Rodrigues Amabelia, Fischer Thea K, Valentiner-Branth Palle, Nielsen Jens, Steinsland Hans, Perch Michael, Garly May-Lill, Mølbak Kåre, Aaby Peter
Bandim Health Project, Danish Epidemiology Science Centre, Statens Serum Institut, Apartado 861, Bissau, Guinea-Bissau.
Vaccine. 2006 May 29;24(22):4737-46. doi: 10.1016/j.vaccine.2006.03.033. Epub 2006 Mar 31.
Community studies in West Africa have demonstrated that routine vaccinations may have non-targeted effects, the female-male mortality ratio being reduced after administration of BCG and increased after diphtheria-tetanus-pertussis (DTP). We examined whether immunisation status was associated with infection with rotavirus and other enteropathogens.
We recruited 200 children shortly after birth and followed them until 2 years of age with weekly morbidity interviews and stool sampling. Vaccination status for each child was classified according to the most recent vaccination as documented by vaccination card.
The female-male incidence rate ratios (IRR) of infection with an enteropathogen and of enteropathogen-associated diarrhoea were estimated for children according to whether they had received BCG or DTP as their last vaccination.
For children who received BCG as their last vaccine, the adjusted female-male IRRs for primary rotavirus-infection and diarrhoea were 1.05 (95% CI: 0.21-5.28) and 0.0 (95% CI: 0-3.02), respectively. For children who received DTP as their last vaccine, the adjusted female-male IRRs were 1.93 (0.89-4.21) and 1.92 (0.70-5.32), respectively, for rotavirus-associated infection and diarrhoea. Restricted to the rotavirus season, the female-male IRRs for rotavirus infection and diarrhoea were 2.56 (1.17-5.63) and 2.63 (0.94-7.34), respectively. The female-male IRR for rotavirus-associated diarrhoea differed significantly among BCG and DTP recipients (p=0.02). Infections with enteropathogens not associated with diarrhoea were associated with lower female-male IRRs after BCG of 0.82 (0.55-1.23) and higher female-male IRRs after DTP vaccination of 1.32 (1.03-1.70) for primary infection (p=0.05). Though there were few infections with other diarrhoea-causing enteropathogens, these were also associated with a lower female-male IRR after BCG of 0.62 (0.26-1.52) and a higher female-male IRR after DTP vaccination of 1.51 (1.04-2.20) for all infection.
Routine immunisations may affect morbidity for non-targeted infections. As in studies of infant mortality, BCG is associated with lower risk for girls, whereas, DTP is associated with higher risk for girls relative to boys.
西非的社区研究表明，常规疫苗接种可能产生非靶向效应，接种卡介苗后男女死亡率之比降低，而接种白喉-破伤风-百日咳（DTP）疫苗后该比值升高。我们研究了免疫状态是否与轮状病毒及其他肠道病原体感染有关。
我们在200名儿童出生后不久招募了他们，并通过每周的发病情况访谈和粪便采样对他们进行追踪，直至2岁。根据疫苗接种卡记录的最近一次疫苗接种情况对每个儿童的疫苗接种状态进行分类。
根据儿童最后一次接种的是卡介苗还是DTP疫苗，估计其肠道病原体感染及肠道病原体相关性腹泻的男女发病率比值（IRR）。
对于最后接种卡介苗的儿童，原发性轮状病毒感染和腹泻的校正男女IRR分别为1.05（95%CI：0.21 - 5.28）和0.0（95%CI：0 - 3.02）。对于最后接种DTP疫苗的儿童，轮状病毒相关性感染和腹泻的校正男女IRR分别为1.93（0.89 - 4.21）和1.92（0.70 - 5.32）。仅限于轮状病毒季节，轮状病毒感染和腹泻的男女IRR分别为2.56（1.17 - 5.63）和2.63（0.94 - 7.34）。卡介苗和DTP疫苗接种者中轮状病毒相关性腹泻的男女IRR差异有统计学意义（p = 0.02）。对于原发性感染，接种卡介苗后与腹泻无关的肠道病原体感染的男女IRR较低，为0.82（0.55 - 1.23），而接种DTP疫苗后较高，为1.32（1.03 - 1.70）（p = 0.05）。虽然由其他致腹泻肠道病原体引起的感染较少，但对于所有感染，接种卡介苗后的男女IRR也较低，为0.62（0.26 - 1.52），接种DTP疫苗后较高，为1.51（1.04 - 2.20）。
常规免疫接种可能会影响非靶向感染的发病率。与婴儿死亡率研究一样，卡介苗与女孩较低的风险相关，而DTP疫苗与女孩相对于男孩较高的风险相关。
