儿童流感疫苗接种对胡特尔社区感染率的影响：一项随机试验。

Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial.

机构信息

Department of Pathology and Molecular Medicine, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5 Canada.

出版信息

JAMA. 2010 Mar 10;303(10):943-50. doi: 10.1001/jama.2010.250.

DOI:10.1001/jama.2010.250

PMID:20215608

Abstract

CONTEXT

Children and adolescents appear to play an important role in the transmission of influenza. Selectively vaccinating youngsters against influenza may interrupt virus transmission and protect those not immunized.

OBJECTIVE

To assess whether vaccinating children and adolescents with inactivated influenza vaccine could prevent influenza in other community members.

DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial involving 947 Canadian children and adolescents aged 36 months to 15 years who received study vaccine and 2326 community members who did not receive the study vaccine in 49 Hutterite colonies in Alberta, Saskatchewan, and Manitoba. Follow-up began December 28, 2008, and ended June 23, 2009.

INTERVENTION

Children were randomly assigned according to community and in a blinded manner to receive standard dosing of either inactivated trivalent influenza vaccine or hepatitis A vaccine, which was used as a control.

MAIN OUTCOME MEASURES

Confirmed influenza A and B infection using a real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay and by measuring serum hemagglutination inhibition titers.

RESULTS

The mean rate of study vaccine coverage among eligible participants was 83% (range, 53%-100%) for the influenza vaccine colonies and 79% (range, 50%-100%) for the hepatitis A vaccine colonies. Among nonrecipients, 39 of 1271 (3.1%) in the influenza vaccine colonies and 80 of 1055 (7.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR, for a protective effectiveness of 61% (95% confidence interval [CI], 8%-83%; P = .03). Among all study participants (those who were and those who were not vaccinated), 80 of 1773 (4.5%) in the influenza vaccine colonies and 159 of 1500 (10.6%) in the hepatitis A vaccine colonies had influenza illness confirmed by RT-PCR for an overall protective effectiveness of 59% (95% CI, 5%-82%; P = .04). No serious vaccine adverse events were observed.

CONCLUSION

Immunizing children and adolescents with inactivated influenza vaccine significantly protected unimmunized residents of rural communities against influenza.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00877396.

摘要

背景

儿童和青少年似乎在流感传播中起着重要作用。有选择地对青少年进行流感疫苗接种可能会中断病毒传播，并保护那些未免疫的人群。

目的

评估对儿童和青少年接种灭活流感疫苗是否可以预防社区其他成员的流感。

设计、地点和参与者：这是一项在加拿大阿尔伯塔省、萨斯喀彻温省和马尼托巴省的 49 个 Hutterite 殖民地进行的 947 名 36 个月至 15 岁儿童和青少年（接受研究疫苗）与 2326 名社区成员（未接种研究疫苗）参与的群组随机试验。随访于 2008 年 12 月 28 日开始，2009 年 6 月 23 日结束。

干预措施

根据社区以盲法方式随机分配儿童接受标准剂量的灭活三价流感疫苗或甲型肝炎疫苗（用作对照）。

主要观察指标

采用实时逆转录酶聚合酶链反应（RT-PCR）检测和血清血凝抑制滴度检测确认 A 型和 B 型流感感染。

结果

在符合条件的参与者中，流感疫苗组的研究疫苗覆盖率平均为 83%（范围，53%-100%），而甲型肝炎疫苗组为 79%（范围，50%-100%）。在未接种疫苗的人群中，流感疫苗组的 1271 名中有 39 名（3.1%）和甲型肝炎疫苗组的 1055 名中有 80 名（7.6%）经 RT-PCR 确诊为流感病例，保护效力为 61%（95%置信区间[CI]，8%-83%；P =.03）。在所有研究参与者（接种疫苗和未接种疫苗者）中，流感疫苗组的 1773 名中有 80 名（4.5%）和甲型肝炎疫苗组的 1500 名中有 159 名（10.6%）经 RT-PCR 确诊为流感病例，总体保护效力为 59%（95%CI，5%-82%；P =.04）。未观察到严重的疫苗不良反应。