BACKGROUND Despite high vaccine coverage rates in children and efficacy of pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) episodes due to serotypes included in the vaccine following completion of the recommended course of immunisation (i.e. vaccine failure) have been reported. METHODS We used data gathered from a population-based enhanced passive surveillance for IPD in children under 18 years of age in Massachusetts and an ensemble model composed of three machine-learning algorithms to predict probability of 13-valent pneumococcal conjugated vaccine (PCV13) failure and to evaluate potential associated features including age, underlying comorbidity, clinical presentation, and vaccine schedule. Vaccine failure was defined as diagnosis of IPD due to vaccine serotype (VST), in a child who received age recommended doses recommended by Advisory Committee of Immunization Practices. RESULTS During the 7-year study period, between April 01, 2010 and March 31, 2017, we identified 296 IPD cases. There were 107 (36%) IPD cases caused by VST, mostly serotype 19A (49, 17%), 7F (21, 7%), and 3 (18, 6%). Thirty-seven (34%) were in children who were completely vaccinated representing 13% of all IPD cases. Vaccine failure was more likely among children older than 60 months (predicted probability 0.40, observed prevalence 0.37, model prediction accuracy 79%), children presenting with pneumonia (predicted probability 0.27, observed prevalence 0.31, model accuracy 77%), and children with underlying comorbidity (predicted probability 0.24, observed prevalence 0.23, model accuracy 96%). Vaccine failure probability for those >60 months of age and had an underlying risk factor was 45% (observed prevalence 0.33, model accuracy 82%). The likelihood of vaccine failure was lowest among children who had completed 3 primary doses plus one booster dose PCV13 (predicted probability 0.14, observed prevalence 0.14, model prediction accuracy 100%). CONCLUSION PCV13 vaccine failure is more frequent among older children with underlying comorbidity, and among those who present with pneumococcal pneumonia. Our study provides a preliminary framework to predict the patterns of vaccine failures and may contribute to decision-making processes to optimize PCV immunization schedules.

中文翻译：

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谁有发生13价结合肺炎球菌疫苗失败的风险？

背景技术尽管在儿童中疫苗覆盖率很高，而且肺炎球菌结合疫苗的疗效很高，但已经报道了在完成建议的免疫过程（即疫苗失败）后，疫苗中所含血清型引起的侵袭性肺炎球菌疾病（IPD）发作。方法我们使用了来自马萨诸塞州18岁以下儿童的基于人群的IPD被动增强监控收集的数据以及由三种机器学习算法组成的集成模型，以预测13价肺炎球菌结合疫苗（PCV13）失败和评估潜在的相关特征，包括年龄，潜在合并症，临床表现和疫苗接种时间表。疫苗失败定义为由于疫苗血清型（VST）导致的IPD诊断，接受了免疫实践咨询委员会建议的推荐剂量的儿童。结果在为期7年的研究期内，从2010年4月1日到2017年3月31日，我们确定了296例IPD病例。VST引起的IPD病例为107（36％），主要是血清型19A（49，17％），7F（21，7％）和3（18，6％）。完全接种疫苗的儿童中有三十七名（34％），占所有IPD病例的13％。60个月以上儿童的疫苗接种失败可能性更高（预测概率为0.40，观察到患病率为0.37，模型预测准确性为79％），患有肺炎的儿童（预测概率为0.27，观察到患病率0.31，模型准确性为77％）和合并症（预测概率0.24，观察患病率0.23，模型准确性96％）。那些>的疫苗失败概率 60个月大时，其潜在危险因素为45％（观察患病率0.33，模型准确性82％）。在完成3个主要剂量加1个加强剂量PCV13的儿童中，疫苗失败的可能性最低（预测概率为0.14，观察到的患病率为0.14，模型预测准确性为100％）。结论PCV13疫苗失败在具有合并症的大龄儿童和出现肺炎球菌性肺炎的儿童中更为常见。我们的研究为预测​​疫苗失败的模式提供了一个初步的框架，并可能有助于优化PCV免疫计划的决策过程。在完成3个主要剂量加1个加强剂量PCV13的儿童中，疫苗失败的可能性最低（预测概率为0.14，观察到的患病率为0.14，模型预测准确性为100％）。结论PCV13疫苗失败在具有合并症的大龄儿童和出现肺炎球菌性肺炎的儿童中更为常见。我们的研究为预测​​疫苗失败的模式提供了一个初步的框架，并可能有助于优化PCV免疫计划的决策过程。在完成3个主要剂量加1个加强剂量PCV13的儿童中，疫苗失败的可能性最低（预测概率为0.14，观察到的患病率为0.14，模型预测准确性为100％）。结论PCV13疫苗失败在具有合并症的大龄儿童和出现肺炎球菌性肺炎的儿童中更为常见。我们的研究为预测​​疫苗失败的模式提供了一个初步的框架，并可能有助于优化PCV免疫计划的决策过程。