Spycher Ben D, Silverman Michael, Egger Matthias, Zwahlen Marcel, Kuehni Claudia E
Institute of Social and Preventive Medicine, Finkenhubelweg 11, CH-3012 Bern, Switzerland.
Pediatrics. 2009 Mar;123(3):944-50. doi: 10.1542/peds.2008-0115.
In industrialized countries vaccination coverage remains suboptimal, partly because of perception of an increased risk of asthma. Epidemiologic studies of the association between childhood vaccinations and asthma have provided conflicting results, possibly for methodologic reasons such as unreliable vaccination data, biased reporting, and reverse causation. A recent review stressed the need for additional, adequately controlled large-scale studies.
Our goal was to determine if routine childhood vaccination against pertussis was associated with subsequent development of childhood wheezing disorders and asthma in a large population-based cohort study.
In 6811 children from the general population born between 1993 and 1997 in Leicestershire, United Kingdom, respiratory symptom data from repeated questionnaire surveys up to 2003 were linked to independently collected vaccination data from the National Health Service database. We compared incident wheeze and asthma between children of different vaccination status (complete, partial, and no vaccination against pertussis) by computing hazard ratios. Analyses were based on 6048 children, 23 201 person-years of follow-up, and 2426 cases of new-onset wheeze.
There was no evidence for an increased risk of wheeze or asthma in children vaccinated against pertussis compared with nonvaccinated children. Adjusted hazard ratios comparing fully and partially vaccinated with nonvaccinated children were close to one for both incident wheeze and asthma.
This study provides no evidence of an association between vaccination against pertussis in infancy and an increased risk of later wheeze or asthma and does not support claims that vaccination against pertussis might significantly increase the risk of childhood asthma.
在工业化国家，疫苗接种覆盖率仍未达到最佳水平，部分原因是人们认为哮喘风险增加。关于儿童疫苗接种与哮喘之间关联的流行病学研究结果相互矛盾，这可能是由于方法学原因，如不可靠的疫苗接种数据、有偏差的报告以及反向因果关系。最近的一项综述强调需要进行更多充分对照的大规模研究。
我们的目标是在一项基于人群的大型队列研究中，确定常规儿童百日咳疫苗接种是否与随后儿童喘息性疾病和哮喘的发生有关。
在英国莱斯特郡1993年至1997年出生的6811名普通儿童中，将截至2003年多次问卷调查的呼吸道症状数据与从国家卫生服务数据库独立收集的疫苗接种数据相联系。我们通过计算风险比，比较了不同疫苗接种状态（完全接种、部分接种和未接种百日咳疫苗）儿童之间的新发喘息和哮喘情况。分析基于6048名儿童、23201人年的随访以及2426例新发喘息病例。
与未接种疫苗的儿童相比，接种百日咳疫苗的儿童没有证据表明喘息或哮喘风险增加。将完全接种和部分接种疫苗的儿童与未接种疫苗的儿童进行比较，调整后的风险比对于新发喘息和哮喘均接近1。
本研究没有证据表明婴儿期接种百日咳疫苗与后期喘息或哮喘风险增加之间存在关联，也不支持百日咳疫苗接种可能显著增加儿童哮喘风险的说法。
