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ホームIMICライブラリMMWR抄訳2019年(Vol.68)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

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2019/11/22Vol. 68 / No. 46

MMWR68(46):1069-1075
Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices

65歳以上の成人における13価肺炎球菌結合型ワクチンと23価肺炎球菌莢膜ポリサッカライドワクチンの使用:Advisory Committee on Immunization Practicesの推奨事項の更新

アメリカでは現在、2つの肺炎球菌ワクチン、すなわち13価肺炎球菌結合型ワクチン[PCV13(プレベナー13)]と23価肺炎球菌莢膜ポリサッカライドワクチン[PPSV23(ニューモバックス23)]が成人への使用で認可されている。2014年に、Advisory Committee on Immunization Practices(ACIP)は、65歳以上のすべての成人に対してPPSV23とPCV13を定期的に使用することを推奨した。当時、小児におけるPCV13の使用が、予防接種を受けた小児からのワクチン血清型の保菌と伝播の減少を通じて、PCV13の間接的な影響を介して成人の疾病負担を軽減し続けると予想されたため(すなわち、PCV13間接効果)、ACIPはこの推奨事項を再評価する必要性を認識した。ACIPは過去3年間に蓄積したエビデンス(https://www.cdc.gov/vaccines/acip/recs/grade/PCV13.html)を再考察した後、2019年6月26日に、65歳以上の成人における定期的なPCV13使用推奨の削除を決定し、免疫不全状態、脳脊髄液(CSF)漏出、人工内耳に該当せず、以前にPCV13を投与されていない65歳以上の成人に対しては、臨床的な共有意思決定に基づいてPCV13投与を推奨することを決定した。ACIPは、養護施設や長期療養施設の居住者、小児PCV13の取り込みが少ない環境に居住している人、小児PCV13プログラムのない環境へ旅行する人のように、一部の65歳以上の成人では、PCV13血清型への曝露のリスクが潜在的に高まることを認識しており、PCV13ワクチン接種から平均よりも高い利益を得る可能性がある。患者とワクチン提供者が、PCV13を使用するための臨床的意思決定を共有する場合、考慮事項には、PCV13血清型への曝露のリスクと、根底にある医学的状態の結果として肺炎球菌疾患を発症するリスクの両方が含まれる。65歳以上のすべての成人は、PPSV23の1回投与を継続する必要がある。PCV13の投与を決定する場合は、PPSV23の少なくとも1年前に投与する必要がある。ACIPは、免疫不全状態、CSF漏出、人工内耳を移植した19歳以上の成人に対しては、引き続きPPSV23とPCV13の連続投与を推奨している。

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