Prompt effect of replacing the 7-valent pneumococcal conjugate vaccine with the 13-valent vaccine on the epidemiology of invasive pneumococcal disease in Norway
Prompt effect of replacing the 7-valent pneumococcal conjugate vaccine with the 13-valent vaccine on the epidemiology of invasive pneumococcal disease in Norway
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DOI：
10.1016/j.vaccine.2013.10.032
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发表时间：
2013-12-16
期刊：
影响因子：
5.5
通讯作者：
Vestrheim, Didrik F.
中科院分区：
文献类型：
--
作者：
Steens, Anneke;Bergsaker, Marianne A. Riise;Vestrheim, Didrik F.
2006年，挪威在儿童免疫规划中引入了7价肺炎球菌结合疫苗（PCV7），大大降低了所有年龄组疫苗型（VT）侵袭性肺炎球菌病（IPD）的发病率。此外，观察到非疫苗（NVT）血清型IPD发生率（血清型替代）略有增加。在2011年用PCV13取代PCV7后，IPD发病率有望进一步下降。然而，六种额外血清型的保护为定植开辟了新的鼻咽生态位，这有利于血清型替代的条件。因此，密切监测IPD仍然很重要，以便迅速发现变化。在这项以人群为基础的观察性回顾性队列研究中，我们使用2004年1月1日至2012年12月31日期间全国通报的数据来确定VT-和NVT-IPD的发病率。使用Simpson多样性指数分析了每年血清型分布的多样性。从挪威疫苗接种登记处获得幼儿的免疫史，以确定疫苗接种失败。自引入PCV7以来，VT-IPD的发生率在目标年龄组（= 5）中下降，并在PCV13替代后进一步下降。仅发现了两例疫苗接种失败病例。这表明PCV7或PCV13的2 + 1疫苗接种计划非常有效，并表明未接种疫苗的个人可通过间接保护获益。PCV7-IPD在非目标年龄组的发病率下降幅度在随后几年变得更大，表明间接作用处于滞后阶段，并提示PCV13的间接保护将在未来几年增加。一些NVT的发生率，特别是血清型23B和15A，在引入PCV13后增加。这与目标年龄组的辛普森多样性指数的增加相吻合。由于这表明再次发生血清型替代，因此继续监测IPD非常重要，以便能够及时发布适应疫苗建议的疫苗。(C) 2013 Elsevier Ltd.版权所有。
The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the childhood immunisation programme in Norway in 2006 substantially decreased the incidence of vaccine-type (VT) invasive pneumococcal disease (IPD) in all age groups. Additionally, a slight increase in the non-vaccine (NVT) serotype IPD incidence (serotype replacement) was observed. After replacing PCV7 with PCV13 in 2011, a further decrease in IPD incidence is expected. However, the protection by the six additional serotypes opens new nasopharyngeal niches for colonisation, which favours conditions for serotype replacement. Close monitoring of IPD therefore remains important in order to quickly detect changes.In this observational retrospective population-based cohort study we used data notified nationally between 1 January 2004 and 31 December 2012 to determine the VT- and NVT-IPD incidences. The diversity in serotype distribution per year was analysed using the Simpson's index of diversity. Immunisation history of young children was obtained from the Norwegian Vaccination Registry to determine vaccine failure.The incidence of VT-IPD decreased in the targeted (= 5) age groups since PCV7 introduction and further decreased after the replacement with PCV13. Only two cases of vaccine failure were identified. This indicates very high effectiveness of the 2 + 1 schedules with PCV7 or PCV13 and suggests that non-vaccinated individuals profit through indirect protection. The decrease in incidence of PCV7-IPD in non-targeted age groups became larger in later years, indicating a lag phase for the indirect effects, and suggests that the indirect protection of PCV13 will increase in coming years. The incidence of some NVT, specifically serotypes 23B and 15A, increased after PCV13 introduction. This coincided with an increased Simpson's index of diversity in the targeted age group. As this suggests that serotype replacement is again occurring, continues monitoring of IPD is important so that adaptations to vaccine recommendations can be promptly issued. (C) 2013 Elsevier Ltd. All rights reserved.