2013—2023年上海市60岁及以上老年人23价肺炎球菌多糖疫苗免费接种情况及效果分析  

Analysis of the status and effects of the public-funded free 23-valent pneumococcal polysaccharide vaccination among elderly aged 60 years or older in Shanghai,2013—2023

作　　者：彭向东 徐瑶瑶 胡晓江 郭丽君[1] 卜佳 Peng Xiangdong;Xu Yaoyao;Hu Xiaojiang;Guo Lijun;Bo Jia(Shanghai University of Medicine&Health Sciences,School of Nursing and Health Management,Shanghai 201318,China;Beijing Yi’an Research Center for Health and Immunization,Beijing 100005,China;Weifang Medical University,School of Public Health,Weifang 261053,China;Beijing Normal University,School of Sociology,Beijing 100875,China)

机构地区：[1]上海健康医学院护理与健康管理学院,上海201318 [2]北京亿安健康免疫研究中心,北京100005 [3]潍坊医学院公共卫生学院,潍坊261053 [4]北京师范大学社会学院,北京100875

出　　处：《结核与肺部疾病杂志》2023年第4期283-294,共12页Journal of Tuberculosis and Lung Disease

基　　金：北京师范大学委托技术咨询项目(2022310031002563)。

摘　　要：目的:分析2013—2023年23价肺炎球菌多糖疫苗(23-valent pneumococcal polysaccharide vaccine,PPV23)在上海市60岁及以上老年人免费接种情况,为老年人疫苗接种的推广和接种率的进一步提升提供借鉴。方法:检索学术期刊数据库、政府和公立机构网站、新闻媒体报道和自媒体文章,获得与“上海”“老年人”“肺炎疫苗”或“肺炎球菌疫苗”相关的公开资料和全文文献,提取及整理相关数据估算接种率及年度变化百分比(APC),并对接种后抗体阳转率、保护率、安全性,以及对接种意愿和预防接种服务满意度等进行分析。结果:2013—2023年上海市≥60岁老年人累积免费接种PPV23疫苗约181.80万人,2023年现存已接种老年人约为156.86万人,总体接种率约为27.74%(156.86万人/565.51万人),且2013—2015年呈快速上升趋势[APC(95%CI)=39.65%(29.95%~49.80%);χ_(趋势)^(2)=176388.24,P<0.001],2016—2020年呈缓慢上升趋势[APC(95%CI)=3.53%(2.01%~5.17%);χ_(趋势)^(2)=35475.49,P<0.001],至2020—2023年呈缓慢下降趋势[APC(95%CI)=-1.07%(-1.68%~-0.46%);χ_(趋势)^(2)=1255.63,P<0.001]。PPV23疫苗接种3个月后抗体阳转率为60.50%(121/200),接种后1年在不同地区对肺炎的保护率为57.70%~88.00%,接种3年后为52.30%~59.50%,5年后对社区获得性肺炎(CAP)的保护率为41.60%。2013—2017年上海市对≥60岁老年人接种131万剂次PPV23的安全性监测共计报告433例预防接种异常反应个案,发生率为33.04/10万剂次,其中一般反应者占90.53%(392例),异常反应者占3.93%(17例),临床处理后转归均较好;偶合症者占5.31%(23例),心因性反应者占0.23%(1例)。结论:2013—2023年上海市≥60岁老年人免费接种PPV23取得了良好的健康收益,但接种率在达到30%左右后徘徊不前,建议根据上海市老龄化人口结构的变化趋势科学制定项目策略,合理配置接种机构资源,加强老年人接种意愿研究,以及证据收集、信息公开和宣传,以Objective:To analyze the overall implementation of the public funded 23-valent pneumococcal polysaccharide vaccine project(PPV23 project)for elderly aged 60 and above in Shanghai in 2013—2023,and to provide insights for the promotion of vaccination among the elderly and the further improvement of vaccination rate in China.Methods:Key words including‘Shanghai’‘elderly’‘pneumococcal polysaccharide vaccine’or‘pneumococcal vaccine’were searched from academic database,government and public institution websites,media reports and social media articles.The vaccination rate was estimated,and the antibody positive conversion rate,protection rate,safety,and vaccination willingness and satisfaction with vaccination services were analyzed by extracting and summarizing the relevant data.Results:From 2013 to 2023,1.818 million elderly people aged 60 or above in Shanghai received free PPV23 vaccination,of which 1.5686 million are still alive.The estimated gross vaccination coverage of PPV23 in 2023 was 27.74%(1568600/5655100).The PPV23 coverage increased rapidly in 2013—2015(APC(95%CI)=39.65%(29.95%-49.80%);χ_(trend)^(2)=176388.24,P<0.001),and increased slightly in 2016—2020(APC(95%CI)=3.53%(2.01%-5.17%);χ_(trend)^(2)=35475.49,P<0.001),and showed a slow declining trend in 2020—2023(APC(95%CI)=-1.07%(-1.68%--0.46%);χ_(trend)^(2)=1255.63,P<0.001).The antibody positive conversion rate was 60.50%(121/200)after 3 months of vaccination.The protection rate against pneumonia ranged 57.70%-88.00%in different regions one year after vaccination,and 52.30%-59.50%3 years after vaccination.After 5 years,the protection rate against community acquired pneumonia(CAP)was 41.60%.The monitoring data of adverse events following immunization(AEFI)during 2013—2017 reported 433 AEFI cases out of 1310660 doses of PPV23.The incidence rate was 33.04/100000 doses,of which 90.53%(392 cases)were mild reactions,and 3.93%(17 cases)were abnormal reactions,which were cured or improved after treatment.There were 5.31%(23 cases)coincid

关 键 词：老年人保健服务 肺炎球菌菌苗 接种 公费医疗 卫生保健调查 

分 类 号：R186[医药卫生—流行病学] R378.14[医药卫生—公共卫生与预防医学]