The role of vaccine coverage within social networks in cholera vaccine efficacy.
The role of vaccine coverage within social networks in cholera vaccine efficacy.
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DOI：
10.1371/journal.pone.0022971
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Emch M
中科院分区：
文献类型：
--
作者：
Root ED;Giebultowicz S;Ali M;Yunus M;Emch M
传统的疫苗试验方法有一个基本假设，即疫苗的效果在整个试验区域是相同的。然而，有许多空间和行为因素会改变感染者和易感者之间的接触率，并导致人群中不同的疗效。我们重新分析了孟加拉国实地试验的数据，以确定当个人的社会网络中疫苗接种率较高时，是否有证据表明霍乱疫苗具有间接保护作用。我们分析了在孟加拉国儿童和成年妇女中进行的B亚单位灭活全细胞和灭活全细胞口服霍乱疫苗的安慰剂对照试验的第一年监测数据。我们计算了在控制了潜在的混杂变量后，个体社会网络中的疫苗覆盖水平与个体疫苗接种者或安慰剂接种者的霍乱发病率之间的关系是否存在相反的趋势。使用巴里水平的社会网络关系，我们发现安慰剂接受者中霍乱的发病率与疫苗覆盖率呈负相关（最低五分之一的每1000人中有5.28例，而最高五分之一的每1000人中有3.27例;趋势p=0.037）。 个人接种疫苗和个人社会网络的疫苗覆盖率与霍乱风险降低独立相关。研究结果表明，在巴里级别的社交网络中，疫苗覆盖率的逐步提高可以导致未接种疫苗的个体的间接保护水平的提高，也可以导致疫苗接种者的总体保护水平的逐步提高。
Traditional vaccine trial methods have an underlying assumption that the effect of a vaccine is the same throughout the trial area. There are, however, many spatial and behavioral factors that alter the rates of contact among infectious and susceptible individuals and result in different efficacies across a population. We reanalyzed data from a field trial in Bangladesh to ascertain whether there is evidence of indirect protection from cholera vaccines when vaccination rates are high in an individual's social network. We analyzed the first year of surveillance data from a placebo-controlled trial of B subunit-killed whole-cell and killed whole-cell-only oral cholera vaccines in children and adult women in Bangladesh. We calculated whether there was an inverse trend for the relation between the level of vaccine coverage in an individual's social network and the incidence of cholera in individual vaccine recipients or placebo recipients after controlling for potential confounding variables. Using bari-level social network ties, we found incidence rates of cholera among placebo recipients were inversely related to levels of vaccine coverage (5.28 cases per 1000 in the lowest quintile vs 3.27 cases per 1000 in the highest quintile; p = 0.037 for trend). Receipt of vaccine by an individual and the level of vaccine coverage of the individual's social network were independently related to a reduced risk of cholera. Findings indicate that progressively higher levels of vaccine coverage in bari-level social networks can lead to increasing levels of indirect protection of non-vaccinated individuals and could also lead to progressively higher levels of total protection of vaccine recipients.
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