Wang Zhong, Tobler Steven, Roayaei Jean, Eick Angelia
Armed Forces Health Surveillance Center, Suite 200, 2900 Linden Ln, Silver Spring, MD 20910, USA.
JAMA. 2009 Mar 4;301(9):945-53. doi: 10.1001/jama.2009.265. Epub 2009 Mar 2.
Since 2004, increasing numbers of military personnel have been immunized with the intranasal live attenuated influenza vaccine (LAIV) while most others received the trivalent inactivated vaccine (TIV). However, data about live virus vaccine effectiveness among healthy adults are limited.
To monitor the effectiveness of vaccines to better inform military vaccination policy.
DESIGN, SETTING, AND PARTICIPANTS: Surveillance of population-based, propensity-matched, and/or vaccine-naive cohorts of more than a million active-duty, nonrecruit military service members aged 17 to 49 years stationed in the United States during the 2004-2005, 2005-2006, or 2006-2007 influenza season.
Incidence of health care encounters resulting in a primary diagnostic code consistent with pneumonia or influenza. Incident hospitalizations was a secondary outcome.
In all 3 seasons, immunization with TIV was associated with lower incidence rates of health care encounters for pneumonia and influenza when compared with no immunization: 8.6 vs 19.4 for 2004-2005, 7.8 vs 10.9 for 2005-2006, and 8.0 vs. 11.7 per 1000 person-years for 2006-2007 (all P < .001). Similar estimates were obtained from propensity-matched and/or vaccine-naive cohorts. Consistently lower vaccine effect following LAIV immunization was only seen during the 2006-2007 influenza season in the total (10.7; 95% confidence interval [CI], 2.72 to 18.1; P = .03) and propensity-matched cohorts (11.8; 95% CI, 0.85 to 21.5; P = .04), and was less than effect from TIV (TIV vs LAIV, 19.8; 95% CI, 13.6 to 25.5; P < .001). Among vaccine-naive service members, however, estimates for LAIV effect were more robust for both the 2005-2006 and 2006-2007 seasons (P = .01) and were comparable with TIV (eg, LAIV, 30.2; 95% CI, 11.2 to 45.2; vs TIV, 35.3; 95% CI, 25.9 to 43.6; in 2005-2006).
Vaccination with TIV was associated with fewer medical encounters related to pneumonia and influenza compared with LAIV or no immunization. In this annually immunized population, this effect was less apparent in those vaccinated with LAIV.
自2004年以来，越来越多的军事人员接种了鼻内减毒活流感疫苗（LAIV），而其他大多数人接种的是三价灭活疫苗（TIV）。然而，关于健康成年人中活病毒疫苗有效性的数据有限。
监测疫苗的有效性，以便为军事疫苗接种政策提供更充分的信息。
设计、地点和参与者：对2004 - 2005年、2005 - 2006年或2006 - 2007年流感季节期间，驻扎在美国的100多万名年龄在17至49岁的现役非新兵军事人员进行基于人群、倾向匹配和/或未接种疫苗队列的监测。
导致与肺炎或流感一致的主要诊断代码的医疗就诊发生率。住院事件为次要结局。
在所有3个季节中，与未接种疫苗相比，接种TIV与肺炎和流感的医疗就诊发生率较低相关：2004 - 2005年为8.6 vs 19.4，2005 - 2006年为7.8 vs 10.9，2006 - 2007年为每1000人年8.0 vs 11.7（所有P < 0.001）。从倾向匹配和/或未接种疫苗队列中也获得了类似的估计值。仅在2006 - 2007年流感季节，LAIV免疫后的疫苗效果持续较低，在总队列（10.7；95%置信区间[CI]，2.72至18.1；P = 0.03）和倾向匹配队列（11.8；95% CI，0.85至21.5；P = 0.04）中均如此，且低于TIV的效果（TIV与LAIV相比，19.8；95% CI，13.6至25.5；P < 0.001）。然而，在未接种疫苗的服役人员中，2005 - 2006年和2006 - 2007年季节LAIV效果的估计值更为可靠（P = 0.01），且与TIV相当（例如，2005 - 2006年LAIV为30.2；95% CI，11.2至45.2；TIV为35.3；95% CI，25.9至43.6）。
与LAIV或未接种疫苗相比，接种TIV与肺炎和流感相关的医疗就诊次数较少。在这个每年接种疫苗的人群中，这种效果在接种LAIV的人群中不太明显。
