International Vaccine Institute, Seoul, Korea.
Philos Trans R Soc Lond B Biol Sci. 2011 Oct 12;366(1579):2799-805. doi: 10.1098/rstb.2011.0033.
Enteric infections are a major cause of morbidity and mortality in developing countries. To date, vaccines have played a limited role in public health efforts to control enteric infections. Licensed vaccines exist for cholera and typhoid, but these vaccines are used primarily for travellers; and there are two internationally licensed vaccines for rotavirus, but they are mainly used in affluent countries. The reasons that enteric vaccines are little used in developing countries are multiple, and certainly include financial and political constraints. Also important is the need for more cogent evidence on the performance of enteric vaccines in developing country populations. A partial inventory of research questions would include: (i) does the vaccine perform well in the most relevant settings? (ii) does the vaccine perform well in all epidemiologically relevant age groups? (iii) is there adequate evidence of vaccine safety once the vaccines have been deployed in developing countries? (iv) how effective is the vaccine when given in conjunction with non-vaccine cointerventions? (v) what is the level of vaccine protection against all relevant outcomes? and (vi) what is the expected population level of vaccine protection, including both direct and herd vaccine protective effects? Provision of evidence addressing these questions will help expand the use of enteric vaccines in developing countries.
肠传染病是发展中国家发病率和死亡率的主要原因。迄今为止，疫苗在控制肠传染病的公共卫生工作中发挥的作用有限。有针对霍乱和伤寒的许可疫苗，但这些疫苗主要用于旅行者；还有两种国际许可的轮状病毒疫苗，但主要在富裕国家使用。肠传染病疫苗在发展中国家使用较少的原因有很多，当然包括财政和政治限制。同样重要的是，需要更多关于肠传染病疫苗在发展中国家人群中表现的有力证据。一个部分的研究问题清单将包括：(i)疫苗在最相关的环境中表现良好吗？(ii)疫苗在所有具有流行病学相关性的年龄组中表现良好吗？(iii)疫苗在发展中国家部署后是否有足够的安全性证据？(iv)疫苗与非疫苗共同干预措施联合使用时效果如何？(v)疫苗对所有相关结果的保护水平是多少？以及 (vi) 包括直接和群体疫苗保护效果在内，预期的人群疫苗保护水平是多少？提供解决这些问题的证据将有助于扩大肠传染病疫苗在发展中国家的使用。
