Acute Lower Respiratory Infection Among Bacille Calmette-Guerin (BCG)-Vaccinated Children
Acute Lower Respiratory Infection Among Bacille Calmette-Guerin (BCG)-Vaccinated Children
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DOI：
10.1542/peds.2013-2218
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发表时间：
2014-01-01
期刊：
影响因子：
8
通讯作者：
Black, Robert E.
中科院分区：
文献类型：
--
作者：
Hollm-Delgado, Maria-Graciela;Stuart, Elizabeth A.;Black, Robert E.
目的：确定卡介苗（BCG）疫苗接种是否与 5 岁儿童急性下呼吸道感染（ALRI）的风险相关。 方法：使用宏观国际人口和健康调查和联合国儿童基金会多指标类集调查的数据来确定 19 个国家（2005-2010 年）的 58 021 名儿童的主要队列和 93 301 名儿童的次要队列18 个国家的儿童（2000-2007 年）。由训练有素的访谈员在家访期间使用标准化问卷、疫苗接种健康卡审查和健康指标测量来收集信息。 结果：卡介苗疫苗接种与两个队列中疑似 ALRI 的风险降低 17% 至 37% 相关。唯一可以改变 BCG 效果的疫苗或维生素补充剂是白喉-破伤风-百日咳 (DTP；P < .001)。首次接种疫苗的顺序是这一现象的核心（DTP 前的 BCG，调整/倾向评分加权相对风险 [apRR]：0.79，95% 置信区间 [CI]：0.70-0.89；DTP 后的 BCG，apRR：0.82，95% CI：0.71-0.94；DTP 后的 BCG，apRR：1.00， 95% CI: 0.87-1.13），但不是接受 DTP 剂量的数量。其他修改措施包括免疫计划中使用的疫苗株、对饮用水进行氯化、使用燃木燃料炉灶以及拥有牲畜。结论：接种 BCG 疫苗的儿童患疑似 ALRI 的风险显着降低。需要澄清这是否是由于结核病或 ALRI 本身的潜在风险降低所致。
OBJECTIVE: To determine whether Bacille Calmette-Guerin (BCG) vaccination is linked to the risk of acute lower respiratory infection (ALRI) among children,5 years of age.METHODS: Data from Macro International Demographic and Health Surveys and United Nations Children's Fund Multiple Indicator Cluster Surveys were used to identify a primary cohort of 58 021 children in 19 countries (2005-2010) and a secondary cohort of 93 301 children in 18 countries (2000-2007). Information was collected by trained interviewers during home visits using standardized questionnaires, review of vaccination health cards, and measurement of health indicators.RESULTS: BCG vaccination was associated with a 17% to 37% risk reduction for suspected ALRI in both cohorts. The only vaccine or vitamin supplement to modify the effect of BCG was diphtheria-tetanus-pertussis (DTP; P < .001). The order in which the vaccines were first received was central to this phenomena (BCG before DTP, adjusted/propensity score-weighted relative risk [apRR]: 0.79, 95% confidence interval [CI]: 0.70-0.89; BCG with DTP, apRR: 0.82, 95% CI: 0.71-0.94; and BCG after DTP, apRR: 1.00, 95% CI: 0.87-1.13) but not number of DTP doses received. Other modifiers included vaccine strain used in immunization programs, chlorinating drinking water, using wood-burning fuel cook stoves, and owning livestock.CONCLUSIONS: Children vaccinated with BCG had a significantly lower risk of suspected ALRI. Clarification is needed as to whether this is due to reductions in the underlying risk of tuberculosis or ALRI per se.