23价肺炎球菌多糖疫苗预防老年人下呼吸道感染的效果考察

Effectiveness of 23-valent Pneumococcal Polysaccharide Vaccine to Prevent LRTIs in the Elderly Population

目的为了对23价肺炎球菌多糖疫苗预防社区老年人下呼吸道感染(Lower respiratory tract infeceions,LRTIs)的效果、成本-效益及接种后的不良反应进行分析.方法抽取600名老年人均分为疫苗组和对照组,疫苗组接种后随访2周观察不良反应.同期追踪两组1年LRTIs、抗生素使用、住院情况、直接医疗费用.结果疫苗对LRTIs、抗生素使用、住院保护效率分别为69.7%、72.6%、65.9%.亚组分析,疫苗可减少慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)、冠状动脉硬化性心脏病(冠心病)患者LRTIs、抗生素使用、住院;减少糖尿病、高血压患者LRTIs、抗生素使用.接种疫苗的成本效益比为1:2.06,净效益66 471.65元.接种后不良反应多为局部反应,经热敷或休息1～3d可缓解.结论社区老年人,尤其是有COPD、冠心病的老年人,接种23价肺炎球菌多糖疫苗具有一定的保护效率、成本-效益和安全性.

Objective To evaluate the effectiveness,cost-benefit,and safety of 23-valent pneumococcal polysaccharide vaccine in prevention of lower respiratory tract infections （LRTIs） in the community elderly population. Methods We selected 600 people aged ≥60 years and divided into experimental group and control group. They were observed the side effects for 2 weeks after vaccination. Both groups were followed up one year about incidence and degree of LRTIs, usage rate and kinds of antibiotics,hospitalization rate and time of LRTIs and direct medical cost. Results The vaccine was a protective factor in LRTIs, usage of antibiotics and hospitalization in this study. Stratified analysis showed that vaccine reduced incidence of LRTIs, usage rate of antibiotics, hospitalization rate and degree of LRTIs of the experimental group in which the elderly have COPD and coronary heart disease. Vaccine was a protective factor in LRTIs, usage rate of antibiotics of the elderly who had diabetes mellitus, hypertension, too. Most of side effects of vaccine were local reactions in inject site. They were mild and relieved by local stupe or rest in 1 -3 days. Vaccine cost was ￥62850.50. Benefit of vaccine was ￥129322.15. Benefit-cost ratio was 2.06,net benefit was ￥66471.65. Conclusion Incidence of LRTIs, usage rate of antibiotics, hospitalization rate and degree of LRTIs of the elderly in the community,especially who had COPD and coronary heart disease, decreased in vaccinated 23-valent pneumococcal polysaccharide vaccine than in unvaccinated elderly. This kind of vaccine had not only costbenefit but also safety.