Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children
Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children
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澳大利亚儿童的百日咳病和产前疫苗的有效性
DOI：
10.1097/inf.0000000000003367
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
N. Wood
中科院分区：
文献类型：
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作者：
H. Quinn;Jeannette L. Comeau;H. Marshall;E. Elliott;N. Crawford;C. Blyth;J. A. Kynaston;T. Snelling;P. Richmond;J. Francis;K. Macartney;P. McIntyre;N. Wood
背景：人群水平上对婴儿期以上的严重百日咳的研究很少，在产前接种方面也没有。我们比较了产前免疫前后出生至15岁的百日咳住院病例。方法：积极监测2012年1月至2019年6月澳大利亚全国儿科医院网络中实验室确认的百日咳住院情况。通过病例和2个月龄试验阴性对照的疫苗效力(VE)和病例年龄分布前后的比较来评估母亲接种疫苗的影响。在有资格接种一剂或多剂疫苗的病例中，我们按年龄组检查了适当接种的年龄和合并疾病的比例。结果：在419例符合条件的病例中，<lt；2个月大婴儿所占比例从2012-2014年间的33.1%显著下降到2016-2019年的19.6%，当时仅有4例(23.5%)<；2个月大婴儿的母亲接受了产前接种。VE估计为84.3%(95%CI，26.1~96.7)。在所有年份(2012年至2019年)，在55例4-11个月龄婴儿中，21例(38%)接种了≥2疫苗，而在155例12个月龄≥婴儿中，122例(85.2%)接种了≥3疫苗。合并症(主要是心肺疾病)的患病率从5个月(2.1%)增加到36(24.2%)≥12个月(P<；0.001)，其中6/16(38%)≥12个月需要重症监护的婴儿合并有合并症。结论：在12个月以下，母亲产前高接种率和婴儿疫苗剂量的及时性将最大限度地预防严重百日咳。尽管进行了全面的免疫接种，但我们发现12个月大的儿童≥占住院人数的27%，其中24%患有合并症，这表明新的疫苗策略，如增加剂量或更多的免疫原性疫苗，需要评估。
Background: Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization. Methods: Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group. Results: Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1–96.7). Across all years (2012–2019), of 55 cases 4–11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities. Conclusions: Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.