Beyond the bombs: cancer risks of low-dose medical radiation.
Beyond the bombs: cancer risks of low-dose medical radiation.
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DOI：
10.1016/s0140-6736(12)60897-6
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发表时间：
2012-08-04
期刊：
影响因子：
168.9
通讯作者：
Einstein, Andrew J.
中科院分区：
文献类型：
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作者：
Einstein, Andrew J.
鼓励在其余三个从未根除该疾病的国家开展根除工作。它显示了仔细检查疫苗接种效果的价值以及优化疫苗接种规划效果的手段。O 'Reilly及其同事1估计单价口服脊髓灰质炎疫苗的每剂量有效性为34.5% (95% CI为16.1 - 48.9)，而二价口服脊髓灰质炎疫苗的每剂量有效性为23.4%(10.4 - 34.6)，三价口服脊髓灰质炎疫苗的每剂量有效性为12.5%(5.6 - 18.8)，这表明，在阿富汗和巴基斯坦接种单价口服脊髓灰质炎疫苗和二价口服脊髓灰质炎疫苗的地方，它们的效果与印度的研究结果一致，它们在根除脊髓灰质炎方面发挥了重要作用。然而，在过去几年中，这些国家的脊髓灰质炎病例数有所上升，这表明没有提供疫苗。考虑到目前的情况，这一发现可能并不令人惊讶，但它确实意味着，如果能够接种疫苗，脊髓灰质炎可能被根除。还有一个问题：考虑到本世纪没有人感染野生2型脊髓灰质炎，继续在疫苗中加入2型成分似乎很奇怪。不包括2型成分和常规使用二价口服脊髓灰质炎疫苗的问题是，疫苗株可能恢复为可传播形式，引起循环疫苗衍生脊髓灰质炎病毒；2型循环疫苗衍生脊髓灰质炎病毒是最常见的，因此出现了数量令人不安的疫情。因此，使用不含2型成分的疫苗可能存在风险。相反，对一种仅由疫苗引起的疾病进行免疫似乎是不可持续的。消灭脊髓灰质炎的最后阶段是有趣的，突出了消灭病毒方面的重要问题，部分原因是大多数感染是无声的，这使得最后的病例难以确定，部分原因是基于病毒生长的疫苗构成的风险，无论其水平多么低，无论是灭活的还是活的。9-12使用适当的疫苗是根除野生型脊髓灰质炎病毒最后病例的关键，但鉴于在印度发生的情况，在世界范围内根除是可能的。
encouragement for eradication efforts in the remaining three countries that have never eradicated the disease. It shows the value of careful examination of the effect of vaccination and the means to optimise the effects of vaccination programmes. O’Reilly and colleagues1 estimate the per-dose effectiveness of monovalent OPV to have been 34· 5%(95% CI 16· 1–48· 9) as compared with 23· 4%(10· 4–34· 6) for bivalent OPV and 12· 5%(5· 6–18· 8) for trivalent OPV, indicating that, where monovalent OPV and bivalent OPV are given in Afghanistan and Pakistan, their effect is consistent with the findings from studies in India where they played such a big part in eradication. However, the number of poliomyelitis cases in these countries has risen in the past few years, suggesting that vaccines are not being delivered. Given the circumstances, this finding might not be surprising but it does imply that if the vaccine could be given, poliomyelitis could be eradicated. There is one additional matter: given that nobody has been infected with wild type 2 poliomyelitis this century, continued inclusion of the type 2 component in vaccines might seem strange. The problem with not including the type 2 component and using bivalent OPV routinely is that the vaccine strains can revert to transmissible forms to cause circulating vaccine-derived poliovirus; 9 type 2 circulating vaccine-derived poliovirus is the most common and there have been an uncomfortable number of outbreaks as a result. 10 Using a vaccine that does not include the type 2 component is therefore probably risky. Conversely, to immunise against a disease that is only caused by the vaccine seems unsustainable. The last stages of poliomyelitis eradication are interesting and highlight important issues in virus eradication, 10 partly because of the silent nature of most infections, which makes the last cases hard to identify, and partly because of the risks that vaccines based on growth of the virus pose, at however low a level and whether inactivated or live. 9–12 The use of suitable vaccines given appropriately is key to the eradication of the last cases attributable to wild type poliovirus but, given what has happened in India, worldwide eradication is possible.