Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design.
Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design.
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DOI：
10.1093/cid/ciy312
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发表时间：
2018-10-30
期刊：
影响因子：
--
通讯作者：
Jodar L
中科院分区：
文献类型：
--
作者：
McLaughlin JM;Jiang Q;Isturiz RE;Sings HL;Swerdlow DL;Gessner BD;Carrico RM;Peyrani P;Wiemken TL;Mattingly WA;Ramirez JA;Jodar L
我们的研究证明了13价肺炎球菌结合疫苗在≥65岁的成年人中引入常规免疫计划后对疫苗型社区获得性肺炎的实际直接有效性，其中许多人具有免疫功能低下和慢性疾病。继2014年9月普遍建议美国年龄≥65岁的成年人使用13价肺炎球菌结合疫苗（PCV 13）后，我们对PCV 13疫苗针对住院疫苗型社区获得性肺炎（CAP）的有效性（VE）进行了首次真实世界评估。在该人群中。采用阴性试验设计，我们从肯塔基州路易斯维尔市因CAP住院的成人人群监测研究中确定病例和对照。我们分析了2015年4月1日至2016年4月30日入组的CAP患者子集，这些患者年龄≥65岁，并同意通过健康保险记录确认其肺炎球菌疫苗接种史。病例定义为经培养或尿型特异性抗原检测确定为PCV 13血清型的住院CAP患者。其余CAP患者作为测试阴性对照。在2034例CAP住院患者中，我们在68例（3.3%）参与者（即病例）中确定了PCV 13血清型，其中6/68例（8.8%）血培养阳性。与对照组相比，免疫功能低下（29.4% vs 46.4%，P = 0.02）和超重或肥胖（41.2% vs 58.6%，P = 0.01）的可能性较小，但其他方面相似。病例接受PCV 13的可能性低于对照组（3/68 [4.4%] vs 285/1966 [14.5%];未校正VE，72.8% [95%置信区间，12.8%-91.5%]）。在调整患者特征（包括免疫功能低下状态、体重指数、流感和肺炎球菌多糖疫苗接种史）时，未观察到混杂因素（调整后的VE范围为71.1%-73.3%）。我们的研究是第一个证明PCV 13在引入国家免疫规划后对≥65岁成人疫苗型CAP的真实有效性的研究。
Our study demonstrated real-world, direct effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia following introduction into a routine immunization program among adults aged ≥65 years, many of whom had immunocompromising and chronic medical conditions. Following universal recommendation for use of 13-valent pneumococcal conjugate vaccine (PCV13) in US adults aged ≥65 years in September 2014, we conducted the first real-world evaluation of PCV13 vaccine effectiveness (VE) against hospitalized vaccine-type community-acquired pneumonia (CAP) in this population. Using a test-negative design, we identified cases and controls from a population-based surveillance study of adults in Louisville, Kentucky, who were hospitalized with CAP. We analyzed a subset of CAP patients enrolled 1 April 2015 through 30 April 2016 who were aged ≥65 years and consented to have their pneumococcal vaccination history confirmed by health insurance records. Cases were defined as hospitalized CAP patients with PCV13 serotypes identified via culture or serotype-specific urinary antigen detection assay. Remaining CAP patients served as test-negative controls. Of 2034 CAP hospitalizations, we identified PCV13 serotypes in 68 (3.3%) participants (ie, cases), of whom 6 of 68 (8.8%) had a positive blood culture. Cases were less likely to be immunocompromised (29.4% vs 46.4%, P = .02) and overweight or obese (41.2% vs 58.6%, P = .01) compared to controls, but were otherwise similar. Cases were less likely to have received PCV13 than controls (3/68 [4.4%] vs 285/1966 [14.5%]; unadjusted VE, 72.8% [95% confidence interval, 12.8%−91.5%]). No confounding was observed during adjustment for patient characteristics, including immunocompromised status, body mass index, and history of influenza and pneumococcal polysaccharide vaccination (adjusted VE range, 71.1%−73.3%). Our study is the first to demonstrate real-world effectiveness of PCV13 against vaccine-type CAP in adults aged ≥65 years following introduction into a national immunization program.
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影响因子：
--
作者：
Marston, BJ;Plouffe, JF;Breiman, RF
通讯作者：
Breiman, RF
影响因子：
3.7
作者：
Said MA;Johnson HL;Nonyane BA;Deloria-Knoll M;O'Brien KL;AGEDD Adult Pneumococcal Burden Study Team;Andreo F;Beovic B;Blanco S;Boersma WG;Boulware DR;Butler JC;Carratalà J;Chang FY;Charles PG;Diaz AA;Domínguez J;Ehara N;Endeman H;Falcó V;Falguera M;Fukushima K;Garcia-Vidal C;Genne D;Guchev IA;Gutierrez F;Hernes SS;Hoepelman AI;Hohenthal U;Johansson N;Kolek V;Kozlov RS;Lauderdale TL;Mareković I;Masiá M;Matta MA;Miró Ò;Murdoch DR;Nuermberger E;Paolini R;Perelló R;Snijders D;Plečko V;Sordé R;Strålin K;van der Eerden MM;Vila-Corcoles A;Watt JP
通讯作者：
Watt JP
影响因子：
4.2
作者：
Grijalva, Carlos G.;Wunderink, Richard G.;Self, Wesley H.
通讯作者：
Self, Wesley H.
影响因子：
7.7
作者：
Lipsitch, Marc;Jha, Ayan;Simonsen, Lone
通讯作者：
Simonsen, Lone
影响因子：
5.5
作者：
Jackson, Michael L.;Nelson, Jennifer C.
通讯作者：
Nelson, Jennifer C.