Effectiveness of pertussis vaccine during outbreaks in schools and centers for disabled children.
Effectiveness of pertussis vaccine during outbreaks in schools and centers for disabled children.
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DOI：
10.1016/s0929-693x(97)83413-6
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发表时间：
1997-08-01
影响因子：
1.8
通讯作者：
Drucker, J
中科院分区：
文献类型：
--
作者：
Baron, S;Grimprel, E;Drucker, J
背景- 随着最近的百日咳疫苗试验，无细胞疫苗的有效性现已众所周知，多组分疫苗的有效性估计为85%。另一方面，全细胞疫苗效力的估计值随所用疫苗的不同而变化，从36%到98%不等。我们评估了法国全细胞百日咳疫苗在学校和残疾儿童中心爆发期间的现场有效性。- 采用回顾性队列研究设计，对1993年至1995年间的4次有限暴发进行了调查。针对以下病例定义评估疫苗有效性（VE）：临床百日咳、实验室确诊百日咳、流行病学确诊百日咳（记录与实验室确诊病例的接触）。通过查阅儿童健康记录簿获得免疫史。整个疫苗接种（4次注射）和部分疫苗接种（1 - 3次注射）的有效性估计为1-（接种疫苗的发病率/未接种疫苗的发病率）。- 一个完整的免疫接种提供了良好的保护，对百日咳的估计VE高于92%，在第四个太阳（84%），其中抗生素预防非常迅速地建立。部分免疫可提供轻度保护（中位数：60%）。- 这些结果与之前在法国医院网络调查中使用筛选方法的全细胞疫苗有效性的报告一致。同样，在塞内加尔进行的一项大型效力试验将其与无细胞二价疫苗进行了比较，估计其效力为96%。这种高效力加上令人满意的疫苗覆盖率导致了法国儿童百日咳目前的流行病学概况：大多数病例发生在6个月龄之前，在学龄儿童中爆发有限，其中许多人未接种疫苗或部分接种疫苗。
Background. - With the recent pertussis vaccine trials, the efficacy of acellular vaccines is now well known, estimated at 85% for multicomponent vaccines. On the other hand, the estimates of whole cell vaccines efficacy varies from 36% to 98% with the different vaccines used. We evaluated the field effectiveness of the French whole cell pertussis vaccine during outbreaks in schools and centers for disabled children.Methods. - Four limited outbreaks between 1993 and 1995 were investigated using a retrospective cohort study design. Vaccine effectiveness (VE) was assessed for the following case definition: clinical pertussis, laboratory-confirmed pertussis, epidemiologically confirmed pertussis (documented contact with a laboratory confirmed case). Immunization history was obtained by reviewing the child health record book. Effectiveness of a whole vaccination (four injections) and of a partial vaccination (one to three injections) were estimated as 1-(attack rare among vaccinated/attack rate among non-vaccinated).Results. - A whole immunization conferred good protection against pertussis with an estimated VE higher than 92% in three surveys, lower in the fourth sun ey (84%) in which antibiotic prophylaxis was set up very rapidly. A partial immunization conferred a mild protection (median: 60%).Conclusions. - These results are consistent with a previous report about the effectiveness of this whole cell vaccine using the screening method in a hospital network survey in France. In the same way, a large efficacy trial in Senegal comparing if with an acellular bivalent vaccine estimated its efficacy at 96%. This high efficacy together with a satisfactory vaccine coverage leads to the current epidemiological profile of pertussis in childhood in France: majority of cases occurring before 6 months of age, limited outbreaks in school children, many of whom being unvaccinated or partially vaccinated.