Comparison of Accelerated and Standard Hepatitis B Vaccination Schedules in High-Risk Healthy Adults: A Meta-Analysis of Randomized Controlled Trials
Comparison of Accelerated and Standard Hepatitis B Vaccination Schedules in High-Risk Healthy Adults: A Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1371/journal.pone.0133464
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发表时间：
2015-07-21
期刊：
影响因子：
3.7
通讯作者：
Liu, Pei
中科院分区：
文献类型：
--
作者：
Jin, Hui;Tan, Zhaoying;Liu, Pei
选择最有效的疫苗接种计划是一个重要的问题。目的评价健康高危成人加快乙肝疫苗接种计划的利、弊影响。方法：我们检索Cochrane图书馆对照试验注册库以及MEDLINE、EMBASE、中国技术期刊VIP数据库和中国国家知识基础设施数据库，检索截至2013年12月发表的比较成人加速乙肝疫苗接种计划与标准疫苗接种计划的随机对照试验。结果以95%置信区间的相对危险度表示。采用固定或随机效应模型进行分析。结果我们确定了10个随机试验，所有试验都有一个或多个方法学上的弱点。与标准计划相比，大多数加速计划导致健康疫苗的比例更高，更快地达到抗乙型肝炎抗体水平（P0.05）。虽然加速计划在初始疫苗剂量后第一个月产生的抗乙型肝炎水平高于标准计划，但在6个月后显著低于标准计划，除了要求在初始剂量12个月后进行第四次加强注射的加速计划。接种加速疫苗方案的受试者与接种标准方案的受试者在接种前6个月的依从率相似（相对风险= 1.00,95%置信区间：0.84-1.21）。结论对于高危人群，加快疫苗接种计划可快速实现血清转化和几乎即时的短期保护。然而，有必要进一步研究加速计划初级剂量的长期保护作用和有效性。
BackgroundSelecting the most efficient vaccination schedule is an important issue. Objective To assess the beneficial and harmful effects of accelerated hepatitis B vaccination schedules in high-risk healthy adults.MethodsWe searched controlled trial registers of The Cochrane Library as well as MEDLINE, EMBASE, VIP Database for Chinese Technical Periodicals, and the Chinese National Knowledge Infrastructure databases for randomized controlled trials published up to December 2013 that compared accelerated hepatitis B vaccine schedules to the standard schedule in adults. The results were presented as relative risk with 95% confidence intervals. Fixed or random effect models were used for analysis.ResultsWe identified 10 randomized trials, all with one or more methodological weaknesses. Compared to the standard schedule, most accelerated schedules resulted in higher proportions of healthy vaccines more rapidly reaching anti-hepatitis B antibody levels >10 IU/L (P0.05). Although accelerated schedules produced anti-hepatitis B levels higher than the standard schedule for the first month after the initial vaccine dose, they were significantly lower than the standard schedule after 6 months, except for an accelerated schedule that called for a fourth booster injection 12 months after the initial dose. Subjects administered accelerated vaccine schedules had similar compliance rate as those administered the standard schedule over the first 6 months of vaccination (relative risk = 1.00, 95% confidence interval: 0.84-1.21).ConclusionFor rapid seroconversion and almost immediate short-term protection, accelerated vaccination schedules could be useful for at-risk groups. However, additional studies on the longterm protection and effectiveness of the primary doses of accelerated schedules are necessary.