Use of Vibrio cholerae Vaccine in an Outbreak in Guinea
Use of Vibrio cholerae Vaccine in an Outbreak in Guinea
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DOI：
10.1056/nejmoa1312680
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发表时间：
2014-05-29
影响因子：
158.5
通讯作者：
Grais, Rebecca F.
中科院分区：
文献类型：
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作者：
Luquero, Francisco J.;Grout, Lise;Grais, Rebecca F.
使用疫苗预防和控制霍乱目前正在辩论中。Shanchol是世界卫生组织预先鉴定的两种口服霍乱疫苗之一;然而，它在实地条件下的有效性以及在接种后的头几个月内提供的保护仍然未知。本研究的主要目的是估计短期有效性的两个剂量的山醇作为一个综合应对的一部分，在Africa.METHODSWe霍乱暴发进行了匹配的病例对照研究，在几内亚5月20日和2012年10月19日之间。疑似霍乱病例通过快速检测得到确认，对照组在与病例患者年龄和性别相同的邻居中选择。在双变量和调整后的条件Logistic回归模型中比较病例患者和对照组之间的疫苗接种几率。疫苗有效性计算为（1-比值比）x 100。结果2012年6月8日至10月19日期间，我们在研究中招募了40名病例患者和160名对照进行初步分析。调整潜在的混杂变量后，两个完整剂量的疫苗接种与显着的预防霍乱（有效性，86.6%; 95%置信区间，56.7至95.8; P=0.001）。这项研究提供了证据，支持增加疫苗接种作为应对疫情的一部分。它还支持目前为建立霍乱疫苗储备以供紧急使用而作出的努力，这将加强预防和控制霍乱爆发的战略。（由无国界医生组织资助）
BACKGROUNDThe use of vaccines to prevent and control cholera is currently under debate. Shanchol is one of the two oral cholera vaccines prequalified by the World Health Organization; however, its effectiveness under field conditions and the protection it confers in the first months after administration remain unknown. The main objective of this study was to estimate the short-term effectiveness of two doses of Shanchol used as a part of the integrated response to a cholera outbreak in Africa.METHODSWe conducted a matched case-control study in Guinea between May 20 and October 19, 2012. Suspected cholera cases were confirmed by means of a rapid test, and controls were selected among neighbors of the same age and sex as the case patients. The odds of vaccination were compared between case patients and controls in bivariate and adjusted conditional logistic-regression models. Vaccine effectiveness was calculated as (1-odds ratio) x 100.RESULTSBetween June 8 and October 19, 2012, we enrolled 40 case patients and 160 controls in the study for the primary analysis. After adjustment for potentially confounding variables, vaccination with two complete doses was associated with significant protection against cholera (effectiveness, 86.6%; 95% confidence interval, 56.7 to 95.8; P=0.001).CONCLUSIONSIn this study, Shanchol was effective when used in response to a cholera outbreak in Guinea. This study provides evidence supporting the addition of vaccination as part of the response to an outbreak. It also supports the ongoing efforts to establish a cholera vaccine stockpile for emergency use, which would enhance outbreak prevention and control strategies. (Funded by Medecins sans Frontieres.)