Tetanus toxoid immunization to reduce mortality from neonatal tetanus
Tetanus toxoid immunization to reduce mortality from neonatal tetanus
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DOI：
10.1093/ije/dyq027
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发表时间：
2010-04-01
影响因子：
7.7
通讯作者：
Cousens, Simon
中科院分区：
文献类型：
--
作者：
Blencowe, Hannah;Lawn, Joy;Cousens, Simon
背景新生儿破伤风仍然是全球新生儿死亡的一个重要和可预防的原因。据报道，在破伤风类毒素免疫接种覆盖率大幅提高后，新生儿破伤风死亡率大幅下降，但令人惊讶的是，破伤风类毒素免疫对死亡率影响的证据水平很低，Cochrane综述中只考虑了两项试验。目的回顾和评价孕妇、育龄妇女接种破伤风类毒素对新生儿破伤风死亡率的影响。方法对多个数据库进行系统回顾。使用了标准化的抽象形式。个体研究质量和证据的整体质量采用GRADE方法进行评估。进行meta分析。结果仅有1项随机对照试验（RCT）和1项对照良好的队列研究符合meta分析的纳入标准。据估计，孕妇或育龄妇女接种至少两剂破伤风类毒素可使新生儿破伤风死亡率降低94%[95%置信区间（Cl） 80-98%]。此外，另一项基于死亡日期的病例定义的随机对照试验、3项病例对照研究和1项前后研究得出了一致的结果。基于死亡率数据的一致性、非常大的效应量以及数据均来自低收入/中等收入国家，该证据的总体质量被判定为中等。结论本综述采用标准方法对破伤风类毒素免疫对新生儿破伤风的高影响进行了透明的评估。
Background Neonatal tetanus remains an important and preventable cause of neonatal mortality globally. Large reductions in neonatal tetanus deaths have been reported following major increases in the coverage of tetanus toxoid immunization, yet the level of evidence for the mortality effect of tetanus toxoid immunization is surprisingly weak with only two trials considered in a Cochrane review.Objective To review the evidence for and estimate the effect on neonatal tetanus mortality of immunization with tetanus toxoid of pregnant women, or women of childbearing age.Methods We conducted a systematic review of multiple databases. Standardized abstraction forms were used. Individual study quality and the overall quality of evidence were assessed using an adaptation of the GRADE approach. Meta-analyses were performed.Results Only one randomised controlled trial (RCT) and one well-controlled cohort study were identified, which met inclusion criteria for meta-analysis. Immunization of pregnant women or women of childbearing age with at least two doses of tetanus toxoid is estimated to reduce mortality from neonatal tetanus by 94% [95% confidence interval (Cl) 80-98%]. Additionally, another RCT with a case definition based on day of death, 3 case control studies and I before-and-after study gave consistent results. Based on the consistency of the mortality data, the very large effect size and that the data are all from low/middle-income countries, the overall quality of the evidence was judged to be moderate.Conclusion This review uses a standard approach to provide a transparent estimate of the high impact of tetanus toxoid immunization on neonatal tetanus.