Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study
Protective efficacy of a monovalent oral type 1 poliovirus vaccine: a case-control study
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DOI：
10.1016/s0140-6736(07)60531-5
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发表时间：
2007-04-21
期刊：
影响因子：
168.9
通讯作者：
Aylward, R. Bruce
中科院分区：
文献类型：
--
作者：
Grassly, Nicholas C.;Wenger, Jay;Aylward, R. Bruce
背景2005年开发了一种高效单价口服1型脊髓灰质炎病毒疫苗（mOPV 1），以应对最后剩余的感染国家中持续的脊髓灰质炎病毒传播。我们的目的是评估这种疫苗在印度的有效性。方法我们评估了在印度由1型野生脊髓灰质炎病毒引起的脊髓灰质炎确诊病例和非脊髓灰质炎急性弛缓性麻痹病例的2076对配对病例对照中用于补充免疫活动的mOPV 1的有效性。根据非脊髓灰质炎急性弛缓性麻痹数据的疫苗接种覆盖率估计数，计算了引进mOPV 1对人群免疫力的影响。在北方邦持续性脊髓灰质炎病毒传播的地区，估计每剂mOPV 1对1型麻痹性疾病的保护效力为30%（95%CI 19-41），而三价口服疫苗的保护效力为11%（7-14）。据估计，2006年底，76-82%的0-23个月儿童通过接种1型脊髓灰质炎病毒疫苗得到保护，而在2004年底，即采用1型脊髓灰质炎疫苗之前，这一比例为59%。在减毒活口服脊髓灰质炎病毒疫苗的效力受到腹泻和其他感染的高流行率的损害的情况下，一剂高效mOPVl对1型脊髓灰质炎疾病的效力几乎是三价疫苗的三倍。在脊髓灰质炎病毒持续传播地区实现这种新疫苗的高覆盖率应能大大提高迅速消除该疾病传播的可能性。
Background A high-potency monovalent oral type 1 poliovirus vaccine (mOPV1) was developed in 2005 to tackle persistent poliovirus transmission in the last remaining infected countries. Our aim was to assess the efficacy of this vaccine in India. Methods We estimated the efficacy of mOPVl used in supplementary immunisation activities from 2076 matched case-control pairs of confirmed cases of poliomyelitis caused by type 1 wild poliovirus and cases of non-polio acute flaccid paralysis in India. The effect of the introduction of mOPVl on population immunity was calculated on the basis of estimates of vaccination coverage from data for non-polio acute flaccid paralysis. Findings In areas of persistent poliovirus transmission in Uttar Pradesh, the protective efficacy of mOPVl was estimated to be 30% (95% CI 19-41) per dose against type 1 paralytic disease, compared with 11% (7-14) for the trivalent oral vaccine. 76-82% of children aged 0-23 months were estimated to be protected by vaccination against type 1 poliovirus at the end of 2006, compared with 59% at the end of 2004, before the introduction of mOPV1. Interpretation Under conditions where the efficacy of live-attenuated oral poliovirus vaccines is compromised by a high prevalence of diarrhoea and other infections, a dose of high-potency mOPVl is almost three times more effective against type 1 poliomyelitis disease than is trivalent vaccine. Achieving high coverage with this new vaccine in areas of persistent poliovirus transmission should substantially improve the probability of rapidly eliminating transmission of the disease.