Low Nicola, Kraemer Sibylle, Schneider Martin, Restrepo Ana Maria Henao
Insititute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Vaccine. 2008 Jan 17;26(3):383-98. doi: 10.1016/j.vaccine.2007.11.010. Epub 2007 Nov 26.
Aerosols are the most promising non-injectable method of measles vaccination studied so far and their efficacy is thought to be comparable to injected vaccine. We conducted a systematic review up to May 2006 to examine the immunogenicity and safety of aerosolized measles vaccine (Edmonston-Zagreb or Schwarz strains) 1 month or more after vaccination. Where possible we estimated pooled serological response rates and odds ratios (with 95% confidence intervals, CI) comparing aerosolized and subcutaneous vaccines in children in three age groups and adults. We included seven randomized trials, four non-randomized trials and six uncontrolled studies providing serological outcome data on 2887 individuals. In children below 10 months, the studies were heterogeneous. In four comparative studies, seroconversion rates were lower with aerosolized than with subcutaneous vaccine and in two of these the difference was unlikely to be due to chance. In children 10-36 months, the pooled seroconversion rate with aerosolized vaccine was 93.5% (89.4-97.7%) and 97.1% (92.4-100%) with subcutaneous vaccine (odds ratio 0.27, 0.04-1.62). In 5-15-year olds the studies were heterogeneous. In all comparative studies aerosolized vaccine was more immunogenic than subcutaneous. Reported side effects were mild. Aerosolized measles vaccine appears to be equally or more immunogenic than subcutaneous vaccine in children aged 10 months and older. Large randomized trials are needed to establish the efficacy and safety of aerosolized measles vaccine as primary and booster doses.
气溶胶是迄今为止研究的最有前景的非注射式麻疹疫苗接种方法，其效果被认为与注射疫苗相当。我们进行了一项截至2006年5月的系统评价，以研究接种雾化麻疹疫苗（埃德蒙斯顿-萨格勒布或施瓦茨株）1个月或更长时间后的免疫原性和安全性。在可能的情况下，我们估计了三个年龄组儿童和成人中雾化疫苗与皮下疫苗相比的合并血清学反应率和比值比（95%置信区间，CI）。我们纳入了7项随机试验、4项非随机试验和6项无对照研究，这些研究提供了2887名个体的血清学结果数据。在10个月以下的儿童中，研究结果存在异质性。在4项比较研究中，雾化疫苗的血清转化率低于皮下疫苗，其中2项研究中的差异不太可能是偶然因素导致的。在10-36个月的儿童中，雾化疫苗的合并血清转化率为93.5%（89.4-97.7%），皮下疫苗为97.1%（92.4-100%）（比值比0.27，0.04-1.62）。在5-15岁的儿童中，研究结果存在异质性。在所有比较研究中，雾化疫苗的免疫原性均高于皮下疫苗。报告的副作用较轻。雾化麻疹疫苗在10个月及以上儿童中的免疫原性似乎与皮下疫苗相当或更高。需要进行大规模随机试验来确定雾化麻疹疫苗作为初免和加强剂量的有效性和安全性。
