Benefit-risk analysis of health benefits of routine childhood immunisation against the excess risk of SARS-CoV-2 infections during the COVID-19 pandemic in Africa
Benefit-risk analysis of health benefits of routine childhood immunisation against the excess risk of SARS-CoV-2 infections during the COVID-19 pandemic in Africa
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非洲 COVID-19 大流行期间常规儿童免疫接种对预防 SARS-CoV-2 感染过度风险的健康益处的效益-风险分析
DOI：
10.1101/2020.05.19.20106278
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Abbas K
中科院分区：
文献类型：
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作者：
Abbas K
由于严重的卫生系统限制和为缓解持续的COVID-19大流行而采取的保持身体距离措施，全球国家免疫规划面临暂停的风险。我们的目的是比较在非洲维持常规儿童免疫接种的健康效益与通过访问常规疫苗接种服务点感染SARS-CoV-2的风险。方法采用两种情景来估计COVID-19暴发期间免疫覆盖率下降可能导致的儿童死亡。首先，我们使用了先前报道的针对儿童接种白喉、破伤风、百日咳、乙型肝炎、乙型流感嗜血杆菌、肺炎球菌、轮状病毒、麻疹、甲型脑膜炎、风疹和黄热病（DTP3、HepB3、Hib3、PCV3、RotaC、MCV1、MCV2、MenA、RCV、YFV）疫苗的国别儿童死亡率影响估计，以估计在没有开展追赶运动的6个月COVID-19风险期通过常规儿童疫苗接种在5岁前避免的未来死亡。其次，我们分析了另一种情景，该情景将维持常规儿童免疫接种的健康效益与COVID-19风险期间因麻疹暴发而避免的儿童死亡相提并论。由于在免疫接种期间额外接触SARS-CoV-2而导致的额外感染人数假定，在COVID-19风险期间，减少接触的干预措施使爆发曲线变平，到该时期结束时，60%的人口将被感染，儿童可能被接种人员感染，也可能在运输过程中感染，一旦儿童感染，整个家庭都将被感染。然后，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可归因于疫苗接种诊所就诊的死亡人数。我们提出了常规儿童免疫接种的收益-风险比以及概率敏感性分析的95%不确定性范围估计。在非洲，在常规疫苗接种诊所就诊期间，每增加一例因SARS-CoV-2感染而导致的COVID-19死亡，通过维持常规儿童免疫接种，就可避免84例（14-267）儿童死亡。接种疫苗的儿童、兄弟姐妹、父母或成年照顾者以及接种疫苗儿童家庭中的老年人的受益风险比分别为85,000（4,900 - 54.6万）、75,000（4,400 - 48.3万）、769（148 - 2,700）和96（14 - 307）。在另一种情况下，根据这些高度保守的假设，对接种疫苗的儿童家庭的利益风险比为3(0 - 10)，如果只考虑对接种疫苗的儿童的风险，则利益风险比为3,000（182 - 21,000）。我们的分析表明，在非洲，通过维持常规儿童免疫接种预防死亡的健康益处远远超过与疫苗接种诊所就诊相关的COVID-19死亡的超额风险，特别是对接种疫苗的儿童而言。然而，为了在2019冠状病毒病大流行期间维持非洲国家的常规儿童免疫接种，在做出战略决策时还必须考虑其他因素。其中包括COVID-19大流行造成的疫苗供应链问题的后勤限制、免疫接种提供者重新分配到其他重点卫生服务、工作人员中SARS-CoV-2感染造成的卫生保健人员短缺、社区因害怕而不愿前往疫苗接种诊所导致的疫苗接种需求下降……
BackgroundNational 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. Our aim is to compare the health benefits of sustaining routine childhood immunisation in Africa against the risk of acquiring SARS-CoV-2 infections through visiting routine vaccination service delivery points.MethodsWe used two scenarios to approximate the child deaths that may be caused by immunisation coverage reductions during COVID-19 outbreaks. First, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B,Haemophilus influenzaetype b, pneumococcal, rotavirus, measles, meningitis A, rubella, and yellow fever (DTP3, HepB3, Hib3, PCV3, RotaC, MCV1, MCV2, MenA, RCV, YFV) to approximate the future deaths averted before completing five years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. Second, we analysed an alternative scenario that approximates the health benefits of sustaining routine childhood immunisation to only the child deaths averted from measles outbreaks during the COVID-19 risk period. The excess number of infections due to additional SARS-CoV-2 exposure during immunisation visits assumes that contact reducing interventions flatten 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 would be infected. Country specific household age structure estimates and age dependent infection fatality rates are then applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit-risk ratios for routine childhood immunisation alongside 95% uncertainty range estimates from probabilistic sensitivity analysis.FindingsFor every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, there could be 84 (14-267) deaths in children prevented by sustaining routine childhood immunisation in Africa. The benefit-risk ratio for the vaccinated children, siblings, parents or adult care-givers, and older adults in the households of vaccinated children are 85,000 (4,900 - 546,000), 75,000 (4,400 - 483,000), 769 (148 - 2,700), and 96 (14 - 307) respectively. In the alternative 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 - 10) under these highly conservative assumptions and if the risk to only the vaccinated children is considered, the benefit-risk ratio is 3,000 (182 - 21,000).InterpretationOur analysis suggests that the health benefits of deaths prevented by sustaining routine childhood immunisation in Africa far outweighs the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. However, there are other factors that must be considered for strategic decision making to sustain routine childhood immunisation in African countries during the COVID-19 pandemic. These include logistical constraints of vaccine supply chain problems caused by the COVID-19 pandemic, reallocation of immunisation providers to other prioritised health services, healthcare staff shortages caused by SARS-CoV-2 infections among the staff, decreased demand for vaccination arising from community reluctance to visit vaccination clinics for fear …
DOI：
10.3760/cma.j.cn112338-20200427-00659
发表时间：
2020-12
影响因子：
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作者：
Chaolin Huang;Ye-ming Wang;Xing-wang Li;L. Ren;Jianping Zhao;Y. Hu;Li Zhang;Guohui Fan;
通讯作者：
Chaolin Huang;Ye-ming Wang;Xing-wang Li;L. Ren;Jianping Zhao;Y. Hu;Li Zhang;Guohui Fan;
DOI：
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发表时间：
2004
期刊：
--
影响因子：
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作者：
Tariq Banuri
通讯作者：
Tariq Banuri