Supplementary Material for: Pneumococcal Vaccine Use and Immunogenicity in Patients with Glomerular Disease: A Scoping Review and Analysis of Healthcare Claims Data

Introduction: Streptococcus pneumoniae infections are a preventable cause of morbidity and mortality in individuals with glomerular disease. There is limited immunogenicity data to inform the effectiveness of vaccination in this high-risk patient population.

Methods: We conducted a scoping review of studies evaluating pneumococcal vaccine immunogenicity in adults and children with idiopathic nephrotic syndrome, focal segmental glomerulosclerosis, IgA vasculitis, or systemic lupus erythematosus with nephritis. We summarize patient characteristics, serotypes assessed, and rates of seroprotection and/or seroconversion. We then used the Merative MarketScan® Commercial Claims & Encounters database to describe rates of adequate, partial, and inadequate pneumococcal vaccination (PCV13 and / or PPSV23) within 12 months of incident glomerular disease diagnosis from 2010-2018.

Results: A total of 879 citations were screened, of which 63 studies were reviewed for inclusion criteria. A final analytic set included 19 studies. Most studies reported clinically meaningful rates of seroprotection, though definitions varied widely across studies. In the analysis of commercial healthcare claims data, 1,343 children aged 2-11 years and 19,987 individuals aged 12- <65 years with incident of GD were identified. Of those inadequately vaccinated prior to GD diagnosis, 4.0% (38/947) of the 2–11-year group and 6.8% (797/11646) of those in the 12 - <65-year group were partially or adequately vaccinated within 12 months of diagnosis. Demographic and clinical factors more commonly identified in those with pneumococcal vaccination included sex, age, region, and prior influenza vaccination.

Conclusion: There is limited literature describing pneumococcal vaccine immunogenicity in patients with glomerular disease. Metrics of reporting seroprotection and seroconversion to pneumococcal vaccines would benefit from standardization. Healthcare claims for pneumococcal vaccines following a diagnosis of glomerular disease suggest that efforts to improve timely vaccination are needed.

引言：肺炎链球菌（Streptococcus pneumoniae）感染是肾小球疾病患者可预防的发病与死亡原因，但目前针对这一高危人群的疫苗接种有效性相关免疫原性数据仍较为匮乏。
方法：本研究针对成人及儿童肾小球疾病患者（涵盖特发性肾病综合征（idiopathic nephrotic syndrome）、局灶节段性肾小球硬化症（focal segmental glomerulosclerosis）、IgA血管炎（IgA vasculitis）或伴肾炎的系统性红斑狼疮（systemic lupus erythematosus）患者）中评估肺炎球菌疫苗免疫原性的相关研究开展范围综述（scoping review）。我们对患者基线特征、所检测的血清型（serotypes）以及血清保护率（seroprotection）和/或血清转换率（seroconversion）进行了汇总分析。随后，我们借助Merative MarketScan® 商业理赔与就诊数据库，对2010-2018年间新发确诊肾小球疾病后12个月内，患者完成充分、部分及未充分接种肺炎球菌疫苗（13价肺炎球菌结合疫苗（PCV13）和/或23价肺炎球菌多糖疫苗（PPSV23））的比例进行了描述性分析。
结果：本研究共筛选得到879篇文献，其中63项研究经纳入标准审查后入选，最终纳入分析的研究共19项。尽管各项研究对血清保护率的定义差异显著，但多数研究均报告了具有临床意义的血清保护率水平。在商业医疗理赔数据分析中，共识别出1343名2~11岁新发肾小球疾病患儿，以及19987名12~<65岁的新发肾小球疾病患者。在确诊肾小球疾病前未充分接种疫苗的人群中，2~11岁组有4.0%（38/947）、12~<65岁组有6.8%（797/11646）在确诊后12个月内完成了部分或充分的肺炎球菌疫苗接种。与肺炎球菌疫苗接种人群相关的常见人口学及临床因素包括性别、年龄、地区以及既往流感疫苗接种史。
结论：目前针对肾小球疾病患者的肺炎球菌疫苗免疫原性相关研究文献仍较为匮乏。肺炎球菌疫苗血清保护率与血清转换率的报告指标亟需统一标准化。肾小球疾病确诊后肺炎球菌疫苗的医疗理赔数据显示，亟需采取措施提升该人群的及时疫苗接种覆盖率。