Using Pneumococcal Carriage Data to Monitor Postvaccination Changes in Invasive Disease
Using Pneumococcal Carriage Data to Monitor Postvaccination Changes in Invasive Disease
复制标题
DOI：
10.1093/aje/kwt156
复制
发表时间：
2013-11-01
影响因子：
5
通讯作者：
Feikin, Daniel R.
中科院分区：
文献类型：
--
作者：
Weinberger, Daniel M.;Bruden, Dana T.;Feikin, Daniel R.
肺炎球菌结合疫苗（PCV）已在世界范围内推出。然而，很少有发展中国家拥有可用于监测疫苗影响的高质量监测系统。我们评估了鼻咽携带研究的数据是否可用于准确监测PCV后5岁以下儿童侵袭性肺炎球菌病（IPD）发病率的变化。在1991 - 2010年期间的不同日期，可从英格兰和威尔士、荷兰、纳瓦霍和白色山地阿帕奇美洲印第安人人群以及美国马萨诸塞州和阿拉斯加州获得7价PCV（PCV 7）给药前后鼻咽肺炎球菌携带和IPD的数据。我们估计了每项研究中每种血清型携带率的变化，然后计算疫苗和非疫苗血清型之间的平均变化（逆方差加权）（模型1）或使用混合效应模型单独估计每种血清型的变化，合并研究内或研究间的血清型数据（模型2和3）。然后，我们将这些值乘以PCV 7前期间各血清型引起的IPD比例，以获得PCV 7后疾病发病率的估计值。对于大多数研究，模型1准确地捕获了PCV 7引入后IPD发病率的总体变化，而更详细的模型（模型2和3）则不太准确。携带数据可用于该简单模型中，以估计PCV后IPD发病率的变化。
Pneumococcal conjugate vaccines (PCVs) have been introduced worldwide. However, few developing countries have high-quality surveillance systems available for monitoring vaccine impact. We evaluated whether data from nasopharyngeal carriage studies can be used to accurately monitor post-PCV changes in the incidence of invasive pneumococcal disease (IPD) among children under 5 years of age. For various dates during 19912010, data on nasopharyngeal pneumococcal carriage and on IPD before and after administration of 7-valent PCV (PCV7) were available from England and Wales, the Netherlands, the Navajo and White Mountain Apache American Indian populations, and the US states of Massachusetts and Alaska. We estimated the change in carriage prevalence for each serotype in each study and then either calculated the average change (inverse variance-weighted) among vaccine and nonvaccine serotypes (model 1) or used mixed-effects models to estimate the change for each serotype individually, pooling serotype data within or between studies (models 2 and 3). We then multiplied these values by the proportion of IPD caused by each serotype during the pre-PCV7 period to obtain an estimate of post-PCV7 disease incidence. Model 1 accurately captured overall changes in IPD incidence following PCV7 introduction for most studies, while the more detailed models, models 2 and 3, were less accurate. Carriage data can be used in this simple model to estimate post-PCV changes in IPD incidence.