アメリカの小児に対する15価肺炎球菌結合型ワクチンの使用：Advisory Committee on Immunization Practicesの最新の推奨 ― アメリカ、2022年

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ホーム IMICライブラリ MMWR抄訳 2022年（Vol.71)アメリカの小児に対する15価肺炎球菌結合型ワクチン･･･

MMWR抄訳

2022/09/16Vol. 71 / No. 37

MMWR71(37):1174－1181
Use of 15-Valent Pneumococcal Conjugate Vaccine Among U.S. Children: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

アメリカの小児に対する15価肺炎球菌結合型ワクチンの使用：Advisory Committee on Immunization Practicesの最新の推奨 ― アメリカ、2022年

13価肺炎球菌結合型ワクチン[PCV13(プレベナー13、Wyeth Pharmaceuticals社、ファイザー社の子会社)]および23価肺炎球菌莢膜ポリサッカライドワクチン[PPSV23(Merck Sharp & Dohme社]はアメリカの小児に対して推奨されており、推奨事項は年齢層とリスクグループにより異なる。2021年には、15価肺炎球菌結合型ワクチン[PCV15(バクニュバンス、Merck Sharp & Dohme社)]が18歳以上の成人に対する使用を認可された。2022年6月17日、FDAは、PCV15に対する抗体応答をPCV13と比較した研究に基づいて、PCV15の使用の拡大に生後6週齢～17歳を含めることを承認した。PCV15にはPCV13の血清型に加えて、CRM197(遺伝子的に解毒されたジフテリア毒素)に結合した血清型22Fおよび33Fが含まれている。2022年6月22日、CDCのAdvisory Committee on Immunization Practices(ACIP)は、現在推奨されているPCV13の投与とスケジュールに従って、19歳未満の人に対する肺炎球菌結合型ワクチン接種の選択肢としてPCV15の使用を推奨した。ACIPはこれらのワクチン使用に関する審議を導くために、Grading of Recommendations, Assessment, Development and Evaluationアプローチを使用した、Evidence to Recommendationフレームワークを採用した。肺炎球菌結合型ワクチン接種の選択肢としてのPCV15は、さらに疾患の原因となる血清型に対する免疫を誘導するため、小児における肺炎球菌疾患の罹患率を低下させることが期待されている。ランダム化比較試験の結果は、PCV15の免疫原性および安全性がPCV13とほとんど同等であることを示唆している。費用対効果に関する研究では、共通する13種類の血清型に対するPCV15の費用および有効性がPCV13の費用および有効性と同等であり、PCV15がさらに2つの血清型に対する防護をもたらすと仮定すると、2歳未満の幼児に対してPCV15を通常に使用することで費用を削減することが示された。ACIPは、生後2～59カ月のすべての小児に対し、PCV(PCV13またはPCV15)の使用を推奨している。さらに、リスクに基づくPCVの使用を、リスクのある生後60～71カ月の幼児、6～18歳の免疫不全、脳脊髄液漏、人工内耳を埋め込んでいる人に対し推奨している。すべての推奨事項について、PCV13とPCV15は区別せず使用できる。予防接種スケジュールを中断しても、シリーズ全体の再投与や追加接種は必要としない。肺炎球菌による疾患のリスクが増加する特定の基礎疾患がある2～18歳の人に対し、PPSV23の使用に関するリスクに基づく推奨事項は変更されていない。

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