65歳以上の成人における13価肺炎球菌結合型ワクチンおよび23価肺炎球菌多糖体ワクチンの利用：Advisory Committee on Immunization Practices (ACIP)の勧告

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ホーム IMICライブラリ MMWR抄訳 2014年（Vol.63)65歳以上の成人における13価肺炎球菌結合型ワクチ･･･

MMWR抄訳

2014/09/19Vol. 63 / No. 37

MMWR63(37):822－825
Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

65歳以上の成人における13価肺炎球菌結合型ワクチンおよび23価肺炎球菌多糖体ワクチンの利用：Advisory Committee on Immunization Practices (ACIP)の勧告

2014年8月13日、Advisory Committee on Immunization Practices (ACIP)は65歳以上の成人に対し、13価肺炎球菌結合型ワクチン(PCV13)の定期的接種に関する勧告を出した。2011年12月30日、PCV13は肺炎球菌(ワクチンに含まれる血清型)による肺炎や侵襲性疾患の予防として50歳以上に対する適応をFDAに承認され、2012年7月20日、ACIPは免疫不全状態、機能的または解剖学的無脾、脳脊髄液漏、人工内耳を有する19歳以上の成人に対し接種を推奨している。オランダにて、65歳以上の成人約85,000例を対象に行われたCAPiTA試験では、ワクチン血清型の肺炎球菌性肺炎に対する有効率が45.6％、非細菌性肺炎に対しては45.0％、侵襲性肺炎球菌疾患では75.0％と報告されており、アメリカおよびヨーロッパにて行われた2つの多施設共同ランダム化免疫原性試験では、PCV13は23価肺炎球菌多糖体ワクチン(PPSV23)と同等以上の免疫応答性を示した。また、約6,000例を対象にPCV13の安全性をPPSV23投与歴の有無別に評価した研究では、初回接種後1ヵ月以内における重篤な有害事象の発現率はPPSV23とほぼ同等で0.2～1.7％であり、接種後1～6ヵ月ではPCV13にて1.2～5.8％、PPSV23にて2.4～5.5％、PPSV23投与歴の有無による発現率の差はなかった。PCV13は、現在、65歳以上に推奨されているPPSV23と連続して使用される。今回、1) 肺炎球菌ワクチン接種歴のない場合はPCV13を接種し、6～12ヵ月後にPPSV23を接種、2)65歳以降にPPSV23の接種歴がある場合はPPSV23の接種から1年以上空けてPCV13を接種、3)65歳未満にPPSV23の接種歴がある場合、PPSV23の接種から1年以上空けてPCV13を接種し、その後6～12ヵ月にて　PPSV23を接種するよう推奨されている。

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