针对2012年在英国流行的百日咳,英国公共卫生机构进行了一项观察性研究,评价在孕妇中使用百日咳疫苗对预防婴儿发生百日咳的有效性。研究发现该疫苗有高度的有效性,可能是由于婴儿的被动抗体和减少母亲暴露所产生的保护作用。

20141025日《柳叶刀》

中文翻译


 

【题目】母亲孕期使用百日咳疫苗的有效性:在英国进行的一项观察性研究

【译文】

背景:在201210月,为了应对横扫英格兰的百日咳流行,一项百日咳疫苗项目在孕妇中开展。我们的目的是评价该疫苗项目在预防婴儿百日咳中的有效性和总体效果。

方法:我们分析了从200811日到2013930日之间,实验室确诊的病例和因百日咳入院的婴儿,并使用了提交到“英格兰公共卫生”的数据以观察疫苗项目的效果,而该数据是加强监视百日咳在英国的情况的一部分。基于“临床实践研究数据链接”的数据,我们通过比较确诊病例母亲的疫苗状况和估计的全国人口中孕妇的疫苗覆盖情况,评价了疫苗的有效性。

结果:每月确诊病例的高峰期是在201210月(1565例),随后在全部年龄组中均下降。2013年的前9个月与2012年相比,小于3个月的婴儿占确诊病例(2012328vs 201372例,-78%95%CI -72-83)和入院病人(2012440例 VS 2013140例,-68%95% -61-74)中的最大部分;发病率在该年龄组也是最高。小于3个月的婴儿也是唯一一个在流行复发之前2013年比2011年病例减少的年龄组(2011118例 vs 201372例)。在2012101日至201393日之间,“临床实践研究数据链接”中包含的26684名妇女分娩了活产儿;本队列妇女在分娩之前,疫苗平均覆盖率是64%。出生于2012101日之后的小于3个月的婴儿,有82人发病并确诊的病例,由此疫苗的有效性是91%95%CI 8495)。如果将病例年龄限制在2个月之内的婴儿后再进行分析,疫苗的有效性是90%95%CI 8295)。

结论:我们对百日咳疫苗项目在英格兰孕妇中的评价是疫苗有高度的有效性。该效果可能是由于婴儿的被动抗体和减少母亲暴露所产生的保护作用。本结果也将为国际政策制定者提供有价值的信息。

 

英文原稿


 

[Title] Effectiveness of maternal pertussis vaccination in England: an observational study.

[Authors] Amirthalingam G, Andrews N, Campbell H, Ribeiro S, Kara E, Donegan K, Fry NK, Miller E,
Ramsay M.

[Abstract]

BACKGROUND: In October, 2012, a pertussis vaccination programme for pregnant women was
introduced in response to an outbreak across England. We aimed to assess the vaccine effectiveness
and the overall effect of the vaccine programme in preventing pertussis in infants.

METHODS: We undertook an analysis of laboratory-confirmed cases and hospital admissions for
pertussis in infants between Jan 1, 2008, and Sept 30, 2013, using data submitted to Public Health
England as part of its enhanced surveillance of pertussis in England, to investigate the effect of the
vaccination programme. We calculated vaccine effectiveness by comparing vaccination status for
mothers in confirmed cases with estimates of vaccine coverage for the national population of pregnant
women, based on data from the Clinical Practice Research Datalink.

FINDINGS: The monthly total of confirmed cases peaked in October, 2012 (1565 cases), and
subsequently fell across all age groups. For the first 9 months of 2013 compared with the same
period in 2012, the greatest proportionate fall in confirmed cases (328 cases in 2012 vs 72 cases
in 2013, -78%, 95% CI -72 to -83) and in hospitalisation admissions (440 admissions in 2012 vs
140 admissions in 2013, -68%, -61 to -74) occurred in infants younger than 3 months, although
the incidence remained highest in this age group. Infants younger than 3 months were also the only
age group in which there were fewer cases in 2013 than in 2011 (118 cases in 2011 vs 72 cases in
2013), before the resurgence. 26 684 women included in the Clinical Practice Research Datalink
had a livebirth between Oct 1, 2012 and Sept 3, 2013; the average vaccine coverage before delivery
based on this cohort was 64%. Vaccine effectiveness based on 82 confirmed cases in infants born from
Oct 1, 2012, and younger than 3 months at onset was 91% (95% CI 84 to 95). Vaccine effectiveness
was 90% (95% CI 82 to 95) when the analysis was restricted to cases in children younger than 2 months.

INTERPRETATION: Our assessment of the programme of pertussis vaccination in pregnancy in England
is consistent with high vaccine effectiveness. This effectiveness probably results from protection of infants
by both passive antibodies and reduced maternal exposure, and will provide valuable information to
international policy makers.

 

 

原文链接:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60686-3/abstract

 

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