Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis.
Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis.
复制标题
DOI：
10.1186/s12916-016-0755-7
复制
发表时间：
2016-12-21
期刊：
影响因子：
9.3
通讯作者：
Watier L
中科院分区：
文献类型：
--
作者：
Alari A;Chaussade H;Domenech De Cellès M;Le Fouler L;Varon E;Opatowski L;Guillemot D;Watier L
肺炎球菌性脑膜炎（PM）是一种主要的侵袭性肺炎球菌疾病。法国已经引入了两种肺炎球菌结合疫苗（PCV）：2003年推荐使用PCV 7，2010年被PCV 13取代，后者有6种额外的血清型。本文评估了2001年至2014年引入这些疫苗对法国PM病例数和血清型分布演变的影响。2001年至2014年期间从法国22个地区的脑脊液中分离出的5166株肺炎链球菌菌株的数据来自国家肺炎球菌参考中心。不同的疫苗接种活动的效果估计使用时间序列分析，通过自回归移动平均模型与外生变量（“流感样”综合征发病率）和干预功能。干预功能使用11个虚拟变量，代表每个疫苗后流行病学时期。评估了整个人群和两个接触最多的年龄组（64岁）血清型分布的演变<5 and >。自2003年引入PCV 7以来，开始使用PCV 13后，PM病例总数首次显著下降：用途：-7.1（95% CI，-10.85至-3.35）例，在5岁以下儿童中确诊（-3.5; 95% CI，-4.81至-2.13）和> 64岁的成人（-2.0; 95% CI，-3.36至-0.57）。在2012-2014年期间，出现了不同的非疫苗血清型：整个人群和儿童中为12 F、24 F，老年人中为6C;血清型3和19 F在整个人群中持续存在。与其他欧洲国家不同，法国的PM病例总数在引入PCV 13后才下降。这表明疫苗压力本身并不能解释肺炎球菌流行病学的变化，其他因素可能也起作用。血清型分布与前疫苗时代相比发生了很大变化，与其他欧洲国家一样，但与美国大不相同。因此，一个高反应性的监测系统是必要的，不仅要监测由于疫苗压力的演变，并验证新的更高价肺炎球菌疫苗的当地血清型的适当性，而且要识别和防止由于其他内部或外部因素的意外变化。本文的在线版本（doi：10.1186/s12916-016-0755-7）包含补充材料，可供授权用户使用。
Pneumococcal meningitis (PM) is a major invasive pneumococcal disease. Two pneumococcal conjugate vaccines (PCVs) have been introduced in France: PCV7 was recommended in 2003 and replaced in 2010 by PCV13, which has six additional serotypes. The impact of introducing those vaccines on the evolution of PM case numbers and serotype distributions in France from 2001 to 2014 is assessed herein. Data on 5166 Streptococcus pneumoniae strains isolated from cerebrospinal fluid between 2001 and 2014 in the 22 regions of France were obtained from the National Reference Center for Pneumococci. The effects of the different vaccination campaigns were estimated using time series analyses through autoregressive moving-average models with exogenous variables (“flu-like” syndromes incidence) and intervention functions. Intervention functions used 11 dummy variables representing each post vaccine epidemiological period. The evolution of serotype distributions was assessed for the entire population and the two most exposed age groups (<5 and > 64 years old). For the first time since PCV7 introduction in 2003, total PM cases decreased significantly after starting PCV13 use: –7.1 (95% CI, –10.85 to –3.35) cases per month during 2013–2014, and was confirmed in children < 5 years old (–3.5; 95% CI, –4.81 to –2.13) and adults > 64 years old (–2.0; 95% CI, –3.36 to –0.57). During 2012–2014, different non-vaccine serotypes emerged: 12F, 24F in the entire population and children, 6C in the elderly; serotypes 3 and 19F persisted in the entire population. Unlike other European countries, the total PM cases in France declined only after introduction of PCV13. This suggests that vaccine pressure alone does not explain pneumococcal epidemiological changes and that other factors could play a role. Serotype distribution had changed substantially compared to the pre-vaccine era, as in other European countries, but very differently from the US. A highly reactive surveillance system is thus necessary not only to monitor evolutions due to vaccine pressure and to verify the local serotypic appropriateness of new higher-valent pneumococcal vaccines, but also to recognise and prevent unexpected changes due to other internal or external factors. The online version of this article (doi:10.1186/s12916-016-0755-7) contains supplementary material, which is available to authorized users.