Serotype distribution of remaining invasive pneumococcal disease after extensive use of ten-valent and 13-valent pneumococcal conjugate vaccines (the PSERENADE project): a global surveillance analysis

IF 36.4 1区医学 Q1 INFECTIOUS DISEASES

Lancet Infectious Diseases Pub Date : 2024-12-17 DOI:10.1016/s1473-3099(24)00588-7

Maria Garcia Quesada, Meagan E Peterson, Julia C Bennett, Kyla Hayford, Scott L Zeger, Yangyupei Yang, Marissa K Hetrich, Daniel R Feikin, Adam L Cohen, Anne von Gottberg, Mark van der Linden, Nina M van Sorge, Lucia H de Oliveira, Sara de Miguel, Inci Yildirim, Didrik F Vestrheim, Jennifer R Verani, Emmanuelle Varon, Palle Valentiner-Branth, Georgina Tzanakaki, Tomoka Nakamura

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引用次数: 0

Abstract

Background

Widespread use of pneumococcal conjugate vaccines (PCVs) has reduced vaccine-type invasive pneumococcal disease (IPD). We describe the serotype distribution of IPD after extensive use of ten-valent PCV (PCV10; Synflorix, GSK) and 13-valent PCV (PCV13; Prevenar 13, Pfizer) globally.

Methods

IPD data were obtained from surveillance sites participating in the WHO-commissioned Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project that exclusively used PCV10 or PCV13 (hereafter PCV10 and PCV13 sites, respectively) in their national immunisation programmes and had primary series uptake of at least 70%. Serotype distribution was estimated for IPD cases occurring 5 years or more after PCV10 or PCV13 introduction (ie, the mature period when the serotype distribution had stabilised) using multinomial Dirichlet regression, stratified by PCV product and age group (<5 years, 5–17 years, 18–49 years, and ≥50 years).

Findings

The analysis included cases occurring primarily between 2015 and 2018 from 42 PCV13 sites (63 362 cases) and 12 PCV10 sites (6806 cases) in 41 countries. Sites were mostly high income (36 [67%] of 54) and used three-dose or four-dose booster schedules (44 [81%]). At PCV10 sites, PCV10 serotypes caused 10·0% (95% CI 6·3–12·9) of IPD cases in children younger than 5 years and 15·5% (13·4–19·3) of cases in adults aged 50 years or older, while PCV13 serotypes caused 52·1% (49·2–65·4) and 45·6% (40·0–50·0), respectively. At PCV13 sites, PCV13 serotypes caused 26·4% (21·3–30·0) of IPD cases in children younger than 5 years and 29·5% (27·5–33·0) of cases in adults aged 50 years or older. The leading serotype at PCV10 sites was 19A in children younger than 5 years (30·6% [95% CI 18·2–43·1]) and adults aged 50 years or older (14·8% [11·9–17·8]). Serotype 3 was a top-ranked serotype, causing about 9% of cases in children younger than 5 years and 14% in adults aged 50 years or older at both PCV10 and PCV13 sites. Across all age and PCV10 or PCV13 strata, the proportion of IPD targeted by higher-valency PCVs beyond PCV13 was 4·1–9·7% for PCV15, 13·5–36·0% for PCV20, 29·9–53·8% for PCV21, 15·6–42·0% for PCV24, and 31·5–50·1% for PCV25. All top-ten ranked non-PCV13 serotypes are included in at least one higher-valency PCV.

Interpretation

The proportion of IPD due to serotypes included in PCVs in use was low in mature PCV10 and PCV13 settings. Serotype distribution differed between PCV10 and PCV13 sites and age groups. Higher-valency PCVs target most remaining IPD and are expected to extend impact.

Funding

Bill & Melinda Gates Foundation as part of the WHO Pneumococcal Vaccines Technical Coordination Project.

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广泛使用十价和13价肺炎球菌结合疫苗（PSERENADE项目）后剩余侵袭性肺炎球菌疾病的血清型分布：一项全球监测分析

肺炎球菌结合疫苗（PCVs）的广泛使用减少了疫苗型侵袭性肺炎球菌病（IPD）。我们描述了广泛使用十价PCV (PCV10；Synflorix， GSK)和13价PCV (PCV13；Prevenar 13，辉瑞)全球。方法从参与世界卫生组织委托的肺炎球菌血清型替代和分布估计（PSERENADE）项目的监测点获得sipd数据，这些监测点在其国家免疫规划中专门使用PCV10或PCV13（分别为PCV10和PCV13站点），并且初级系列接种率至少为70%。采用多项Dirichlet回归估计在PCV10或PCV13引入后5年或更长时间（即血清型分布稳定的成熟期）发生的IPD病例的血清型分布，并按PCV产品和年龄组（5岁、5 - 17岁、18-49岁和≥50岁）分层。该分析包括主要发生在2015年至2018年之间的病例，来自41个国家的42个PCV13站点（63 362例）和12个PCV10站点（6806例）。大多数是高收入地区（54个站点中有36个[67%]），使用三剂或四剂强化方案（44个[81%]）。在PCV10位点，5岁以下儿童IPD病例中PCV10血清型占10.0% (95% CI为6.3 ~ 12.9)，50岁以上成人IPD病例中PCV10血清型占15.5%(13.4 ~ 19.3)，而PCV13血清型分别占52.1%（49.2 ~ 65.4）和45.6%（40.0 ~ 50.0）。在PCV13位点，5岁以下儿童IPD病例中，PCV13血清型占26.4%(21.3 ~ 30.0)，50岁以上成人IPD病例中，PCV13血清型占29.5%（27.5 ~ 33.0）。5岁以下儿童（30.6% [95% CI 18.2 ~ 43.1]）和50岁以上成人（14.8% [11.9 ~ 17.8]）PCV10位点的主要血清型为19A。血清型3是排名最高的血清型，在PCV10和PCV13站点中，5岁以下儿童和50岁以上成人中分别造成约9%和14%的病例。在所有年龄层和PCV10或PCV13层中，PCV13以外的高价pcv靶向IPD的比例为PCV15为4.1% ~ 9.7%，PCV20为13.5 ~ 36.0%，PCV21为29.9 ~ 53.8%，PCV24为15.6 ~ 42.0%，PCV25为31.5 ~ 50.1%。所有排名前十的非pcv13血清型至少包含一种高价PCV。在成熟的PCV10和PCV13环境中，使用的pcv中由于血清型引起的IPD的比例较低。PCV10和PCV13的血清型分布在不同地点和年龄组之间存在差异。高价pcv的目标是大多数剩余的IPD，预计将扩大影响。FundingBill,梅琳达·盖茨基金会作为世卫组织肺炎球菌疫苗技术协调项目的一部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Infectious Diseases 医学-传染病学

CiteScore

60.90

自引率

0.70%

发文量

1064

审稿时长

6-12 weeks

期刊介绍： The Lancet Infectious Diseases was launched in August, 2001, and is a lively monthly journal of original research, review, opinion, and news covering international issues relevant to clinical infectious diseases specialists worldwide.The infectious diseases journal aims to be a world-leading publication, featuring original research that advocates change or sheds light on clinical practices related to infectious diseases. The journal prioritizes articles with the potential to impact clinical practice or influence perspectives. Content covers a wide range of topics, including anti-infective therapy and immunization, bacterial, viral, fungal, and parasitic infections, emerging infectious diseases, HIV/AIDS, malaria, tuberculosis, mycobacterial infections, infection control, infectious diseases epidemiology, neglected tropical diseases, and travel medicine. Informative reviews on any subject linked to infectious diseases and human health are also welcomed.