Lindsay Lisa, Jackson Lisa A, Savitz David A, Weber David J, Koch Gary G, Kong Lan, Guess Harry A
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA.
Am J Epidemiol. 2006 May 1;163(9):838-48. doi: 10.1093/aje/kwj095. Epub 2006 Mar 22.
This study investigated the relation between weekly levels of influenza activity and the risk of acute influenza-like illness episodes among 8,323 healthy pregnant and postpartum women enrolled in a Puget Sound region, Washington, health maintenance organization, Group Health Cooperative, between June 1991 and December 1997. The authors classified weeks between October and May for isolate activity level based on surveillance data for influenza, respiratory syncytial virus, parainfluenza, and adenovirus infection. Influenza-like illness episodes were identified from medical encounters assigned a diagnostic code consistent with a symptomatic influenza infection. The authors compared the occurrence of influenza-like illness episodes within each pregnancy stage for periods with varying levels of influenza isolate detection in the community. Repeated-measures logistic regression methods accounted for time-dependent factors. The adjusted strength of association between influenza exposure and influenza-like illness episodes increased as the pregnancy stage progressed (first trimester odds ratio = 1.12, 95% confidence interval: 0.79, 1.59; second trimester odds ratio = 1.30, 95% confidence interval: 0.97, 1.73; third trimester odds ratio = 1.84, 95% confidence interval: 1.31, 2.59; postpartum period odds ratio = 2.28, 95% confidence interval: 1.42, 3.68). Pregnancy stage modified the association between influenza activity and influenza-like illness episodes. Findings estimate that 20-43 pregnant/postpartum women would need to be vaccinated with an 80% effective vaccine to prevent one influenza-like illness episode.
本研究调查了1991年6月至1997年12月期间，华盛顿普吉特海湾地区健康维护组织Group Health Cooperative登记的8323名健康孕妇和产后妇女中，每周流感活动水平与急性流感样疾病发作风险之间的关系。作者根据流感、呼吸道合胞病毒、副流感和腺病毒感染的监测数据，对10月至次年5月期间的分离株活动水平进行了分类。通过分配与有症状流感感染一致的诊断代码的医疗就诊记录来识别流感样疾病发作。作者比较了社区中流感分离株检测水平不同时期内，每个妊娠阶段流感样疾病发作的发生率。重复测量逻辑回归方法考虑了时间依赖性因素。随着妊娠阶段的推进，流感暴露与流感样疾病发作之间的调整后关联强度增加（孕早期优势比=1.12，95%置信区间：0.79，1.59；孕中期优势比=1.30，95%置信区间：0.97，1.73；孕晚期优势比=1.84，95%置信区间：1.31，2.59；产后阶段优势比=2.28，95%置信区间：1.42，3.68）。妊娠阶段改变了流感活动与流感样疾病发作之间的关联。研究结果估计，20 - 43名孕妇/产后妇女需要接种一种有效率为80%的疫苗，以预防一次流感样疾病发作。
