Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review.
Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review.
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DOI：
10.1371/journal.pone.0166736
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Toscano CM
中科院分区：
文献类型：
--
作者：
de Oliveira LH;Camacho LA;Coutinho ES;Martinez-Silveira MS;Carvalho AF;Ruiz-Matus C;Toscano CM
几个拉丁美洲和加勒比国家已在其常规国家免疫规划中引入肺炎球菌结合疫苗（PCV-10或PCV-13）。我们的目的是总结PCV对LAC地区5岁以下儿童的影响和有效性的证据。我们对PCV对侵袭性肺炎球菌病（IPD）、肺炎、脑膜炎和败血症所致死亡或住院的影响或有效性的文献进行了系统综述。我们检索了2009年至2016年1月以任何语言发表的Medline、WoS、Lilacs、Scopus、Central和灰色文献。我们纳入了针对目标年龄组儿童关注结果的研究，并采用以下设计：随机试验，队列或病例对照，干预前后至少有三个数据点的中断时间序列，以及前后研究。根据PROSPERO上注册的研究方案，由独立审查员进行引文筛选、数据提取和偏倚风险评估，一式两份。进行有效性测量的描述性分析和敏感性分析。有效性报告为病例对照或队列/临床试验的1-OR或1-RR，以及研究前后疾病发生率的百分比变化。我们确定了1，085篇引文，892篇来自数据库，193篇来自其他来源。其中，22个进行了进一步分析。研究来自巴西、智利、乌拉圭、阿根廷、秘鲁和尼加拉瓜。X线确诊肺炎住院治疗的有效性范围为8.8-37.8%，临床肺炎为7.4-20.6%，脑膜炎住院治疗为13.3-87.7%，IPD住院治疗为56-83.3%，不同年龄，结局定义，疫苗类型和研究设计。迄今为止的现有证据表明PCV-10和PCV-13对研究结果有显著影响，没有证据表明一种疫苗在减少5岁以下儿童肺炎、IPD或脑膜炎住院率方面优于另一种疫苗。
Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs. We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region. We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies. We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design. Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.