Understanding reduced rotavirus vaccine efficacy in low socio-economic settings.
Understanding reduced rotavirus vaccine efficacy in low socio-economic settings.
复制标题
DOI：
10.1371/journal.pone.0041720
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Parashar UD
中科院分区：
文献类型：
--
作者：
Lopman BA;Pitzer VE;Sarkar R;Gladstone B;Patel M;Glasser J;Gambhir M;Atchison C;Grenfell BT;Edmunds WJ;Kang G;Parashar UD
轮状病毒疫苗的有效性范围从高社会经济环境（SES）中的>90%到低SES中的50%。随着轮状病毒疫苗即将在低SES国家引入，了解在这些环境中效力降低的原因可以确定提高疫苗性能的策略。我们开发了一个数学模型来预测轮状病毒疫苗在高，中，低SES的发病率，自然感染和免疫反应的保护赋予每一个设置的基础上的数据的基础上的有效性。然后，我们研究了影响疗效的因素。在高、中、低SES人群中，预测接种疫苗可分别预防93%、86%和51%的严重轮状病毒胃肠炎。还预测，疫苗对严重疾病最有效，并且在低而不是高SES中随着年龄的增长而下降。疫苗接种的免疫原性降低和自然感染带来的保护性降低是影响低SES患者疗效的主要因素。在低社会经济地位的非原发性自然感染中，持续存在的严重疾病风险是轮状病毒疫苗有效性降低的关键因素。预测的疗效与观察到的不同SES的临床试验结果显著一致，验证了模型。疫苗效力降低的现象可以通过低SES人群的内在免疫学和流行病学因素来预测。修改疫苗的某些方面（例如，在低SES中提高免疫原性）和疫苗接种程序（例如，额外剂量）可能会带来改善。
Rotavirus vaccine efficacy ranges from >90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements.
登录
查看更多内容
影响因子：
8
作者：
Boom, Julie A.;Tate, Jacqueline E.;Parashar, Umesh D.
通讯作者：
Parashar, Umesh D.
影响因子：
105.7
作者：
de Palma, Orbelina;Cruz, Lilian;Patel, Manish
通讯作者：
Patel, Manish
影响因子：
120.7
作者：
Patel, Manish;Pedreira, Cristina;Parashar, Umesh
通讯作者：
Parashar, Umesh
影响因子：
5.5
作者：
Atchison, Christina;Lopman, Ben;Edmunds, William John
通讯作者：
Edmunds, William John
影响因子：
168.9
作者：
Armah, George E.;Sow, Samba O.;Neuzil, Kathleen M.
通讯作者：
Neuzil, Kathleen M.