Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review.
Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review.
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DOI：
10.1136/bmj.i5170
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发表时间：
2016-10-13
期刊：
影响因子：
--
通讯作者：
Reingold AL
中科院分区：
文献类型：
--
作者：
Higgins JP;Soares-Weiser K;López-López JA;Kakourou A;Chaplin K;Christensen H;Martin NK;Sterne JA;Reingold AL
目标 评估卡介苗 (BCG)、白喉-破伤风-百日咳 (DTP) 和标准滴度麻疹疫苗 (MCV) 对 5 岁以下儿童非特异性和全因死亡率的影响；检查研究的内部有效性；并检查性别、年龄、疫苗序列和维生素 A 联合给药的任何改变影响。设计系统审查，包括偏倚风险评估和类似研究的荟萃分析。研究资格标准 关于 BCG、全细胞 DTP 和标准滴度 MCV 对 5 岁以下儿童死亡率影响的临床试验、队列研究和病例对照研究。 数据来源 Medline、Embase、Global Index Medicus 和 WHO 国际临床试验注册平台的搜索，并通过与该领域专家的联系进行补充。为了避免纳入的文章中研究的儿童出现重叠，我们确定了非重叠出生队列的研究结果。结果 确定了 34 个出生队列的结果。大多数证据来自观察性研究，其中一些来自短期临床试验。大多数研究报告了全因（而非非特异性）死亡率。接受 BCG 疫苗与全因死亡率降低相关：五项临床试验的平均相对风险为 0.70（95% 置信区间 0.49 至 1.01），九项高偏倚风险观察研究的平均相对风险为 0.47（0.32 至 0.69）。根据 10 项高偏倚风险的研究，接受 DTP（几乎总是口服脊髓灰质炎疫苗）与平均全因死亡率可能增加有关（相对风险 1.38、0.92 至 2.08）；这种效应在女孩中似乎比男孩更强。接受标准滴度 MCV 与全因死亡率降低相关（四项临床试验的相对风险为 0.74（0.51 至 1.07），18 项高偏倚风险观察研究的相对风险为 0.51（0.42 至 0.63））；这种效应在女孩中似乎比男孩更强。七项被评估为存在高偏倚风险的观察性研究比较了疫苗序列；其中一部分结果表明，与 MCV 之前施用 DTP 相比，在 MCV 的同时或之后施用 DTP 可能会导致更高的死亡率。结论 证据表明，接受 BCG 和 MCV 通过其预防疾病的作用，使总体死亡率降低的幅度超过预期，并且接受 DTP 可能与全因死亡率的增加有关。尽管应努力确保所有儿童按计划接种 BCG、DTP 和 MCV，但仍需要随机试验来比较不同序列的效果。
Objectives To evaluate the effects on non-specific and all cause mortality, in children under 5, of Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), and standard titre measles containing vaccines (MCV); to examine internal validity of the studies; and to examine any modifying effects of sex, age, vaccine sequence, and co-administration of vitamin A. Design Systematic review, including assessment of risk of bias, and meta-analyses of similar studies. Study eligibility criteria Clinical trials, cohort studies, and case-control studies of the effects on mortality of BCG, whole cell DTP, and standard titre MCV in children under 5. Data sources Searches of Medline, Embase, Global Index Medicus, and the WHO International Clinical Trials Registry Platform, supplemented by contact with experts in the field. To avoid overlap in children studied across the included articles, findings from non-overlapping birth cohorts were identified. Results Results from 34 birth cohorts were identified. Most evidence was from observational studies, with some from short term clinical trials. Most studies reported on all cause (rather than non-specific) mortality. Receipt of BCG vaccine was associated with a reduction in all cause mortality: the average relative risks were 0.70 (95% confidence interval 0.49 to 1.01) from five clinical trials and 0.47 (0.32 to 0.69) from nine observational studies at high risk of bias. Receipt of DTP (almost always with oral polio vaccine) was associated with a possible increase in all cause mortality on average (relative risk 1.38, 0.92 to 2.08) from 10 studies at high risk of bias; this effect seemed stronger in girls than in boys. Receipt of standard titre MCV was associated with a reduction in all cause mortality (relative risks 0.74 (0.51 to 1.07) from four clinical trials and 0.51 (0.42 to 0.63) from 18 observational studies at high risk of bias); this effect seemed stronger in girls than in boys. Seven observational studies, assessed as being at high risk of bias, have compared sequences of vaccines; results of a subset of these suggest that administering DTP with or after MCV may be associated with higher mortality than administering it before MCV. Conclusions Evidence suggests that receipt of BCG and MCV reduce overall mortality by more than would be expected through their effects on the diseases they prevent, and receipt of DTP may be associated with an increase in all cause mortality. Although efforts should be made to ensure that all children are immunised on schedule with BCG, DTP, and MCV, randomised trials are needed to compare the effects of different sequences.
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DOI：
10.1111/tmi.12192
发表时间：
2013-11-01
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Krishnan, A;Srivastava, R;Pandav, C S
通讯作者：
Pandav, C S
影响因子：
5
作者：
GREENLAND, S;LONGNECKER, MP
通讯作者：
LONGNECKER, MP
DOI：
10.1093/trstmh/tru186
发表时间：
2015-01-01
影响因子：
2.2
作者：
Aaby, Peter;Nielsen, Jens;Trape, Jean-Francois
通讯作者：
Trape, Jean-Francois
影响因子：
34.3
作者：
Fisker, Ane B.;Hornshoj, Linda;Aaby, Peter
通讯作者：
Aaby, Peter
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N