Effect of Reduced-Dose Schedules With 7-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Pneumococcal Carriage in Children

作者：Elske J. M. van Gils, Reinier H. Veenhoven, Eelko Hak, Gerwin D. Rodenburg, Debby Bogaert, E. P. F. IJzerman, Jacob P. Bruin, Loek van Alphen, Elisabeth A. M. Sanders · 发表于：JAMA · 年份：2009 · DOI：10.1001/jama.2009.975 · 被引用次数：166 · 研究领域：Pneumonia and Respiratory Infections、Respiratory viral infections research、Nosocomial Infections in ICU

CONTEXT: The effects of reduced-dose schedules of 7-valent pneumococcal conjugate vaccine (PCV-7) on pneumococcal carriage in children are largely unknown, although highly relevant in the context of subsequent herd effects. OBJECTIVE: To examine the effects of a 2-dose and 2 + 1-dose PCV-7 schedule on nasopharyngeal pneumococcal carriage in young children compared with controls. DESIGN, SETTING, AND PATIENTS: A randomized controlled trial of nasopharyngeal carriage of Streptococcus pneumoniae enrolling 1003 healthy newborns and 1 of their parents in a general community in The Netherlands, with follow-up to age 24 months and conducted between July 7, 2005, and February 14, 2008. INTERVENTION: Infants were randomly assigned to receive 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group). MAIN OUTCOME MEASURE: Vaccine serotype pneumococcal carriage rates in infants in the second year of life. RESULTS: At 12 months, vaccine serotype pneumococcal carriage was significantly decreased after both PCV-7 schedules, with vaccine serotype pneumococcal carriage rates of 25% (95% confidence interval [CI], 20%-30%) and 20% (95% CI, 16%-25%) in the 2-dose and 2 + 1-dose schedule groups, respectively, vs 38% (95% CI, 33%-44%) in the control group (both P < .001). At 18 months, in the 2 + 1-dose schedule group, vaccine serotype pneumococcal carriage had further decreased to 16% (95% CI, 12%-20%) and, at 24 months, to 14% (95% CI, 11%-18%...