世界卫生组织140个成员国肺炎球菌疫苗常规免疫程序现状分析

Vaccination schedules of PCV and PPV in 140 member states of World Health Organization

目的了解世界卫生组织(WHO)140个成员国肺炎球菌疫苗免疫程序,为优化中国肺炎球菌疫苗免疫策略提供参考依据。方法汇总WHO网站2018年2月28日更新的疫苗可预防疾病监测公开数据,分析WHO 140个成员国肺炎球菌疫苗的种类、常规免疫程序、接种年龄和地区分布。结果 WHO的140个成员国中,有118个(84.3%)国家实施3剂肺炎球菌多糖结合疫苗(PCV)免疫程序,21个(15.0%)国家实施4剂PCV免疫程序,1个(0.7%)国家实施≥5剂PCV免疫程序;PCV为3剂的118个国家中,59个(50.0%)国家在2月龄开始接种,47个(39.8%)国家在1.5月龄开始接种;PCV第2剂和第3剂在全程接种3剂且选择基础免疫3剂和全程接种≥4剂的81个国家中,分别有44个(54.3%)和43个(53.1%)国家在2.5月龄和3.5月龄接种;PCV第2剂和第3剂在全程接种3剂且选择基础免疫2剂加强免疫1剂的59个国家中,分别有40个(67.8%)和39个(66.1%)国家在4月龄和12月龄接种;PCV第4剂接种月龄在接种≥4剂的22个国家中,6个(27.3%)国家在15月龄接种,5个(22.7%)国家在18月龄接种。WHO公布肺炎球菌多糖疫苗(PPV)免疫程序的40个国家中,17个(42.5%)国家在欧洲区(EUR),13个(32.5%)国家在美洲区(AMR),7个(17.5%)国家在西太平洋区(WPR),3个(7.5%)国家在东地中海区(EMR);PPV多推荐接种1剂次,22个(55.0%)国家在≥50岁人群接种。结论 WHO 140个成员国的PCV常规免疫程序根据肺炎发病情况分为基础免疫3剂、基础免疫2剂加强免疫1剂和基础免疫3剂加强1剂,PPV多推荐接种1剂次,中国可根据国内肺炎球菌性疾病的流行水平、特征及疫苗各剂次时间安排等因素确定相应的免疫策略。

Objective To analyze immunization schedules of pneumococcal conjugate vaccine （PCV） and pneumococcal polysaccharide vaccine （PPV） in the 140 member states of World Health Organization （WHO） and to provide evidences to optimizing pneumococcal vaccine vaccination strategy in China. Methods We collected publicly-accessible relevant data updated till February 28, 2018 from the WHO website and then analyzed vaccine type, number of doses, recommended ages for each dose and region distribution of PCV and PPV among the 140 member states of WHO. Results Among the 140 WHO member states, 118 （60.8%） and 21 （15.0%） states adopted three- and four-doses PCV immunization schedule; only one state used five or more doses immunization schedule. Of the 118 member states with 3 doses PCV vaccination schedule, 59 （50.0%） and 47 （39.8%） administered the first dose when the infants aged 2 and 1.5 months; of the 81 states with 3 doses PCV as both full and primary immunization or with 4 or more doses as full immunization, 44 （54.3%） administered the second dose when the infants aged 2.5 months and 43 （53.1%） administered the third dose when the infants aged 3.5 months; of the 59 states with 3 doses PCV as the full immunization of two primary immunization plus one booster immunization, 40 （67.8%） administered the second dose when the infants aged 4 months and 39 （66.1%） administered the third dose when the infants aged 12 months; of the 22 states with 4 or more doses of PCV as full immunization, 6 （27.3%） and 5 （22.7%） administered the fourth dose when the infants aged 15 and 18 months. Among the 40 member states with PPV vaccination schedule, 17 （42.5%）, 13 （32.5%）, 7 （17.5%）, and 3 （7.5%） were in WHO division of Region for the Europe （EUR）, Americas （AMR）, Western Pacific （WPR）, and Eastern Mediterranean （EMR）, respectively; the majority of the states adopted one dose of PPV vaccination schedule and 22 （55.0%） of the states administered the one dose PPV to the population aged 50 years or older. Conclusion The routine PCV immunization schedules adopted by thel40 member states of WHO include 3-dose of primary immunization, 2-dose of primary plus 1-dose of booster immunization, and 3-dose of primary plus 1-dose of booster immunization based on the prevalence of pneumococcal pneumonia. One dose of PPV vaccination is the schedule adopted by the majority of the member states. China can establish PCV immunization strategies according to the epidemic and characteristics of pneumococcal diseases in the country.