Effectiveness of mass oral cholera vaccination in Beira, Mozambique
Effectiveness of mass oral cholera vaccination in Beira, Mozambique
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DOI：
10.1056/nejmoa043323
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发表时间：
2005-02-24
影响因子：
158.5
通讯作者：
Clemens, JD
中科院分区：
文献类型：
--
作者：
Lucas, MES;Deen, JL;Clemens, JD
背景：新一代口服霍乱疫苗有望改善撒哈拉以南非洲的霍乱控制。然而，在许多受霍乱影响的非洲人口中，人类免疫缺陷病毒(艾滋病毒)感染的高流行率使人们对接种疫苗可能获得的保护水平产生了怀疑。我们评估了重组霍乱毒素B亚单位全细胞灭活霍乱口服疫苗(RBS-WC)在莫桑比克贝拉的大规模免疫方案，该市HIV血清阳性率为20%至30%。方法：2003年12月至2004年1月，我们在贝拉的埃斯特罗市(人口21,818人)采用两剂RBS-WC疫苗方案，对年龄至少两岁的非孕妇进行大规模免疫接种。然后，我们在2004年1月至5月贝拉爆发El Tor Ogawa霍乱期间的一项病例对照研究中评估了疫苗保护。为了评估疫苗保护水平，比较了培养确认的霍乱严重到足以促使他们寻求治疗、年龄和性别匹配的社区对照而没有治疗腹泻的人之间的疫苗接种率。结果：我们评估了43名霍乱患者和172名对照的疫苗效果。接受一剂或多剂RBS-WC疫苗的保护率为78%(95%可信区间，39%至92%；P=0.004)。该疫苗对5岁以下儿童和老年人同样有效。同时进行的一项旨在检测偏见的病例对照研究在同一人群中比较了经治疗的非霍乱腹泻患者和没有腹泻的对照组，发现接种RBS-WC疫苗没有任何保护作用。结论：RBS-WC疫苗对艾滋病毒感染高发的撒哈拉以南非洲城市人口中的临床意义重大的霍乱非常有效。
BACKGROUND:New-generation, orally administered cholera vaccines offer the promise of improved control of cholera in sub-Saharan Africa. However, the high prevalence of human immunodeficiency virus (HIV) infection in many cholera-affected African populations has raised doubts about the level of protection possible with vaccination. We evaluated a mass immunization program with recombinant cholera-toxin B subunit, killed whole-cell (rBS-WC) oral cholera vaccine in Beira, Mozambique, a city where the seroprevalence of HIV is 20 to 30 percent.METHODS:From December 2003 to January 2004, we undertook mass immunization of nonpregnant persons at least two years of age, using a two-dose regimen of rBS-WC vaccine in Esturro, Beira (population 21,818). We then assessed vaccine protection in a case-control study during an outbreak of El Tor Ogawa cholera in Beira between January and May 2004. To estimate the level of vaccine protection, antecedent rates of vaccination were compared between persons with culture-confirmed cholera severe enough to have prompted them to seek treatment and age- and sex-matched neighborhood controls without treated diarrhea.RESULTS:We assessed the effectiveness of the vaccine in 43 persons with cholera and 172 controls. Receipt of one or more doses of rBS-WC vaccine was associated with 78 percent protection (95 percent confidence interval, 39 to 92 percent; P=0.004). The vaccine was equally effective in children younger than five years of age and in older persons. A concurrently conducted case-control study designed to detect bias compared persons with treated, noncholeraic diarrhea and controls without diarrhea in the same population and found no protection associated with receipt of the rBS-WC vaccine.CONCLUSIONS:The rBS-WC vaccine was highly effective against clinically significant cholera in an urban sub-Saharan African population with a high prevalence of HIV infection.