Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys
Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys
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DOI：
10.1093/aje/kwv125
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发表时间：
2015-11-01
影响因子：
5
通讯作者：
Canning, David
中科院分区：
文献类型：
--
作者：
McGovern, Mark E.;Canning, David
根据具有校准感染参数、病死率和疫苗功效的模型，估计儿童基本疫苗接种具有很高的成本效益。我们直接根据调查数据估计了疫苗接种与死亡率的关联。我们利用 149 项横断面人口统计和健康调查，确定了调查群体层面的疫苗接种覆盖率与出生至 5 岁之间死亡概率之间的关系。我们的数据包括来自 62 个国家的 68,490 个集群中的约 100 万儿童。我们考虑了儿童麻疹、卡介苗、白喉-百日咳-破伤风、脊髓灰质炎和孕产妇破伤风疫苗接种。使用修正的泊松回归来估计每个集群中儿童死亡率的相对风险，我们还调整了由于未报告死亡儿童的疫苗接种状况而导致的选择偏差。儿童疫苗接种，特别是麻疹和破伤风疫苗接种，与儿童死亡率的大幅降低有关。我们估计，疫苗接种完全覆盖的聚集区儿童的相对死亡风险是未接种疫苗的聚集区儿童的 0.73（95% 置信区间：0.68，0.77）倍。尽管广泛使用，但在许多国家基本疫苗的覆盖率仍然远低于 100%，我们的结果强调了提高覆盖率对于降低儿童死亡率的有效性。
Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guerin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality.