Effectiveness of Non-Adjuvanted Pandemic Influenza A Vaccines for Preventing Pandemic Influenza Acute Respiratory Illness Visits in 4 US Communities
Effectiveness of Non-Adjuvanted Pandemic Influenza A Vaccines for Preventing Pandemic Influenza Acute Respiratory Illness Visits in 4 US Communities
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DOI：
10.1371/journal.pone.0023085
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发表时间：
2011-08-12
期刊：
影响因子：
3.7
通讯作者：
Shay, David K.
中科院分区：
文献类型：
--
作者：
Griffin, Marie R.;Monto, Arnold S.;Shay, David K.
我们评估了大流行期间美国市场上提供的四种单价甲型H1N1流感疫苗(三种未加佐剂灭活疫苗，一种减毒活疫苗)的有效性。四个合作机构的住院和门诊机构就诊的急性呼吸道疾病患者被前瞻性招募、同意并进行流感检测。分析被限制在2009年10月至2010年4月，那时大流行疫苗可用。实时RT-PCR检测大流行性流感阳性的患者为病例；检测为阴性的患者为对照组。疫苗有效性是在Logistic回归模型中估计的，这些模型根据研究社区、患者年龄、患病时间、保险状况、登记地点和存在高风险医疗条件进行了调整。在6757名登记的患者中，有1011人(15%)检测到大流行病毒。在1011例流感阳性病例中有15例(1%)和5746例检测阴性对照中的1042例(18%)在发病前14天接受了经记录核实的大流行疫苗接种。大流行疫苗的调整后有效性(95%可信区间)为56%(-23%，75%)。仅灭活疫苗的调整有效率(占总数的79%)总体为62%(25%，81%)，在0.5至9岁、10至49岁和50岁以上的人群中分别为32%(-92%，76%)、89%(15%，99%)和-6%(-231%，66%)。减毒活疫苗在2至49岁人群中的有效性只有在发病前14天考虑接种>；7而不是>；(61%：12%，82%)。灭活的无佐剂大流行疫苗对年轻人中确诊的大流行性流感相关的医疗护理就诊提供了重大保护。
We estimated the effectiveness of four monovalent pandemic influenza A (H1N1) vaccines (three unadjuvanted inactivated, one live attenuated) available in the U.S. during the pandemic. Patients with acute respiratory illness presenting to inpatient and outpatient facilities affiliated with four collaborating institutions were prospectively recruited, consented, and tested for influenza. Analyses were restricted to October 2009 through April 2010, when pandemic vaccine was available. Patients testing positive for pandemic influenza by real-time RT-PCR were cases; those testing negative were controls. Vaccine effectiveness was estimated in logistic regression models adjusted for study community, patient age, timing of illness, insurance status, enrollment site, and presence of high-risk medical conditions. Pandemic virus was detected in 1,011 (15%) of 6,757 enrolled patients. Fifteen (1%) of 1,011 influenza positive cases and 1,042 (18%) of 5,746 test-negative controls had record-verified pandemic vaccination > 14 days prior to illness onset. Adjusted effectiveness (95% confidence interval) for pandemic vaccines combined was 56% (-23%, 75%). Adjusted effectiveness for inactivated vaccines alone (79% of total) was 62% (25%, 81%) overall and 32% (-92%, 76%), 89% (15%, 99%), and -6% (-231%, 66%) in those aged 0.5 to 9, 10 to 49, and 50+ years, respectively. Effectiveness for the live attenuated vaccine in those aged 2 to 49 years was only demonstrated if vaccination >7 rather than >14 days prior to illness onset was considered (61%: 12%, 82%). Inactivated non-adjuvanted pandemic vaccines offered significant protection against confirmed pandemic influenza-associated medical care visits in young adults.