23价肺炎球菌疫苗防治老年人肺炎的临床观察

目的观察23价肺炎球菌多糖疫苗(PPV23)防治老年人肺炎的临床效果。方法选取老年肺部疾病患者126例,随机分为对照组和疫苗组各63例,对照组给予常规对症治疗,疫苗组在常规对症治疗的基础上给予PPV23皮下注射,随访2年,观察两组患者肺炎发生次数、发作间隔天数、住院次数、住院天数、死亡率、疫苗接种后不良反应及效益成本比(BCR)。结果疫苗组患者肺炎发作次数减少,间隔时间延长,住院次数减少及住院时间缩短,死亡率明显降低,差异有统计学意义(P0.01)。疫苗组接种PPV23后的效益成本比为25.79,净效益为374 803.89元。不良反应的总发生率为25.39%,均于12~72 h内未经特殊处理自行缓解。结论慢性肺部疾病的老年人接种PPV23后可以减少肺炎发作次数及住院的天数,具有较好的安全性,临床效果良好。     

23价肺炎球菌多糖疫苗和流行性感冒病毒裂解疫苗联合接种对老年人呼吸系统疾病防治效果观察与效益分析

目的评价老年人群联合接种23价肺炎球菌多糖疫苗(23-Valent Penumococcal Polysaccharide Vaccine,PenV23)和流行性感冒(流感)病毒裂解疫苗(Split-Virus Influenza Vaccine,InfV-B),预防上呼吸系统疾病的效果和成本-效益。方法选取日照市城区部分预防接种门诊,在2005年联合接种过PenV23和InfV-B的151名老年人为接种组,抽取匹配的均未接种两种疫苗的188名社区人员为对照组。在基线调查的基础上,联合接种后2年内对接种组和对照组进行随访,记录入院诊断治疗情况、直接医疗费用等。结果 PenV23和InfV-B联合接种对上呼吸道感染的保护效率为60%(比值比为0.35,95%可信区间为0.153～0.794),差异有统计学意义(P=0.009)。联合接种疫苗组平均住院时间(20.00±5.66)d,对照组为(24.19±7.24)d,差异有统计学意义(t=5.82,P0.001)。联合接种疫苗的效益成本比为4.03,净效益为177994.86元。结论社区老年人群联合接种PenV23和InfV-B能减少上呼吸系统疾病的发生,具有一定的保护效力,且能获得较高的成本效益。     

北京市老年人肺炎多糖疫苗接种成本效益分析

目的 评价23价肺炎球菌多糖疫苗在北京市老年人群中接种的效果和成本效益。方法 采用历史性队列研究,选择2005-2008年接种过23价肺炎球菌多糖疫苗的老年人116人作为接种组,选择同期未接种疫苗的老年人116人为未接种组,进行1:1配对,通过问卷调查回顾性收集2组基本情况和相关疾病患病及其医疗花费情况,采用卫生经济学方法进行成本效益分析。结果 接种组和未接种组老年人群2005-2008年肺炎及其相关疾病发病密度分别为9.17/百人年和48.42/百人年,疫苗保护率为81.10%,接种与未接种疫苗发生肺炎及其相关疾病的相对危险度(RR)为0.19,95%CI=0.10～0.34;接种总成本24 418元,通过接种疫苗减少的医疗支出及相关总费用为458435.32元,效益成本比值(BCR)为6.49;效益成本比值随疫苗价格和发病情况改变而波动。结论 北京市老年人群接种肺炎球菌多糖疫苗具有较好的成本效益,可有效预防老年人群肺炎及其相关疾病的发生。     

国产23价肺炎球菌多糖疫苗上市后安全性评价

目的评价23价肺炎球菌多糖疫苗大面积使用的临床安全性。方法对接种23价肺炎球菌多糖疫苗的受种者发放监测卡,30 d以后回收监测卡,统计局部及全身反应情况,收集罕见不良反应。结果观察共接种6 550人,回收有效监测卡4 361张,局部反应发生率0.71%,全身反应发生率1.56%,未见罕见和极罕见不良反应。结论国产23价肺炎球菌多糖疫苗上市后大面积使用是安全的。     

接种23价肺炎球菌多糖疫苗的安全性观察

肺炎球菌感染以老年人及婴幼儿最为严重,主要引起中耳炎、鼻窦炎、咽炎/扁桃体炎、下呼吸道感染(主要是肺炎)、菌血症、脑膜炎等。接种23价肺炎球菌多糖疫苗是预防肺炎球菌感染的有效途径。为了了解使用23价肺炎球菌多糖疫苗安全性,柳城县疾病预防控制中心对2012年10月接种23价肺炎疫苗的415人开展了临床观察。     

老年人同时接种23价肺炎球菌多糖疫苗与流感病毒亚单位疫苗的安全性观察

目的 提高老年人对同时接种23价肺炎球菌多糖疫苗（PPV23）和流感病毒亚单位疫苗的安全性认识.方法 2012年10-12月对符合接种条件的≥60岁的老年人在接种流感病毒亚单位疫苗的同时接种23价肺炎球菌多糖疫苗（须分别注射于不同手臂）,观察接种后30 min内的即时反应、72 h内的局部反应和全身反应. 结果 不良反应发生率36.2％,发生的预防接种反应都是一般反应,并以局部反应为主,且无1人发生急性过敏反应和疑似异常反应.流感病毒亚单位疫苗的局部反应发生率为11.9％,低于PPV23 （28.5％,x2=20.07,P＜0.01）;健康老人与患有慢性疾病的老人同时接种疫苗后不良反应发生率差异无统计学意义（x2=1.67,P＞0.05）. 结论 老年人同时接种23价肺炎球菌多糖疫苗和流感病毒亚单位疫苗是安全的、可耐受的.     

23价肺炎球菌多糖疫苗在慢性阻塞性肺疾病患者中的免疫原性和效果

肺炎球菌是导致慢性阻塞性肺疾病(COPD)患者感染性急性加重的主要病原体之一.世界卫生组织等权威机构均推荐COPD患者接种肺炎球菌疫苗,但肺炎球菌疫苗对COPD患者的保护作用尚存在争议.本文通过检索国内外截止到2020年7月发表的最新文献资料,梳理和综述COPD患者接种23价肺炎球菌多糖疫苗(PPSV23)的免疫原性和...     

常州市武进区慢性病患者接种23价肺炎球菌多糖疫苗的保护效果和成本效益北大核心

目的评价慢性病患者接种23价肺炎球菌多糖疫苗(PPV23)的保护效果(VE)和成本效益。方法在常州市武进区选取10个乡镇招募慢性病患者,分为PPV23接种组和不接种疫苗的对照组,观察1年内两组肺炎、呼吸道感染和慢性病发作发病率,收集接种成本和医疗费用,计算接种PPV23的VE和效益成本比。结果本研究共纳入慢性病患者900人,其中接种组440人、对照组460人。慢性病患者接种PPV23对肺炎、呼吸道感染、慢性病发作的VE(95%CI)分别为55.19%(-57.90%-87.32%)、51.63%(27.79%-67.71%)、44.08%(9.36%-65.60%);人均接种成本为202元,人均接种效益为696元,效益成本比为3.45:1。结论慢性病患者接种PPV23具有较好的保护效果和成本效益。     

常州市武进区慢性病患者接种23价肺炎球菌多糖疫苗的保护效果和成本效益

目的评价慢性病患者接种23价肺炎球菌多糖疫苗(PPV23)的保护效果(VE)和成本效益。方法在常州市武进区选取10个乡镇招募慢性病患者,分为PPV23接种组和不接种疫苗的对照组,观察1年内两组肺炎、呼吸道感染和慢性病发作发病率,收集接种成本和医疗费用,计算接种PPV23的VE和效益成本比。结果本研究共纳入慢性病患者900人,其中接种组440人、对照组460人。慢性病患者接种PPV23对肺炎、呼吸道感染、慢性病发作的VE(95%CI)分别为55.19%(-57.90%-87.32%)、51.63%(27.79%-67.71%)、44.08%(9.36%-65.60%);人均接种成本为202元,人均接种效益为696元,效益成本比为3.45:1。结论慢性病患者接种PPV23具有较好的保护效果和成本效益。     

广州地区老年人肺炎球菌血清型及疫苗免疫效果研究

目的了解广州地区老年人感染肺炎球菌的血清型别特征,评估广州地区老年人群接种肺炎疫苗的免疫效果。方法随机抽取2015年11月至2016年10月哨点医院的肺炎球菌感染老年病例为病例组,在病例所在社区随机选取同性别、60岁及以上年龄相近(±3岁)、接种疫苗适应证相似的健康居民作为对照组。采用1∶1配对病例对照研究23价肺炎球菌多糖疫苗(PPV23)的免疫效果。采用多重PCR法进行病例肺炎球菌血清分型。结果共276对病例及对照纳入研究,PPV23疫苗对老年人肺炎的保护效果为77.3%(95%CI 62.8%~91.8%)。检出肺炎球菌血清型主要为19F、19A、6B和23F;PPV23疫苗包含的血清型对其覆盖率达96.6%。结论 PPV23疫苗对老年人肺炎有较好的保护效果,PPV23疫苗包含的血清型别与广州地区老年人群病例菌株检出的血清型别的吻合程度较高,PPV23疫苗适用于广州地区的老年人群。     

248例成人社区获得性肺炎病例疾病负担调查

肺炎链球菌是引起婴幼儿和老年人发病和死亡的重要病因,肺炎球菌性疾病是全球较为严重的公共卫生问题之一,肺炎球菌疫苗是预防肺炎链球菌感染的有效手段,23价肺炎球菌多糖疫苗（PPSV23）是目前成人高危人群最常用的预防肺炎球菌性疾病（PD）的疫苗,尤其对于老年人群。国内外研究均显示PPSV23具有较好的安全性和保护效果,老年人群接种PPSV23,可减少其侵袭性肺炎球菌性疾病（IPD）及呼吸道感染性疾病的发病,减轻PD疾病负担,既能提升老年人群的健康,又可节省大量医疗资源,因此PPSV23值得在老年人群中推广应用。     

Decreasing invasive pneumococcal disease in the elderly: a state-level analysis

Evidence has accumulated supporting the relationship between the use of 7-valent pneumococcal conjugate vaccine (PCV7) in children and a decline in invasive pneumococcal disease (IPD) in the elderly. We conducted a state-level analysis of vaccination coverage rates among children 19-35 months of age and IPD hospitalization rates among elderly Medicare beneficiaries. Simple correlations were suggestive of a negative relationship. Multivariate analysis using a state fixed-effect model which helped control for the time invariant factors at the state level also indicated a negative relationship, and it was statistically significant, p = 0.035. The relationship between the use of 23-valent pneumococcal polysaccharide vaccine (PPV23) and IPD hospitalizations was not statistically significant using either method.     

Immunogenicity of varying dosages of 7-valent pneumococcal polysaccharide-protein conjugate vaccine in seniors previously vaccinated with 23-valent pneumococcal polysaccharide vaccine

In this dose-ranging study 220 seniors who had received the 23-valent pneumococcal polysaccharide (PnPS) vaccine at least 5 years prior to enrollment were assigned to receive one of four volumes (0.1, 0.5, 1 or 2 ml) of 7-valent pneumococcal conjugate (PnC) vaccine or a 0.5 ml dose of 23-valent PnPS vaccine. All participants received a reduced challenge dose of 0.1 ml of PnPS vaccine 1 year after enrollment. There was evidence of a dose response to PnC vaccine and antibody levels in the 1 ml PnC group tended to be significantly higher than in the PnPS group. A booster response to the challenge vaccination was not observed. Administration of a 1 ml dose of PnC vaccine is more immunogenic than 0.5 ml of PnPS vaccine in elderly adults previously vaccinated with PnPS vaccine.     

Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria,Australia

Within Australia, Victoria is the only jurisdiction where the 23-valent polysaccharide pneumococcal vaccine (23vPPV) has been publicly funded for the elderly (aged ≥65 years). We compared age-specific rates of invasive pneumococcal disease (IPD) for periods before and after implementation of the program, and data from a comparable Australian population that does not have a funded program. Vaccine effectiveness (VE) was estimated using the screening and indirect cohort methods. Compared to the pre-program period, there was a 36% reduction in the reported rates of IPD among persons aged ≥65 years. Adjusted for under-reporting in the referent rate, the decrease was equivalent to an annual reduction of 112 cases and an estimated 14 deaths among persons ≥65 years. VE was 71% (95% CI 54–82) using the screening method and 79% (95% CI −14 to 96) by the indirect cohort method. Both point estimates were consistent with the VE expected among persons aged ≥65 years, although the small number of isolates meant the indirect cohort method was inconclusive at the lower 95% confidence limit. Consideration should be given to publicly funding pneumococcal vaccine for this age group in other settings.     

Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in middle-aged and older adults: A matched case–control study

The 23-valent polysaccharide pneumococcal vaccine is currently recommended in elderly and high-risk adults. Its efficacy against invasive pneumococcal disease has been demonstrated, but its effectiveness in preventing pneumonia remains uncertain. This study assessed the clinical effectiveness of vaccination against pneumonia among middle-aged and older adults. We conducted a population-based case–control study including 304 case patients over 50 years old with radiographically confirmed pneumococcal pneumonia (94 bacteremic and 210 nonbacteremic cases) and 608 outpatient control subjects (matched by primary care centre, age, sex and risk stratum). Adjusted odds ratios (ORs) for vaccination were calculated using conditional logistic regression, controlling for underlying conditions. Vaccine effectiveness against all pneumococcal pneumonia was 48% (OR: 0.52; 95% confidence interval [CI]: 0.37–0.73). Vaccination was effective against bacteremic cases (OR: 0.34; 95% CI: 0.27–0.66) as well as nonbacteremic cases (OR: 0.58; 95% CI: 0.39–0.86). Vaccine effectiveness was highest against bacteremic infections caused by vaccine types (OR: 0.24; 95% CI: 0.09–0.66). These findings confirm the effectiveness of the vaccine against invasive disease, but they also support the benefit of vaccination in preventing nonbacteremic pneumococcal pneumonia.     

慢性阻塞性肺疾病患者流感疫苗和23价肺炎球菌多糖疫苗接种研究进展

近年来国内外慢性阻塞性肺疾病（COPD）患者流感疫苗和23价肺炎球菌多糖疫苗（PPV23）接种有效性的相关研究发现,接种流感疫苗和PPV23可显著降低COPD患者的流感和肺炎感染风险,减少疾病的急性加重以及与之相关的住院,尤其是接种流感疫苗还可降低患者诱发缺血性心脏病、急性冠脉综合征、室性心律失常、肺癌、痴呆和死亡的风险,二者联合接种保护作用更加显著。国内外权威指南、共识均建议COPD患者接种流感疫苗和PPV23。目前国内流感疫苗和肺炎球菌疫苗接种率均偏低,且在COPD患者中的应用研究较少。应采取有效措施加强知识普及和指南宣传,提高疫苗接种率。同时还应进一步加强COPD患者接种流感和PPV23的临床研究,尤其是联合接种的临床效益分析,以切实改善COPD患者的生存现状和预后。     

Is there any connection between a second pneumonia shot and hospitalization among Medicare beneficiaries?

To learn whether the risk of revaccination in adults should limit its use, the authors investigated whether adverse events requiring hospitalization occurred in a group of Medicare enrollees revaccinated with pneumococcal polysaccharide vaccine. A prospective cohort analysis and case study of revaccinated people involved five percent of all elderly Medicare enrollees from 1985 through 1988, consisting of 66,256 people receiving one dose of vaccine and 1,099 receiving two doses. Comparison was made of the hospitalization rate within 30 days after revaccination and rates of singly vaccinated persons using discharge diagnosis for all those hospitalized during the 30 days after revaccination. No significant difference was found between the hospitalization rate of the revaccinated cohort and comparison group. No adverse reactions attributable to pneumococcal polysaccharide vaccine causing hospitalization were identified among 39 revaccinated persons who were hospitalized within 30 days of revaccination. Revaccination of elderly Medicare beneficiaries does not cause events serious enough to require hospitalization. Vaccination of persons according to the Public Health Service Immunization Practice Advisory Committee guidelines is recommended when the prior immunization status is unknown.     

Effectiveness of a publicly funded pneumococcal vaccination program against invasive pneumococcal disease among the elderly in Victoria, Australia

Within Australia, Victoria is the only jurisdiction where the 23-valent polysaccharide pneumococcal vaccine (23vPPV) has been publicly funded for the elderly (aged > or = 65 years). We compared age-specific rates of invasive pneumococcal disease (IPD) for periods before and after implementation of the program, and data from a comparable Australian population that does not have a funded program. Vaccine effectiveness (VE) was estimated using the screening and indirect cohort methods. Compared to the pre-program period, there was a 36% reduction in the reported rates of IPD among persons aged > or = 65 years. Adjusted for under-reporting in the referent rate, the decrease was equivalent to an annual reduction of 112 cases and an estimated 14 deaths among persons > or = 65 years. VE was 71% (95% CI 54-82) using the screening method and 79% (95% CI -14 to 96) by the indirect cohort method. Both point estimates were consistent with the VE expected among persons aged > or = 65 years, although the small number of isolates meant the indirect cohort method was inconclusive at the lower 95% confidence limit. Consideration should be given to publicly funding pneumococcal vaccine for this age group in other settings.