The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England
The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England
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DOI：
10.1016/j.jinf.2012.02.017
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发表时间：
2012-07-01
影响因子：
28.2
通讯作者：
Miller, Elizabeth
中科院分区：
文献类型：
--
作者：
van Hoek, Albert Jan;Andrews, Nick;Miller, Elizabeth
目的：评估临床危险人群中侵袭性肺炎球菌(IPD)结局的风险增加，为国家在危险人群中使用13价肺炎球菌疫苗提供决策依据。研究对象包括7价肺炎球菌结合疫苗(PCV7)后3年的数据，以调查人群保护效果。方法：在英格兰，超过22,000名IPD患者(2002年3月至2009年3月-2岁及以上)与他们的住院记录相关联。结果：高危人群中因IPD住院(OR11.72~15岁；OR7.16~；2.765+)和死亡(OR2.42~15年；OR3.16~，1.265+)的优势比(OR)增加。预测IPD的最重要的危险因素是慢性肝病、免疫抑制和慢性呼吸道疾病。在风险组和非风险组中，PCV7血清型引起的IPD所占比例的下降表明，引入7价疫苗在两组患者中的群体保护效果是相同的。结论：在具有特定临床条件的人群中，IPD的风险明显增加，提示有针对性的疫苗接种方法可能会带来好处。然而，儿童联合接种PCV疫苗的间接保护表明，一旦群体免疫生效，高危人群接种PCV疫苗可能不会提供实质性的额外好处。(C)2012年英国感染协会。爱思唯尔有限公司出版。保留所有权利。
Objective: To inform national policy making on the use of the 13-valent pneumococcal vaccine among risk groups we estimated the increased risk of invasive pneumococcal disease (IPD) outcomes among clinical risk groups. Three years of post 7-valent pneumococcal conjugate vaccine (PCV7) data was included to investigate the herd protection effects.Methods: Over 22,000 IPD patients in England (March 2002-March 2009 - aged 2 and over) were linked to their hospitalisation records. The prevalence of risk factors in these patients was compared to the prevalence of risk factors in the general population.Results: There was an increased odds ratio (OR) for hospitalisation (OR 11.7 2-15 years; 7.6 16-64; 2.7 65+) and death (OR 2.4 2-15 years, 3.9 16-64, 1.2 65+) from IPD among risk group. The most important risk factors that predict IPD are chronic liver disease, immunosuppression, and chronic respiratory diseases. Herd protection effects due to introduction of the 7-valent vaccine were identical in both patient groups as shown by the similar decline in the proportion of IPD caused by PCV7 serotypes in risk and non-risk groups.Conclusions: There is a marked increased risk of IPD among those with certain clinical conditions, suggesting potential benefit from a targeted vaccination approach. However, the indirect protection from conjugate vaccination of children suggests PCV vaccination of high-risk groups may not provide substantial additional benefit once herd immunity takes effect. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.