Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival.
Measles vaccination in the presence or absence of maternal measles antibody: impact on child survival.
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DOI：
10.1093/cid/ciu354
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发表时间：
2014-08-15
期刊：
影响因子：
--
通讯作者：
Benn CS
中科院分区：
文献类型：
--
作者：
Aaby P;Martins CL;Garly ML;Andersen A;Fisker AB;Claesson MH;Ravn H;Rodrigues A;Whittle HC;Benn CS
在两剂试验中，在有母体麻疹抗体的情况下，早期接种4-6个月的麻疹疫苗比在没有麻疹抗体的情况下接种疫苗能显著提高5岁的存活率。混杂因素不能解释这种影响。背景： 麻疹疫苗(MV)在婴儿早期接种时对儿童存活率有更大的影响，此时母体抗体可能仍然存在。方法： 为了测试如果在母体麻疹抗体存在的情况下给予MV是否对总存活率有更大的影响，我们重新分析了先前发表的两个随机试验的数据，该试验分别在4-6个月和9个月龄时给予MV。在这两个试验中，在早期接种麻疹疫苗之前都测量了抗体水平。结果： 在试验一(1993年至1995年)中，在有母体抗体的情况下接种MV的儿童死亡率为每千人年0.0人，而没有母体抗体的儿童死亡率为每千人年32.3人(死亡率比为0.0；95%可信区间[CI]为0-0.52)。在试验II(2003-2007年)中，接种母源麻疹抗体的儿童死亡率为4.2/1000人年，未接种麻疹抗体的儿童死亡率为14.5/1000人年(MRR为0.29；95%CI为0.09-0.91)。可能的混杂因素无法解释这种差异。在一项联合分析中，在4-6个月大时接受第一剂MV时检测到麻疹抗体的儿童比没有母体抗体的儿童死亡率更低，4-6个月至5年间的MRR为0.22(95%CI，0.07-0.64)。结论：低收入国家的 儿童死亡率可以通过在有母体抗体的情况下接种麻疹疫苗来降低，使用两剂疫苗，第一剂在4-6个月(比目前推荐的时间更早)，加强剂量在9-12个月大。临床试验注册。 NCT00168558。
In 2-dose trials, early measles vaccination at 4–6 months in presence of maternal measles antibody was associated with significantly better survival to age 5 years than vaccination in absence of measles antibody. Confounding factors did not explain the effect. Background. Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present. Methods. To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4–6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination. Results. In trial I (1993–1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0–.52). In trial II (2003–2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09–.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4–6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07–.64) between 4–6 months and 5 years. Conclusions. Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4–6 months (earlier than currently recommended) and a booster dose at 9–12 months of age. Clinical Trials Registration. NCT00168558.
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DOI：
10.1093/infdis/jit804
发表时间：
2014-06-01
期刊：
The Journal of infectious diseases
影响因子：
--
作者：
Martins CL;Benn CS;Andersen A;Balé C;Schaltz-Buchholzer F;Do VA;Rodrigues A;Aaby P;Ravn H;Whittle H;Garly ML
通讯作者：
Garly ML
影响因子：
105.7
作者：
Martins, Cesario L.;Garly, May-Lill;Aaby, Peter
通讯作者：
Aaby, Peter
影响因子：
2.7
作者：
Jacobson, Robert M.;Ovsyannikova, Irina G.;Poland, Gregory A.
通讯作者：
Poland, Gregory A.
影响因子：
6.4
作者：
Gans, H;Yasukawa, L;Arvin, AM
通讯作者：
Arvin, AM
影响因子：
3.6
作者：
Aaby, P;Garly, ML;Whittle, H
通讯作者：
Whittle, H