Use of oral cholera vaccines in an outbreak in Vietnam: a case control study.
Use of oral cholera vaccines in an outbreak in Vietnam: a case control study.
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DOI：
10.1371/journal.pntd.0001006
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发表时间：
2011-01-25
影响因子：
3.8
通讯作者：
Clemens JD
中科院分区：
文献类型：
--
作者：
Anh DD;Lopez AL;Thiem VD;Grahek SL;Duong TN;Park JK;Kwon HJ;Favorov M;Hien NT;Clemens JD
灭活口服霍乱疫苗（OCV）是可用的，但不用于霍乱控制常规，除了在越南，它生产自己的疫苗。2007-2008年，首都河内爆发了前所未有的霍乱疫情，促使两个地区进行了免疫接种。在一次暴发调查中，我们评估了霍乱暴发后使用灭活OCV的有效性。2008年1月16日至28日，在河内的两个区开展了越南灭活OCV疫苗接种活动。2008年2月5日至3月4日期间没有发现霍乱病例，之后又发现了病例。从2008年4月8日开始，招募河内四个区2008年3月5日之后因急性腹泻而入住五家医院之一的居民进行匹配的、以医院为基础的病例控制暴发调查。病例按医院、入院日期、地区、性别和年龄与因非创伤性疾病入院的对照组相匹配。对来自两个接种区的受试者进行评价，以确定疫苗的有效性。来自接种区的54个病例对照对被纳入分析。在病例组和对照组中分别有8例（15%）和16例（30%）疫苗接种者。在调整狗肉或生蔬菜的摄入量以及大部分时间不饮用煮沸或瓶装水后，疫苗对霍乱的保护率为76%（95%CI 5%至94%，P =0.042）。 这是第一项探讨在霍乱爆发期间反应性使用被杀死的OCV的有效性的研究。我们的研究结果表明，被杀死的OCV可能在控制霍乱爆发方面发挥作用。适当的卫生设施和清洁饮水等简单措施可以阻止霍乱的传播;然而，在没有这些设施的地区，霍乱传播迅速，如果不立即开始治疗，可能在几小时内导致死亡。使用拯救生命的补液疗法是控制霍乱的主要手段，然而，疾病传播速度快，偏远地区获得适当保健单位的机会有限，这些因素共同导致死亡人数令人无法接受。自2001年以来，世卫组织一直建议使用口服霍乱疫苗作为预防霍乱暴发的措施，但最近更新了这一建议，以便一旦霍乱暴发开始，也可以考虑使用疫苗。这项研究的结果表明，反应性使用灭活的口服霍乱疫苗可提供对疾病的保护，并可能成为爆发时的潜在工具。必须进行进一步的研究来证实这些发现。
Killed oral cholera vaccines (OCVs) are available but not used routinely for cholera control except in Vietnam, which produces its own vaccine. In 2007–2008, unprecedented cholera outbreaks occurred in the capital, Hanoi, prompting immunization in two districts. In an outbreak investigation, we assessed the effectiveness of killed OCV use after a cholera outbreak began. From 16 to 28 January 2008, vaccination campaigns with the Vietnamese killed OCV were held in two districts of Hanoi. No cholera cases were detected from 5 February to 4 March 2008, after which cases were again identified. Beginning 8 April 2008, residents of four districts of Hanoi admitted to one of five hospitals for acute diarrhea with onset after 5 March 2008 were recruited for a matched, hospital-based, case-control outbreak investigation. Cases were matched by hospital, admission date, district, gender, and age to controls admitted for non-diarrheal conditions. Subjects from the two vaccinated districts were evaluated to determine vaccine effectiveness. 54 case-control pairs from the vaccinated districts were included in the analysis. There were 8 (15%) and 16 (30%) vaccine recipients among cases and controls, respectively. The vaccine was 76% protective against cholera in this setting (95% CI 5% to 94%, P = 0.042) after adjusting for intake of dog meat or raw vegetables and not drinking boiled or bottled water most of the time. This is the first study to explore the effectiveness of the reactive use of killed OCVs during a cholera outbreak. Our findings suggest that killed OCVs may have a role in controlling cholera outbreaks. Simple measures such as adequate sanitation and clean water stops the spread of cholera; however, in areas where these are not available, cholera spreads quickly and may lead to death in a few hours if treatment is not initiated immediately. The use of life-saving rehydration therapy is the mainstay in cholera control, however, the rapidity of the disease and the limited access to appropriate healthcare units in far-flung areas together result in an unacceptable number of deaths. The WHO has recommended the use of oral cholera vaccines as a preventive measure against cholera outbreaks since 2001, but this was recently updated so that vaccine use may also be considered once a cholera outbreak has begun. The findings from this study suggest that reactive use of killed oral cholera vaccines provides protection against the disease and may be a potential tool in times of outbreaks. Further studies must be conducted to confirm these findings.