Trivalent live attenuated intranasal influenza vaccine administered during the 2003-2004 influenza type A (H3N2) outbreak provided immediate, direct, and indirect protection in children
Trivalent live attenuated intranasal influenza vaccine administered during the 2003-2004 influenza type A (H3N2) outbreak provided immediate, direct, and indirect protection in children
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DOI：
10.1542/peds.2006-2836
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发表时间：
2007-09-01
期刊：
影响因子：
8
通讯作者：
Glezen, W. Paul
中科院分区：
文献类型：
--
作者：
Piedra, Pedro A.;Gaglani, Manjusha J.;Glezen, W. Paul
OBJECTIVE.减毒活流感疫苗可在接种疫苗后不久通过先天免疫预防野生型流感疾病。2003-2004年甲型流感（H3 N2）爆发较早，流行毒株的抗原性与疫苗毒株不同。本研究的目的是确定流感爆发期间接种流感疫苗对健康学龄儿童的有效性。在5至18岁的儿童中进行了一项开放标签、非随机、以社区为基础的流感疫苗试验。符合条件的健康儿童接种三价流感减毒活疫苗。对有基础健康状况的儿童接种三价灭活流感疫苗。流感阳性疾病在接种疫苗和未接种疫苗的儿童之间进行了比较。将斯科特和白色健康计划疫苗接种者的急性呼吸道疾病和肺炎及流感发病率与干预社区中符合年龄条件的斯科特和白色健康计划非参与者进行比较。通过比较干预社区和对照社区中Scott和白色健康计划成员的特定年龄段的医疗护理急性呼吸道疾病发生率来评估畜群保护。2003年10月10日至12月30日，我们分别对6569名和1040名儿童接种了1剂三价流感减毒活疫苗或三价流感灭活疫苗（接种覆盖率为31.5%）。流感爆发于2003年10月12日至12月20日。在接种三价减毒活流感疫苗而非三价灭活流感疫苗的儿童中检测到对流感阳性疾病（37.3%）以及肺炎和流感事件（50%）的显著保护。三价减毒活流感疫苗接种者在接种后14天内对流感阳性疾病的保护作用与> 14天相似（10/25 vs 9/30）。在5 - 11岁儿童和35 - 44岁成人中检测到对内科治疗的急性呼吸道疾病的间接有效性。一剂三价减毒活流感疫苗对儿童有效，即使在流感爆发期间接种，并且主要流行的流感病毒与疫苗株的抗原性不同。我们假设三价流感减毒活疫苗通过先天性和适应性免疫机制提供针对流感的保护。
OBJECTIVE. Live attenuated influenza vaccine may protect against wild-type influenza illness shortly after vaccine administration by innate immunity. The 2003-2004 influenza A ( H3N2) outbreak arrived early, and the circulating strain was antigenically distinct from the vaccine strain. The objective of this study was to determine the effectiveness of influenza vaccines for healthy school-aged children when administered during the influenza outbreak.DESIGN/ METHODS. An open-labeled, nonrandomized, community-based influenza vaccine trial was conducted in children 5 to 18 years old. Age-eligible healthy children received trivalent live attenuated influenza vaccine. Trivalent inactivated influenza vaccine was given to children with underlying health conditions. Influenza-positive illness was compared between vaccinated and nonvaccinated children. Medically attended acute respiratory illness and pneumonia and influenza rates for Scott and White Health Plan vaccinees were compared with age-eligible Scott and White Health Plan nonparticipants in the intervention communities. Herd protection was assessed by comparing age-specific medically attended acute respiratory illness rates in Scott and White Health Plan members in the intervention and comparison communities.RESULTS. We administered 1 dose of trivalent live attenuated influenza vaccine or trivalent inactivated influenza vaccine to 6569 and 1040 children, respectively ( 31.5% vaccination coverage), from October 10 to December 30, 2003. The influenza outbreak occurred from October 12 to December 20, 2003. Significant protection against influenza-positive illness ( 37.3%) and pneumonia and influenza events ( 50%) was detected in children who received trivalent live attenuated influenza vaccine but not trivalent inactivated influenza vaccine. Trivalent live attenuated influenza vaccine recipients had similar protection against influenza-positive illness within 14 days compared with > 14 days ( 10 of 25 vs 9 of 30) after vaccination. Indirect effectiveness against medically attended acute respiratory illness was detected in children 5 to 11 and adults 35 to 44 years of age.CONCLUSION. One dose of trivalent live attenuated influenza vaccine was efficacious in children even when administered during an influenza outbreak and when the dominant circulating influenza virus was antigenically distinct from the vaccine strain. We hypothesize that trivalent live attenuated influenza vaccine provides protection against influenza by both innate and adaptive immune mechanisms.