英国加速免疫计划与婴儿猝死综合征：病例对照研究。

The UK accelerated immunisation programme and sudden unexpected death in infancy: case-control study.

作者信息

Fleming P J, Blair P S, Platt M W, Tripp J, Smith I J, Golding J

机构信息

Institute of Child Health, Royal Hospital for Children, Bristol BS2 8BJ, United Kingdom.

出版信息

BMJ. 2001 Apr 7;322(7290):822. doi: 10.1136/bmj.322.7290.822.

DOI:10.1136/bmj.322.7290.822

PMID:11290634

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC30557/

Abstract

OBJECTIVES

To investigate whether the accelerated immunisation programme in the United Kingdom is associated, after adjustment for potential confounding, with the sudden infant death syndrome.

DESIGN

Population based case-control study, February 1993 to March 1996. Parental interviews were conducted for each death and for four controls matched for age, locality, and time of sleep. Immunisation status was taken from records held by the parents.

SETTING

Five regions in England with a combined population of over 17 million.

SUBJECTS

Immunisation details were available for 93% (303/325) of infants whose deaths were attributed to the sudden infant death syndrome (SIDS); 90% (65/72) of infants with explained sudden deaths; and 95% (1515/1588) of controls.

RESULTS

After all potential confounding factors were controlled for, immunisation uptake was strongly associated with a lower risk of SIDS (odds ratio 0.45 (95% confidence interval 0.24 to 0.85)). This difference became non-significant (0.67 (0.31 to 1.43)) after further adjustment for other factors specific to the infant's sleeping environment. Similar proportions of SIDS deaths and reference sleeps (corresponding to the time of day during which the index baby had died) among the controls occurred within 48 hours of the last vaccination (5% (7/149) v 5% (41/822)) and within two weeks (21% (31/149) v 27% (224/822)). No longer term temporal association with immunisation was found (P=0.78). Of the SIDS infants who died within two weeks of vaccination, 16% (5/31) had signs and symptoms of illness that suggested that medical contact was required, compared with 26% (16/61) of the non-immunised SIDS infants of similar age. The findings for the infants who died suddenly and unexpectedly but of explained causes mirrored those for SIDS infants.

CONCLUSIONS

Immunisation does not lead to sudden unexpected death in infancy, and the direction of the relation is towards protection rather than risk.

摘要

目的

在对潜在混杂因素进行调整后，调查英国的加速免疫计划是否与婴儿猝死综合征相关。

设计

基于人群的病例对照研究，时间为1993年2月至1996年3月。对每例死亡病例以及与死亡婴儿年龄、居住地点和睡眠时间匹配的4名对照进行家长访谈。免疫状况取自家长保存的记录。

地点

英格兰的五个地区，总人口超过1700万。

研究对象

93%（303/325）归因于婴儿猝死综合征（SIDS）的死亡婴儿、90%（65/72）死因明确的猝死婴儿以及95%（1515/1588）对照的免疫详情可用。

结果

在控制了所有潜在混杂因素后，免疫接种与较低的SIDS风险密切相关（比值比0.45（95%置信区间0.24至0.85））。在对婴儿睡眠环境的其他特定因素进行进一步调整后，这种差异变得不显著（0.67（0.31至1.43））。对照中，SIDS死亡病例和参照睡眠（对应于索引婴儿死亡的时间段）在最后一次接种疫苗后48小时内发生的比例相似（5%（7/149）对5%（41/822）），在两周内发生的比例也相似（21%（31/149）对27%（224/822））。未发现与免疫接种存在长期时间关联（P = 0.78）。在接种疫苗后两周内死亡的SIDS婴儿中，16%（5/31）有疾病体征和症状，表明需要就医，而年龄相似的未接种疫苗的SIDS婴儿中这一比例为26%（16/61）。死因明确的意外猝死婴儿的研究结果与SIDS婴儿相似。