Abstract：
In the era of childhood pneumococcal conjugate vaccine (PCV) immunization, especially 13-valent pneumococcal conjugate vaccine (PCV13) immunization, serotype replacement of Streptococcus pneumoniae and herd immunity in adults have been reported worldwide. Therefore, continuous evaluation of the effectiveness of the pneumococcal vaccine in adults is crucial because vaccine effectiveness may change owing to these factors. The purpose of this study was to evaluate the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against all-cause pneumonia and pneumococcal pneumonia in older individuals with community-acquired pneumonia (CAP) after the introduction of childhood PCV13 in Japan, a topic that has remained largely unexplored.
We evaluated pneumococcal vaccine effectiveness in this multicenter, matched case-control study conducted in hospitals and clinics. Cases included patients (aged ≥ 65 years) newly diagnosed with CAP between October 2016 and September 2019. A maximum of five non-pneumonia control patients matched for sex, school grade, date of outpatient visit, and medical institution were selected for each case. Conditional logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of pneumococcal vaccines for the occurrence of all-cause CAP and pneumococcal CAP.
The analysis included 740 individuals (142 patients and 598 controls). The median age of participants was 75 years (men: 54%). The adjusted OR for pneumococcal vaccination against all-cause CAP was 1.31 (95% CI: 0.84-2.06), while that for PPSV23 vaccination in the previous 5 years was 1.33 (95% CI: 0.85-2.09). The adjusted OR for PPSV23 vaccination in the previous 5 years against pneumococcal CAP was 0.93 (95% CI: 0.35-2.50).
This study was unable to demonstrate the effectiveness of PPSV23 against all-cause and pneumococcal pneumonia after the introduction of childhood PCV13 in Japan. Nonetheless, additional studies are needed to validate these results.
We evaluated pneumococcal vaccine effectiveness in this multicenter, matched case-control study conducted in hospitals and clinics. Cases included patients (aged ≥ 65 years) newly diagnosed with CAP between October 2016 and September 2019. A maximum of five non-pneumonia control patients matched for sex, school grade, date of outpatient visit, and medical institution were selected for each case. Conditional logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of pneumococcal vaccines for the occurrence of all-cause CAP and pneumococcal CAP.
The analysis included 740 individuals (142 patients and 598 controls). The median age of participants was 75 years (men: 54%). The adjusted OR for pneumococcal vaccination against all-cause CAP was 1.31 (95% CI: 0.84-2.06), while that for PPSV23 vaccination in the previous 5 years was 1.33 (95% CI: 0.85-2.09). The adjusted OR for PPSV23 vaccination in the previous 5 years against pneumococcal CAP was 0.93 (95% CI: 0.35-2.50).
This study was unable to demonstrate the effectiveness of PPSV23 against all-cause and pneumococcal pneumonia after the introduction of childhood PCV13 in Japan. Nonetheless, additional studies are needed to validate these results.
摘要：
在儿童肺炎球菌结合疫苗（PCV）免疫的时代，特别是13价肺炎球菌结合疫苗（PCV13）免疫，肺炎链球菌的血清型替代和成人的群体免疫已在世界范围内报道。因此,持续评估成人肺炎球菌疫苗的有效性至关重要,因为疫苗的有效性可能因这些因素而发生变化.这项研究的目的是评估23价肺炎球菌多糖疫苗（PPSV23）在日本引入儿童PCV13后对患有社区获得性肺炎（CAP）的老年人的全因肺炎和肺炎球菌肺炎的有效性，这个话题在很大程度上仍未被探索。
我们在这个多中心评估了肺炎球菌疫苗的有效性，在医院和诊所进行的匹配病例对照研究。病例包括2016年10月至2019年9月期间新诊断为CAP的患者（年龄≥65岁）。最多五名性别匹配的非肺炎对照患者，学校年级,门诊就诊日期,并为每个病例选择医疗机构。使用条件逻辑回归模型计算肺炎球菌疫苗发生全因CAP和肺炎球菌CAP的比值比（ORs）和95％置信区间（CIs）。
分析包括740名个体（142名患者和598名对照）。参与者的平均年龄为75岁（男性：54%）。肺炎球菌疫苗针对全因CAP的校正OR为1.31（95％CI：0.84-2.06），而前5年PPSV23疫苗接种为1.33（95%CI：0.85-2.09）。前5年PPSV23疫苗接种对肺炎球菌CAP的校正OR为0.93(95%CI:0.35-2.50)。
这项研究无法证明PPSV23在日本引入儿童PCV13后对全因肺炎和肺炎球菌肺炎的有效性。尽管如此，需要更多的研究来验证这些结果.
我们在这个多中心评估了肺炎球菌疫苗的有效性，在医院和诊所进行的匹配病例对照研究。病例包括2016年10月至2019年9月期间新诊断为CAP的患者（年龄≥65岁）。最多五名性别匹配的非肺炎对照患者，学校年级,门诊就诊日期,并为每个病例选择医疗机构。使用条件逻辑回归模型计算肺炎球菌疫苗发生全因CAP和肺炎球菌CAP的比值比（ORs）和95％置信区间（CIs）。
分析包括740名个体（142名患者和598名对照）。参与者的平均年龄为75岁（男性：54%）。肺炎球菌疫苗针对全因CAP的校正OR为1.31（95％CI：0.84-2.06），而前5年PPSV23疫苗接种为1.33（95%CI：0.85-2.09）。前5年PPSV23疫苗接种对肺炎球菌CAP的校正OR为0.93(95%CI:0.35-2.50)。
这项研究无法证明PPSV23在日本引入儿童PCV13后对全因肺炎和肺炎球菌肺炎的有效性。尽管如此，需要更多的研究来验证这些结果.
