Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection
Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection
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DOI：
10.1016/52214-109x(20)30308-9
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发表时间：
2020-10-01
影响因子：
34.3
通讯作者：
Flasche, Stefan
中科院分区：
文献类型：
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作者：
Abbas, Kaja;Procter, Simon R.;Flasche, Stefan
背景 由于卫生系统的严重限制和为缓解持续的 COVID-19 大流行而采取的物理疏远措施，全球国家免疫计划面临暂停的风险。我们的目的是比较非洲维持常规儿童免疫接种的健康益处与通过访问常规疫苗接种服务点而感染严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的风险。方法我们考虑了高影响情景和低影响情景，以估算 COVID-19 爆发期间免疫覆盖率下降可能导致的儿童死亡。在高影响情景中，我们使用之前报告的针对白喉、破伤风、百日咳、乙型肝炎、b型流感嗜血杆菌、肺炎链球菌、轮状病毒、麻疹、甲型脑膜炎、风疹和黄热病的儿童免疫接种的具体国家儿童死亡率影响估计值，来估算在 6 个月的 COVID-19 风险期内通过常规儿童疫苗接种避免的未来死亡人数，而无需开展后续活动。在低影响情景中，我们仅根据在 COVID-19 风险期内避免麻疹爆发的儿童死亡来估算维持常规儿童免疫接种的健康益处。我们假设减少接触的干预措施使 COVID-19 风险期的爆发曲线趋于平缓，到该时期结束时 60% 的人口将被感染，儿童可能通过疫苗接种者或在运输过程中被感染，并且一旦儿童感染，整个家庭都将被感染。应用特定国家家庭年龄结构估计值和与年龄相关的感染死亡率来计算因疫苗接种诊所就诊而导致的死亡人数。我们提出了常规儿童免疫接种的获益风险比，其中来自概率敏感性分析的 95% 不确定区间 (UI)。结果在高影响场景中，在非洲，通过维持常规儿童免疫接种，在常规疫苗接种诊所就诊期间，每增加 1 例因 SARS-CoV-2 感染而导致的 COVID-19 死亡，就可以预防 84 例 (95% UI 14-267) 儿童死亡。接种疫苗的儿童的受益风险比为 85 000 (4900-546 000)，其兄弟姐妹（60 岁）的受益风险比为 96 (14-307)。在低影响情景中，健康效益近似于仅避免麻疹爆发的儿童死亡，接种疫苗的儿童家庭的效益风险比为 3 (0.5-10)；如果仅考虑接种疫苗的儿童的风险，则受益风险比为 3000 (182-21000)。 解释 在非洲，通过维持常规儿童免疫接种所预防的死亡超过了与疫苗接种诊所就诊相关的 COVID-19 死亡的超额风险，特别是对于接种疫苗的儿童。非洲应尽可能维持常规儿童免疫接种，同时考虑其他因素，例如后勤限制、人员短缺以及 COVID-19 大流行期间的资源重新分配。版权所有 (C) 2020 作者。由爱思唯尔有限公司出版
Background National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavinis 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points.Methods We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood imtnunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae, rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6 -month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis.Findings In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14-267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit risk ratio for the vaccinated children is 85 000 (4900-546 000), for their siblings (60 years) is 96 (14-307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit risk ratio to the households of vaccinated children is 3 (0.5-10); if the risk to only the vaccinated children is considered, the benefit risk ratio is 3000 (182-21000).Interpretation The deaths prevented by sustaining routine childhood imtnunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.