Early Evidence of Inactivated Enterovirus 71 Vaccine Impact Against Hand, Foot, and Mouth Disease in a Major Center of Ongoing Transmission in China, 2011-2018: A Longitudinal Surveillance Study
Early Evidence of Inactivated Enterovirus 71 Vaccine Impact Against Hand, Foot, and Mouth Disease in a Major Center of Ongoing Transmission in China, 2011-2018: A Longitudinal Surveillance Study
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DOI：
10.1093/cid/ciz1188
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发表时间：
2020-12-15
影响因子：
11.8
通讯作者：
Remais, Justin, V
中科院分区：
文献类型：
--
作者：
Head, Jennifer R.;Collender, Philip A.;Remais, Justin, V
背景肠道病毒71型（EV71）是手足口病（HFMD）的主要病原体，与疾病的严重表现相关。2016年，包括中国在内的亚太地区启动了EV71灭活疫苗的儿科免疫接种。我们分析了一个时间序列的手足口病病例归因于EV71，柯萨奇病毒A16（CA16），和其他肠道病毒在成都，在中国的主要传播中心，以评估免疫接种的早期影响。报告的手足口病病例来自中国法定报告疾病监测系统。我们比较了2017 - 2018年期间观察到的疫苗接种后发病率与负二项回归和随机森林模型拟合疫苗接种前年份（2011 - 2015年）的反事实预测。我们将一个变点模型拟合到完整的时间序列中，以评估EV71型手足口病在接种疫苗后的趋势是否发生了变化。在2011年至2018年期间，研究地区报告了279352例手足口病病例。2017 - 2018年EV71手足口病的平均发病率比没有免疫接种的预测低60%（95%预测区间[PI]，41%-72%），相当于估计在2年内避免了6911例EV71病例（95% PI，3246 - 11542）。重症手足口病病例比预测减少52%（95%PI，42%-60%）。然而，2018年非CA16和非EV71手足口病的发病率有所上升。我们发现EV71型手足口病在接种疫苗后4个月内呈显著下降趋势。我们提供了第一个真实世界的证据，针对EV71的程序性疫苗接种对儿童手足口病是有效的，并提出了一种方法来检测早期疫苗的影响或预期的后果，从监测数据。
Background. Enterovirus 71 (EV71) is a major causative agent of hand, foot, and mouth disease (HFMD), associated with severe manifestations of the disease. Pediatric immunization with inactivated EV71 vaccine was initiated in 2016 in the Asia-Pacific region, including China. We analyzed a time series of HFMD cases attributable to EV71, coxsackievirus A16 (CA16), and other enteroviruses in Chengdu, a major transmission center in China, to assess early impacts of immunization.Methods. Reported HFMD cases were obtained from China's notifiable disease surveillance system. We compared observed postvaccination incidence rates during 2017-2018 with counterfactual predictions made from a negative binomial regression and a random forest model fitted to prevaccine years (2011-2015). We fit a change point model to the full time series to evaluate whether the trend of EV71 HFMD changed following vaccination.Results. Between 2011 and 2018, 279 352 HFMD cases were reported in the study region. The average incidence rate of EV71 HFMD in 2017-2018 was 60% (95% prediction interval [PI], 41%-72%) lower than predicted in the absence of immunization, corresponding to an estimated 6911 (95% PI, 3246-11 542) EV71 cases averted over 2 years. There were 52% (95% PI, 42%-60%) fewer severe HFMD cases than predicted. However, the incidence rate of non-CA16 and non-EV71 HFMD was elevated in 2018. We identified a significant decline in the trend of EV71 HFMD 4 months into the postvaccine period.Conclusions. We provide the first real-world evidence that programmatic vaccination against EV71 is effective against childhood HFMD and present an approach to detect early vaccine impact or intended consequences from surveillance data.