The Japanese experience with vaccinating schoolchildren against influenza.
The Japanese experience with vaccinating schoolchildren against influenza.
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DOI：
10.1056/nejm200103223441204
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发表时间：
2001-03-22
影响因子：
158.5
通讯作者：
Tashiro, M
中科院分区：
文献类型：
--
作者：
Reichert, TA;Sugaya, N;Tashiro, M
背景资料：流感流行导致死亡率增加，主要是在老年人和其他高危人群中，在大多数发达国家，流感控制工作的重点是为这一群体接种疫苗。然而，日本曾经将其控制流感的政策建立在为学童接种疫苗的基础上。从1962年到1987年，大部分日本学生都接种了流感疫苗。十多年来，疫苗接种是强制性的，但法律在1987年放宽，并于1994年废除;随后，疫苗接种率下降到低水平。当大多数学龄儿童接种疫苗时，日本可能实现了对流感的群体免疫。如果是这样的话，无论是流感的发病率和死亡率归因于流感应该已经减少老年人。方法：我们分析了每月的死亡率，从所有原因和死亡归因于肺炎和流感，以及人口普查数据和统计接种率为日本和美国从1949年到1998年。对于每个冬天，我们估计每月超过基线水平的死亡人数，定义为11月的平均死亡率。结果：肺炎和流感的超额死亡率以及所有原因的超额死亡率在每个国家都高度相关。在美国，这些比率几乎一直保持不变。随着日本启动学龄儿童疫苗接种计划，超额死亡率从美国的3 ~ 4倍下降到与美国相似的水平。日本儿童的疫苗接种每年防止约37，000至49，000人死亡，即每420名接种疫苗的儿童中约有1人死亡。由于疫苗接种的学童被停止，超额死亡率在日本increased.Conclusions：流感对死亡率的影响是在日本比在美国大得多，可以同样好地衡量在所有原因和死亡归因于肺炎或流感的死亡。为学龄儿童接种流感疫苗可提供保护，并降低老年人流感的死亡率。（N Engl J Med 2001;344：889-96.）版权所有（C）2001马萨诸塞州医学会。
Background: Influenza epidemics lead to increased mortality, principally among elderly persons and others at high risk, and in most developed countries, influenza-control efforts focus on the vaccination of this group. Japan, however, once based its policy for the control of influenza on the vaccination of schoolchildren. From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. When most schoolchildren were vaccinated, it is possible that herd immunity against influenza was achieved in Japan. If this was the case, both the incidence of influenza and mortality attributed to influenza should have been reduced among older persons.Methods: We analyzed the monthly rates of death from all causes and death attributed to pneumonia and influenza, as well as census data and statistics on the rates of vaccination for both Japan and the United States from 1949 through 1998. For each winter, we estimated the number of deaths per month in excess of a base-line level, defined as the average death rate in November.Results: The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased.Conclusions: The effect of influenza on mortality is much greater in Japan than in the United States and can be measured about equally well in terms of deaths from all causes and deaths attributed to pneumonia or influenza. Vaccinating schoolchildren against influenza provides protection and reduces mortality from influenza among older persons. (N Engl J Med 2001;344:889-96.) Copyright (C) 2001 Massachusetts Medical Society.