Abstract：
BACKGROUND: Pneumococcal disease in older adults in the United Kingdom is rising despite immunisation. A key gap in the literature is the clinical effectiveness of revaccination with the pneumococcal polysaccharide vaccine (PPV23).
METHODS: A cohort study was performed in England, using electronic medical records in the Clinical Practice Research Datalink. Individuals aged ≥64 years and vaccinated with PPV23 were included. Rates of hospitalised pneumonia (HP) and invasive pneumococcal disease (IPD) were compared between individuals receiving a single PPV23 dose versus those receiving two doses using multi-level Cox proportional hazards models. Propensity score weighting was performed to minimise the effect of confounding covariates across the comparison groups.
RESULTS: Between 2006 and 2019, there were 462 505 eligible participants. Of those, 6747 (1·5 %) received revaccination. Two doses compared to one dose was associated with an increased risk of HP (adjusted Hazard Ratio [aHR] 1·95; 95 %CI 1·74-2·20) and IPD (aHR 1·44; 95 %CI 1·41-1·46). In participants aged 64-74 years PPV23 revaccination was associated with more IPD (aHR 2·02; 95 %CI 1·75-2·33) and HP (aHR 1·46; 95 %CI 1·42-1.49). In those aged ≥75 years PPV23 revaccination was associated with more HP (aHR 1·12; 95 %CI 1·08-1·16) with no statistically significant difference detected in risk of IPD (aHR 1·20; 95 %CI 0·94-1·52).
CONCLUSIONS: No clear benefit of PPV23 revaccination was measured in older adults in this observational study. The small proportion of revaccinated subjects limits the strength of the conclusions. Further research evaluating the clinical effectiveness of PPV23 revaccination is required.
METHODS: A cohort study was performed in England, using electronic medical records in the Clinical Practice Research Datalink. Individuals aged ≥64 years and vaccinated with PPV23 were included. Rates of hospitalised pneumonia (HP) and invasive pneumococcal disease (IPD) were compared between individuals receiving a single PPV23 dose versus those receiving two doses using multi-level Cox proportional hazards models. Propensity score weighting was performed to minimise the effect of confounding covariates across the comparison groups.
RESULTS: Between 2006 and 2019, there were 462 505 eligible participants. Of those, 6747 (1·5 %) received revaccination. Two doses compared to one dose was associated with an increased risk of HP (adjusted Hazard Ratio [aHR] 1·95; 95 %CI 1·74-2·20) and IPD (aHR 1·44; 95 %CI 1·41-1·46). In participants aged 64-74 years PPV23 revaccination was associated with more IPD (aHR 2·02; 95 %CI 1·75-2·33) and HP (aHR 1·46; 95 %CI 1·42-1.49). In those aged ≥75 years PPV23 revaccination was associated with more HP (aHR 1·12; 95 %CI 1·08-1·16) with no statistically significant difference detected in risk of IPD (aHR 1·20; 95 %CI 0·94-1·52).
CONCLUSIONS: No clear benefit of PPV23 revaccination was measured in older adults in this observational study. The small proportion of revaccinated subjects limits the strength of the conclusions. Further research evaluating the clinical effectiveness of PPV23 revaccination is required.
摘要：
背景：尽管免疫接种，英国老年人的肺炎球菌疾病仍在上升。文献中的一个关键差距是用肺炎球菌多糖疫苗(PPV23)再接种的临床有效性。
方法：在英格兰进行了一项队列研究，在临床实践研究数据链中使用电子病历。包括年龄≥64岁并接种PPV23的个体。使用多级Cox比例风险模型，比较了接受单一PPV23剂量的个体与接受两种剂量的个体之间住院肺炎（HP）和侵袭性肺炎球菌疾病（IPD）的发生率。进行倾向评分加权以最小化在比较组中混杂协变量的影响。
结果：在2006年至2019年之间，有462505名合格参与者。其中,6747（1·5%）接受了再接种。两种剂量与一种剂量相比，HP（调整后的危险比[aHR]1·95;95CI1·74-2·20）和IPD（aHR1·44;95CI1·41-1·46）的风险增加。在64-74岁的参与者中，PPV23再接种与更多的IPD（aHR2·02;95CI1·75-2·33）和HP（aHR1·46;95CI1·42-1.49）相关。在年龄≥75岁的人群中，PPV23再接种与更多的HP（aHR1·12;95CI1·08-1·16）相关，IPD风险无统计学差异（aHR1·20;95CI0·94-1·52）。
结论：在这项观察性研究中，在老年人中没有发现PPV23再接种的明显益处。再接种疫苗的受试者比例小限制了结论的强度。需要进一步研究评估PPV23再接种的临床有效性。
方法：在英格兰进行了一项队列研究，在临床实践研究数据链中使用电子病历。包括年龄≥64岁并接种PPV23的个体。使用多级Cox比例风险模型，比较了接受单一PPV23剂量的个体与接受两种剂量的个体之间住院肺炎（HP）和侵袭性肺炎球菌疾病（IPD）的发生率。进行倾向评分加权以最小化在比较组中混杂协变量的影响。
结果：在2006年至2019年之间，有462505名合格参与者。其中,6747（1·5%）接受了再接种。两种剂量与一种剂量相比，HP（调整后的危险比[aHR]1·95;95CI1·74-2·20）和IPD（aHR1·44;95CI1·41-1·46）的风险增加。在64-74岁的参与者中，PPV23再接种与更多的IPD（aHR2·02;95CI1·75-2·33）和HP（aHR1·46;95CI1·42-1.49）相关。在年龄≥75岁的人群中，PPV23再接种与更多的HP（aHR1·12;95CI1·08-1·16）相关，IPD风险无统计学差异（aHR1·20;95CI0·94-1·52）。
结论：在这项观察性研究中，在老年人中没有发现PPV23再接种的明显益处。再接种疫苗的受试者比例小限制了结论的强度。需要进一步研究评估PPV23再接种的临床有效性。
