PDF(Pubmed)
Abstract：
Vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) is available in the United Kingdom to adults aged 65 years or older and those in defined clinical risk groups. We evaluated the vaccine effectiveness (VE) of PPV23 against vaccine-type pneumococcal pneumonia in a cohort of adults hospitalised with community-acquired pneumonia (CAP).
Using a case-control test-negative design, a secondary analysis of data was conducted from a prospective cohort study of adults (aged ≥16 years) with CAP hospitalised at 2 university teaching hospitals in Nottingham, England, from September 2013 to August 2018. The exposure of interest was PPV23 vaccination at any time point prior to the index admission. A case was defined as PPV23 serotype-specific pneumococcal pneumonia and a control as non-PPV23 serotype pneumococcal pneumonia or nonpneumococcal pneumonia. Pneumococcal serotypes were identified from urine samples using a multiplex immunoassay or from positive blood cultures. Multivariable logistic regression was used to derive adjusted odds of case status between vaccinated and unvaccinated individuals; VE estimates were calculated as (1 - odds ratio) × 100%. Of 2,357 patients, there were 717 PPV23 cases (48% vaccinated) and 1,640 controls (54.5% vaccinated). The adjusted VE (aVE) estimate against PPV23 serotype disease was 24% (95% CI 5%-40%, p = 0.02). Estimates were similar in analyses restricted to vaccine-eligible patients (n = 1,768, aVE 23%, 95% CI 1%-40%) and patients aged ≥65 years (n = 1,407, aVE 20%, 95% CI -5% to 40%), but not in patients aged ≥75 years (n = 905, aVE 5%, 95% CI -37% to 35%). The aVE estimate in relation to PPV23/non-13-valent pneumococcal conjugate vaccine (PCV13) serotype pneumonia (n = 417 cases, 43.7% vaccinated) was 29% (95% CI 6%-46%). Key limitations of this study are that, due to high vaccination rates, there was a lack of power to reject the null hypothesis of no vaccine effect, and that the study was not large enough to allow robust subgroup analysis in the older age groups.
In the setting of an established national childhood PCV13 vaccination programme, PPV23 vaccination of clinical at-risk patient groups and adults aged ≥65 years provided moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. These findings suggest that PPV23 vaccination may continue to have an important role in adult pneumococcal vaccine policy, including the possibility of revaccination of older adults.
Using a case-control test-negative design, a secondary analysis of data was conducted from a prospective cohort study of adults (aged ≥16 years) with CAP hospitalised at 2 university teaching hospitals in Nottingham, England, from September 2013 to August 2018. The exposure of interest was PPV23 vaccination at any time point prior to the index admission. A case was defined as PPV23 serotype-specific pneumococcal pneumonia and a control as non-PPV23 serotype pneumococcal pneumonia or nonpneumococcal pneumonia. Pneumococcal serotypes were identified from urine samples using a multiplex immunoassay or from positive blood cultures. Multivariable logistic regression was used to derive adjusted odds of case status between vaccinated and unvaccinated individuals; VE estimates were calculated as (1 - odds ratio) × 100%. Of 2,357 patients, there were 717 PPV23 cases (48% vaccinated) and 1,640 controls (54.5% vaccinated). The adjusted VE (aVE) estimate against PPV23 serotype disease was 24% (95% CI 5%-40%, p = 0.02). Estimates were similar in analyses restricted to vaccine-eligible patients (n = 1,768, aVE 23%, 95% CI 1%-40%) and patients aged ≥65 years (n = 1,407, aVE 20%, 95% CI -5% to 40%), but not in patients aged ≥75 years (n = 905, aVE 5%, 95% CI -37% to 35%). The aVE estimate in relation to PPV23/non-13-valent pneumococcal conjugate vaccine (PCV13) serotype pneumonia (n = 417 cases, 43.7% vaccinated) was 29% (95% CI 6%-46%). Key limitations of this study are that, due to high vaccination rates, there was a lack of power to reject the null hypothesis of no vaccine effect, and that the study was not large enough to allow robust subgroup analysis in the older age groups.
In the setting of an established national childhood PCV13 vaccination programme, PPV23 vaccination of clinical at-risk patient groups and adults aged ≥65 years provided moderate long-term protection against hospitalisation with PPV23 serotype pneumonia. These findings suggest that PPV23 vaccination may continue to have an important role in adult pneumococcal vaccine policy, including the possibility of revaccination of older adults.
摘要：
23价肺炎球菌多糖疫苗（PPV23）的疫苗接种在英国适用于65岁或以上的成年人以及定义的临床风险人群。我们在一组住院社区获得性肺炎（CAP）的成年人中评估了PPV23对疫苗型肺炎球菌肺炎的疫苗有效性（VE）。
使用病例对照测试阴性设计，对在诺丁汉的2所大学教学医院住院CAP的成年人（年龄≥16岁）的前瞻性队列研究进行了二次数据分析，英格兰,2013年9月至2018年8月。感兴趣的暴露是在索引入院之前的任何时间点的PPV23疫苗接种。1例被定义为PPV23血清型特异性肺炎球菌肺炎，对照组被定义为非PPV23血清型肺炎球菌肺炎或非肺炎球菌肺炎。使用多重免疫测定法从尿液样品或从阳性血液培养物中鉴定肺炎球菌血清型。多变量逻辑回归用于得出接种疫苗和未接种疫苗的个体之间的病例状态的调整后的几率;VE估计值计算为(1-比值比)×100%。在2357名患者中，有717例PPV23病例(48%接种疫苗)和1,640例对照(54.5%接种疫苗).针对PPV23血清型疾病的校正VE（AVE）估计值为24％（95％CI5％-40％，p=0.02)。在仅限于疫苗合格患者的分析中，估计结果相似(n=1,768，AVE23%，95%CI1%-40%)和年龄≥65岁的患者(n=1,407，AVE20%，95%CI-5%至40%)，但不在年龄≥75岁的患者中(n=905，AVE5%，95%CI-37%至35%）。与PPV23/非13价肺炎球菌结合疫苗（PCV13）血清型肺炎相关的AVE估计（n=417例，43.7%接种疫苗）为29%（95%CI6%-46%）。这项研究的主要局限性在于，由于疫苗接种率高，缺乏拒绝没有疫苗效应的零假设的力量，并且该研究的规模不足以在年龄较大的人群中进行稳健的亚组分析.
在建立国家儿童PCV13疫苗接种计划的背景下，临床高危患者组和年龄≥65岁的成年人接种PPV23疫苗可提供中度长期保护，防止因PPV23血清型肺炎住院。这些结果表明，PPV23疫苗可能继续在成人肺炎球菌疫苗政策中发挥重要作用。包括老年人重新接种疫苗的可能性。
使用病例对照测试阴性设计，对在诺丁汉的2所大学教学医院住院CAP的成年人（年龄≥16岁）的前瞻性队列研究进行了二次数据分析，英格兰,2013年9月至2018年8月。感兴趣的暴露是在索引入院之前的任何时间点的PPV23疫苗接种。1例被定义为PPV23血清型特异性肺炎球菌肺炎，对照组被定义为非PPV23血清型肺炎球菌肺炎或非肺炎球菌肺炎。使用多重免疫测定法从尿液样品或从阳性血液培养物中鉴定肺炎球菌血清型。多变量逻辑回归用于得出接种疫苗和未接种疫苗的个体之间的病例状态的调整后的几率;VE估计值计算为(1-比值比)×100%。在2357名患者中，有717例PPV23病例(48%接种疫苗)和1,640例对照(54.5%接种疫苗).针对PPV23血清型疾病的校正VE（AVE）估计值为24％（95％CI5％-40％，p=0.02)。在仅限于疫苗合格患者的分析中，估计结果相似(n=1,768，AVE23%，95%CI1%-40%)和年龄≥65岁的患者(n=1,407，AVE20%，95%CI-5%至40%)，但不在年龄≥75岁的患者中(n=905，AVE5%，95%CI-37%至35%）。与PPV23/非13价肺炎球菌结合疫苗（PCV13）血清型肺炎相关的AVE估计（n=417例，43.7%接种疫苗）为29%（95%CI6%-46%）。这项研究的主要局限性在于，由于疫苗接种率高，缺乏拒绝没有疫苗效应的零假设的力量，并且该研究的规模不足以在年龄较大的人群中进行稳健的亚组分析.
在建立国家儿童PCV13疫苗接种计划的背景下，临床高危患者组和年龄≥65岁的成年人接种PPV23疫苗可提供中度长期保护，防止因PPV23血清型肺炎住院。这些结果表明，PPV23疫苗可能继续在成人肺炎球菌疫苗政策中发挥重要作用。包括老年人重新接种疫苗的可能性。
