Deming M S, Jaiteh K O, Otten M W, Flagg E W, Jallow M, Cham M, Brogan D, N'jie H
International Health Program Office, Centers for Disease Control, Atlanta, GA 30333.
Am J Epidemiol. 1992 Feb 15;135(4):393-408. doi: 10.1093/oxfordjournals.aje.a116300.
An epidemic of poliomyelitis caused by poliovirus type 1 occurred in The Gambia from May to November 1986. Descriptive findings and vaccination coverage levels are reported in part I. This article (part II) describes a case-control study to estimate the clinical efficacy of three or more doses of trivalent oral polio vaccine compared with zero doses. "Cases" were 1- to 7-year-old children paralyzed during the epidemic who were diagnosed as having poliomyelitis by designated referral physicians. They were identified by reports from referral physicians during the epidemic and by a nationwide village-to-village search after the epidemic. Up to five controls were randomly selected for each case from among children of the same age and sex living in neighboring households. In a matched analysis of 195 cases and 839 controls, the efficacy of three or more doses of trivalent oral polio vaccine was 72% (95% confidence interval 57-82) when children without vaccination cards were considered unvaccinated. The efficacy of three or more doses in 1- to 2-year-old children, in whom the determination of vaccination status was considered to be more accurate than in older children, was 81% (95% confidence interval 66-90). Vaccine failure was not associated with short intervals between doses. Higher levels of vaccination coverage and efficacy than those achieved in The Gambia may be needed in African countries to prevent the return of poliomyelitis as an epidemic disease after it has been controlled as an endemic disease.
1986年5月至11月，冈比亚发生了由1型脊髓灰质炎病毒引起的脊髓灰质炎疫情。第一部分报告了描述性研究结果和疫苗接种覆盖率。本文（第二部分）描述了一项病例对照研究，以评估三剂或更多剂次三价口服脊髓灰质炎疫苗与零剂次相比的临床效果。“病例”为疫情期间1至7岁的瘫痪儿童，由指定的转诊医生诊断为脊髓灰质炎。他们在疫情期间通过转诊医生的报告以及疫情后在全国范围内逐村搜索得以确认。从居住在相邻家庭中的同年龄、同性别的儿童中，为每个病例随机选取多达5名对照。在对195例病例和839名对照进行的匹配分析中，当没有接种卡的儿童被视为未接种时，三剂或更多剂次三价口服脊髓灰质炎疫苗的效果为72%（95%置信区间57 - 82）。在1至2岁儿童中，接种状态的判定被认为比年龄较大的儿童更准确，三剂或更多剂次疫苗的效果为81%（95%置信区间66 - 90）。疫苗失效与剂次间隔时间短无关。非洲国家可能需要比冈比亚所达到的更高的疫苗接种覆盖率和效果水平，以防止脊髓灰质炎在作为地方病得到控制后再次作为流行病出现。
