Pertussis vaccine effectiveness among children 6 to 59 months of age in the United States, 1998-2001
Pertussis vaccine effectiveness among children 6 to 59 months of age in the United States, 1998-2001
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DOI：
10.1542/peds.2004-2759
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发表时间：
2005-08-01
期刊：
影响因子：
8
通讯作者：
Ehresmann, KR
中科院分区：
文献类型：
--
作者：
Bisgard, KM;Rhodes, P;Ehresmann, KR
背景。尽管自20世纪40年代中期全细胞百日咳（白喉-破伤风类毒素-百日咳[DTP]）疫苗获得许可以来，百日咳急剧减少，但百日咳仍在美国流行，并可在任何年龄的人群中引起疾病；bbb2003年报告了11000例百日咳病例。自1996年7月以来，除了已在使用的2种百白破疫苗外，还批准在婴儿中使用5种无细胞百日咳（白喉-破伤风类毒素-无细胞百日咳[DTaP]）疫苗；在研究期间，DTaP疫苗广泛分布。由于三种百日咳疫苗和两种百日咳疫苗的可用性，以及两种疫苗可能交替使用，以推荐的五剂时间表为儿童接种疫苗，因此测量百日咳疫苗的有效性是一个高度优先考虑的问题。测量百日咳疫苗在美国6 - 59个月儿童中的有效性。我们在辛辛那提、俄亥俄州、大都市区、科罗拉多州、爱达荷州和明尼苏达州进行了一项病例对照研究。纳入了1998-2001年发病时6至59个月的儿童确诊百日咳病例。对于每个病例受试者，根据出生日期和居住地，从出生证明记录中匹配5名对照儿童。结果的措施。使用标准化问卷从家长和提供者处获取疫苗接种数据。父母/监护人被问及人口统计学特征、儿童保育出勤率、每周与入组儿童在同一家住满2晚的家庭成员人数，以及这些家庭成员在患者咳嗽发作前一个月内咳嗽病程为2周的人数。病例儿童的百日咳疫苗剂量如果在咳嗽发作日期（“有效期”）前>= 14天接种，则算有效。在有效期限结束时确定病例患者的年龄（以天为单位），如果匹配的对照受试者在该年龄之前接种了疫苗，则视为有效。使用条件logistic回归模型根据百日咳疫苗剂量估计百日咳的匹配优势比（ORs）。VE的计算公式为：（1 - OR） × 100。由于不同疫苗的百日咳抗原成分或数量不同，因此根据记录的疫苗生产厂家和疫苗类型，估计了DTP和/或DTaP的3剂或4剂的VE。所有入组儿童（184例病例组和893例对照组）均有疫苗接种史验证。病例组接种0、1或2、3和>= 4剂百日咳（DTP和/或DTaP）疫苗的儿童比例分别为26%、14%、26%和34%，对照组分别为2%、8%、33%和57%。与0剂相比，1剂或2剂百日咳的未调整VE估计为83.6%(95%可信区间[CI]: 61.1-93.1%)， 3剂百日咳的未调整VE估计为95.6% (95% CI: 89.7-98.0%), >= 4剂百日咳的未调整VE估计为97.7% （95% CI: 94.7 99.0%）。在接受4次百日咳疫苗接种的儿童中，仅接受1种疫苗（4剂百白破或4剂百白破）的儿童患百日咳的风险略高于接受1至3剂百白破和4剂百白破联合接种的儿童（or: 2.4; 95% CI: 1.1-5.2）。在接种3剂或4剂百日咳疫苗的儿童中，接种含有4种百日咳抗原成分的百日咳疫苗的儿童患百日咳的风险略高于接种含有2种百日咳抗原成分的百日咳疫苗的儿童（or: 2.5; 95% CI: 1.1-5.8）。在接受4剂疫苗的儿童中，早期（年龄= 14个月）接受4剂疫苗的儿童百日咳风险高出2.7倍（95% CI: 1.1-6.8）。对于6 ~ 23月龄的儿童，家庭结构特征是百日咳的重要危险因素。在多变量模型中,相比之下,生活在一个年长的父母(> = 25岁),不是生活在一个“其他”家庭成员(相对其他比父母或兄弟姐妹或nonrelated人),而不是生活在兄弟姐妹6到11岁的儿童百日咳的风险6 - 23月龄是6.8倍,如果他们住在一个年轻的父母(= 2周(87年168例受试者(52%),与79年相比860年[8%]对照组).Conclusions。6 - 59月龄儿童接种>= 3百白破/百白破疫苗剂量的任何组合都对百日咳具有高度保护作用。然而，根据疫苗类型（DTaP或DTP）和DTaP制造商的不同，存在差异。在接种4剂百日咳疫苗的儿童中，3剂百白破和1剂百白破的组合比其他组合的VE略高；在接种3剂或4剂DTaP疫苗的儿童中，1剂DTaP疫苗的效果较差。如果卫生保健提供者更有可能因为疫苗接种不足的风险而给12个月大的儿童接种疫苗，并且如果这些儿童也有更高的百日咳风险，那么对bb0 = 14个月大的儿童接种4剂百日咳疫苗更有效的发现可能会混淆。任何年龄组和关系的家庭成员都可能是百日咳的来源，家庭结构与6至23个月大的儿童患百日咳的风险有关。与研究中的对照儿童相比，26%的病例儿童从未接种过百日咳疫苗。未接种疫苗的儿童有患百日咳的危险，在与其他未接种疫苗的儿童一起的社区中，可能导致全社区的百日咳暴发。需要教育家长了解与百日咳博德泰拉感染相关的发病率和死亡率风险，并鼓励他们按时为孩子接种百日咳疫苗，并按照建议的剂量接种疫苗，以获得最佳保护。
Background. Despite the dramatic pertussis decrease since the licensure of whole-cell pertussis (diphtheria-tetanus toxoids-pertussis [DTP]) vaccines in the middle 1940s, pertussis remains endemic in the United States and can cause illness among persons at any age; > 11000 pertussis cases were reported in 2003. Since July 1996, in addition to 2 DTP vaccines already in use, 5 acellular pertussis (diphtheria-tetanus toxoids-acellular pertussis [DTaP]) vaccines were licensed for use among infants; 3 DTaP vaccines were distributed widely during the study period. Because of the availability of 3 DTaP and 2 DTP vaccines and the likelihood of the vaccines being used interchangeably to vaccinate children with the recommended 5-dose schedule, measuring the effectiveness of the pertussis vaccines was a high priority.Objective. To measure the pertussis vaccine effectiveness (VE) among US children 6 to 59 months of age.Design. We conducted a case-control study in the Cincinnati, Ohio, metropolitan area, Colorado, Idaho, and Minnesota.Participants. Confirmed pertussis cases among children 6 to 59 months of age at the time of disease onset, with onset in 1998-2001, were included. For each case subject, 5 control children were matched from birth certificate records, according to the date of birth and residence.Outcome Measures. A standardized questionnaire was used to obtain vaccination data from parents and providers. Parents/guardians were asked about demographic characteristics, child care attendance, the number of household members who stayed at the same home as the enrolled child for >= 2 nights per week, and cough illness of >= 2-week duration among these household members in the month before the case patient's cough onset. Pertussis vaccine doses among case children were counted as valid if they were received >= 14 days before the cough onset date ("valid period"). The age of the case patient (in days) at the end of the valid period was determined, and doses of vaccine for the matched control subjects were counted as valid if they were received by that age. Conditional logistic regression models were used to estimate the matched odds ratios (ORs) for pertussis according to the number of pertussis vaccine doses. The VE was calculated with the following formula: (1 - OR) x 100. Because the pertussis antigen components or amounts differed according to vaccine, the VE of 3 or 4 doses of DTP and/or DTaP was estimated according to the recorded vaccine manufacturer and vaccine type.Results. All enrolled children (184 case subjects and 893 control subjects) had their vaccine history verified. The proportions of children who received 0, 1 or 2, 3, and >= 4 pertussis (DTP and/or DTaP) vaccine doses among case subjects were 26%, 14%, 26%, and 34% and among control subjects were 2%, 8%, 33%, and 57%, respectively. Compared with 0 doses, the unadjusted VE estimate for 1 or 2 pertussis doses was 83.6% (95% confidence interval [CI]: 61.1-93.1%), that for 3 doses was 95.6% (95% CI: 89.7-98.0%), and for >= 4 doses was 97.7% (95% CI: 94.7 99.0%). Among children who received 4 pertussis vaccinations, the risk of pertussis was slightly higher among those who received only 1 type of vaccine (either 4 DTP doses or 4 DTaP doses), compared with those who received a combination of DTP for doses 1 to 3 and DTaP for dose 4 (OR: 2.4; 95% CI: 1.1-5.2). Among children who received 3 or 4 DTaP vaccine doses, the risk of pertussis was slightly higher among those who received a DTaP vaccine with 4 pertussis antigen components (a vaccine no longer available), compared with those who received the DTaP vaccine with 2 pertussis antigen components ( OR: 2.5; 95% CI: 1.1-5.8). Among children who received 4 doses, the risk of pertussis was 2.7 times higher for children who received dose 4 early (age of = 14 months) 95% CI: 1.1-6.8). For children 6 to 23 months of age, features of household structure were significant risk factors for pertussis. In a multivariate model, compared with living with an older parent (>= 25 years of age), not living with an "other" household member ( a relative other than a parent or sibling or a nonrelated person), and not living with a sibling 6 to 11 years of age, the risk of pertussis for children 6 to 23 months of age was 6.8 times higher if they lived with a young parent (= 2 weeks (87 [52%] of 168 case subjects, compared with 79 [8%] of 860 control subjects).Conclusions. Any combination of >= 3 DTP/DTaP vaccine doses for children 6 to 59 months of age was highly protective against pertussis. However, there were differences according to vaccine type (DTaP or DTP) and DTaP manufacturer. Among children who received 4 pertussis vaccine doses, a combination of 3 DTP doses followed by 1 DTaP dose had a slightly higher VE than other combinations; among children who received 3 or 4 DTaP vaccine doses, 1 DTaP vaccine performed less well. The finding that pertussis dose 4 was more effective when given to children at >= 14 months of age might be confounded if health care providers were more likely to vaccinate children at 12 months of age because of a perceived risk of undervaccination and if these same children were also at higher risk for pertussis. Household members of any age group and relationship could have been the source of pertussis, and household structure was associated with risk for pertussis for children 6 to 23 months of age. In contrast to control children in the study, 26% of case children had never been vaccinated against pertussis. Unvaccinated children are at risk for pertussis and, in a community with other unvaccinated children, can lead to community-wide pertussis outbreaks. Parents need to be educated about the morbidity and mortality risks associated with Bordetella pertussis infection, and they need to be encouraged to vaccinate their children against pertussis on time and with the recommended number of vaccine doses for optimal protection.