预防肺炎球菌肺炎的总负担而开发的一个模型估计，因肺炎球菌肺炎住院的人数减少了788，838人（CI，695，406至875，476）。在18岁及以上的成年人中，通过群体免疫减少了90%的模型归因的肺炎球菌肺炎住院率;在疫苗预防的肺炎球菌疾病死亡率中发现了类似的比例。在PCV引入后的第一个季节，当<5岁儿童的覆盖率存在实质性差异时，覆盖率较高的州在儿童中的流感相关肺炎住院率显着降低，这表明PCV 7的使用也减少了流感相关肺炎住院率。肺炎是世界上儿童死亡的主要原因，也是美国65岁及以上成年人死亡的主要传染性原因。婴儿肺炎球菌结合疫苗接种以前已被证明可以通过预防肺炎球菌从婴儿传播给成人（群体免疫）来减少老年人中的侵袭性肺炎球菌疾病（IPD）。我们的分析表明，接种疫苗不仅可以显著降低IPD，还可以显著降低接种疫苗的儿童和未接种疫苗的成人的肺炎球菌肺炎住院率和住院死亡率。我们估计，肺炎住院负担减少的90%发生在成年人中。此外，更快地引入婴儿肺炎球菌免疫计划的国家，流感相关肺炎住院儿童的减少幅度更大，这可能是因为疫苗可以预防流感病毒感染后经常发生的肺炎球菌肺炎。我们的研究结果表明，七价肺炎球菌结合疫苗的使用产生了更大的好处，通过群体免疫比以前被认为。
A seven-valent pneumococcal conjugate vaccine (PCV7) introduced in the United States in 2000 has been shown to reduce invasive pneumococcal disease (IPD) in both vaccinated children and adults through induction of herd immunity. We assessed the impact of infant immunization on pneumococcal pneumonia hospitalizations and mortality in all age groups using Health Care Utilization Project State Inpatient Databases (SID) for 1996 to 2006 from 10 states; SID contain 100% samples of ICD9-coded hospitalization data for the selected states. Compared to a 1996–1997 through 1998–1999 baseline, by the 2005–2006 season, both IPD and pneumococcal pneumonia hospitalizations and deaths had decreased substantially in all age groups, including a 47% (95% confidence interval [CI], 38 to 54%) reduction in nonbacteremic pneumococcal pneumonia (ICD9 code 481 with no codes indicating IPD) in infants <2 years old and a 54% reduction (CI, 53 to 56%) in adults ≥65 years of age. A model developed to calculate the total burden of pneumococcal pneumonia prevented by infant PCV7 vaccination in the United States from 2000 to 2006 estimated a reduction of 788,838 (CI, 695,406 to 875,476) hospitalizations for pneumococcal pneumonia. Ninety percent of the reduction in model-attributed pneumococcal pneumonia hospitalizations occurred through herd immunity among adults 18 years old and older; similar proportions were found in pneumococcal disease mortality prevented by the vaccine. In the first seasons after PCV introduction, when there were substantial state differences in coverage among <5-year-olds, states with greater coverage had significantly fewer influenza-associated pneumonia hospitalizations among children, suggesting that PCV7 use also reduces influenza-attributable pneumonia hospitalizations. Pneumonia is the world’s leading cause of death in children and the leading infectious cause of death among U.S. adults 65 years old and older. Pneumococcal conjugate vaccination of infants has previously been shown to reduce invasive pneumococcal disease (IPD) among seniors through prevention of pneumococcal transmission from infants to adults (herd immunity). Our analysis documents a significant vaccine-associated reduction not only in IPD but also in pneumococcal pneumonia hospitalizations and inpatient mortality rates among both vaccinated children and unvaccinated adults. We estimate that fully 90% of the reduction in the pneumonia hospitalization burden occurred among adults. Moreover, states that more rapidly introduced their infant pneumococcal immunization programs had greater reductions in influenza-associated pneumonia hospitalization of children, presumably because the vaccine acts to prevent the pneumococcal pneumonia that frequently follows influenza virus infection. Our results indicate that seven-valent pneumococcal conjugate vaccine use has yielded far greater benefits through herd immunity than have previously been recognized.