Relationship between neighbourhood-level killed oral cholera vaccine coverage and protective efficacy: evidence for herd immunity
Relationship between neighbourhood-level killed oral cholera vaccine coverage and protective efficacy: evidence for herd immunity
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DOI：
10.1093/ije/dyl100
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发表时间：
2006-08-01
影响因子：
7.7
通讯作者：
Clemens, John D.
中科院分区：
文献类型：
--
作者：
Emch, Michael;Ali, Mohammad;Clemens, John D.
疫苗在人群中的有效性必须考虑直接和间接保护。本研究重新分析了1985年至1990年在孟加拉国农村进行的一项大型随机口服霍乱疫苗试验的数据。最近对该试验结果的分析表明，在监测的第一年，家庭群集中接种疫苗的人口比例与安慰剂发病率呈负相关，这归因于群体免疫。在这项研究中，我们在2年的随访期间测量了社区一级口服霍乱疫苗覆盖率与保护效力（PE）之间的关系，控制了已知的效果调节剂。我们将试验数据与家庭地理信息系统连接起来，以方便社区层面的分析。结果在调整生态变量后，疫苗覆盖率可以部分解释社区水平PE。结论疫苗覆盖率与有效性呈反比关系，表明生活在高覆盖率地区的人们可能间接受到霍乱的保护，因为他们周围的人都接种了疫苗。
Objectives The effectiveness of vaccines in populations must consider both direct and indirect protection. This study reanalyses data from a large individually randomized oral cholera vaccine trial that was conducted in rural Bangladesh from 1985 to 1990. A recent analysis of the results of that trial showed that the proportion of people in household clusters who received the vaccine was inversely related to placebo incidence during the first year of surveillance, which was attributed to herd immunity.Methods in this study we measure the relationship between neighbourhood-level oral cholera vaccine coverage and protective efficacy (PE) during a 2 year follow-up period, controlling for known effect modifiers. We link trial data to a household geographic information system to facilitate the neighbourhood-level analysis.Findings Neighbourhood-level PE can be partially explained by vaccine coverage after adjusting for ecological variables.Conclusions The inverse relationship between vaccine coverage and efficacy illustrates that people living in high-coverage areas may be indirectly protected from cholera because people living around them are vaccinated.