嘉定区60岁以上老年人接种23价肺炎疫苗临床效果前瞻性研究及成本效益分析  

Prospective study and cost-benefit analysis of 23-valent pneumococcal polysaccharide vaccine among the elderly in Jiading District of Shanghai

作　　者：潘黎[1] 钟培松[1] 李伟[1] 张伟[1] 费洁[1] Pan Li;Zhong Peisong;Li Wei;Zhang Wei;Fei Jie(Shanghai Jiading Center for Disease Control and Prevention, Shanghai 201800, China)

机构地区：[1]上海市嘉定区疾病预防控制中心,201800

出　　处：《中华微生物学和免疫学杂志》2018年第2期149-155,共7页Chinese Journal of Microbiology and Immunology

基　　金：上海市嘉定区卫计委基金资助（2014-KY-13）

摘　　要：目的 评估23价肺炎疫苗预防上海市嘉定区60岁以上户籍老年人下呼吸道感染（lower respiratory tract infections,LRTIs）的临床效果及成本效益.方法 采用前瞻性队列研究,对接种组和未接种组开展为期3年的追踪调查,比较两组LRTIs发病情况和经济负担.结果 接种23价肺炎疫苗后LRTIs的发生率下降明显且效果稳定,约接种10名老人就可预防1次 LRTIs发生,对LRTIs、抗生素使用和住院的保护效率分别为59.5%、63.5%和89.0%.随着LRTIs发生频率的增加,疫苗的保护效益也呈增加趋势.亚组分析,疫苗可减少高血压患者LRTIs、抗生素使用和住院次数;减少糖尿病患者和健康老年人LRTIs、抗生素使用.接种疫苗的成本效益比为1 ： 1.64,净效益58544元.接种后不良反应多为局部反应,无1例因接种后不适而就诊.结论 23价肺炎疫苗可有效降低60岁以上老年人LRTIs的发生率,并且效果稳定,疫苗使用安全,有一定的成本效益.Objective To evaluate the clinical efficacy and cost-benefit of 23-valent pneumococcal polysaccharide vaccine （PPV23） in prevention of lower respiratory tract infections （LRTIs） in the elderly over 60 years old in Jiading District, Shanghai. Methods A prospective cohort study was conduct, in which the sample size was 1 000 for both inoculated and uninoculated groups. This study followed the two groups for three years. Incidence and economic burden of LRTIs were compared between the two groups. Re-sults Compared with the uninoculated group,the incidence of LRTIs in the inoculated group reduced sig-nificantly and the efficacy of PPV23 was stable. Inoculation of about every 10 elderly people could prevent one incidence of LRTIs. The overall protective efficacy of PPV23 against LRTIs, usage of antibiotics and hospitalization were 59.5%,63.5% and 89%,respectively. As the incidence of LRTIs increased,the pro-tective rate of PPV23 also tended to increase. Subgroup analysis showed that PPV23 reduced the incidence of LRTIs,usage of antibiotics and hospitalization in the elderly with hypertension,and decreased the incidence of LRTIs and usage of antibiotics in the elderly who were healthy or had diabetes.The cost-benefit ratio was 1 ： 1.64 and the net benefit was ￥58 544. Adverse events following immunization were mostly local reac-tions and none were treated. Conclusion PPV23 can effectively reduce the incidence of LRTIs in the elder-ly over 60 years old with stable efficacy,safety and benefits outweighing costs.

关 键 词：老年人 肺炎链球菌疫苗 下呼吸道感染 队列研究 临床效果评估 

分 类 号：R186[医药卫生—流行病学]