Tinnion O N, Hanlon M
NCEPH, The Australian National University, Canberra, Australia, ACT 0200.
Cochrane Database Syst Rev. 2000(2):CD001478. doi: 10.1002/14651858.CD001478.
Routine use of whole cell pertussis vaccines was suspended in some countries in the late 1970s and early 1980s, leading to a resurgence of whooping cough. Acellular pertussis vaccines containing purified or recombinant Bordetella pertussis antigens were developed in the hope that they would be as effective but less toxic than the whole cell vaccines. The objective of this review was to assess the effects of acellular pertussis vaccines in children.
The Cochrane Controlled Trials Register and Medline were searched up to January 1998.
Double-blind randomised efficacy and safety trials of acellular pertussis vaccines in children, with active follow-up of participants and laboratory verification of pertussis cases.
One reviewer assessed trial quality and extracted data.
Six efficacy trials and 45 safety trials were included. Acellular pertussis vaccines with three or more pertussis vaccines were more effective than those with one or two antigens. They were also more effective than one type of whole cell pertussis vaccine, but less effective than two other types of whole cell vaccines. Differences in trial design precluded pooling of the efficacy data and results should be interpreted with caution. Most systemic and local adverse events were significantly less common with acellular than with whole cell pertussis vaccines.
REVIEWER'S CONCLUSIONS: Multi-component acellular pertussis vaccines are effective, and show less adverse effects than whole cell pertussis vaccines. However in areas where whooping cough is more likely to be fatal, the higher toxicity of some whole cell vaccines may be offset by their increased effectiveness.
20世纪70年代末80年代初，一些国家暂停了全细胞百日咳疫苗的常规使用，导致百日咳疫情卷土重来。于是研发出了含有纯化或重组百日咳博德特氏菌抗原的无细胞百日咳疫苗，希望其效果与全细胞疫苗相当，但毒性更低。本综述的目的是评估无细胞百日咳疫苗对儿童的影响。
检索了截至1998年1月的Cochrane对照试验注册库和Medline。
无细胞百日咳疫苗在儿童中的双盲随机疗效和安全性试验，对参与者进行积极随访，并对百日咳病例进行实验室核实。
由一名综述作者评估试验质量并提取数据。
纳入了6项疗效试验和45项安全性试验。含有三种或更多百日咳疫苗成分的无细胞百日咳疫苗比含有一两种抗原的疫苗更有效。它们也比一种全细胞百日咳疫苗更有效，但比另外两种全细胞疫苗效果差。试验设计的差异使得无法汇总疗效数据，结果应谨慎解读。与全细胞百日咳疫苗相比，无细胞百日咳疫苗的大多数全身和局部不良反应明显较少见。
多组分无细胞百日咳疫苗是有效的，且比全细胞百日咳疫苗不良反应更少。然而，在百日咳更可能致命的地区，一些全细胞疫苗较高的毒性可能会被其更高的有效性所抵消。
