National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, NSW, Australia.
Bull World Health Organ. 2011 Sep 1;89(9):666-74. doi: 10.2471/BLT.11.086538. Epub 2011 Jul 5.
To compare the impact of three strategies for delivering a booster dose of adult-formulated tetanus-diphtheria-pertussis (Tdap) vaccine to adolescents in Australia. These comprise: (i) administering Tdap to: a one-year age cohort; (ii) administering Tdap to the entire high school and to subsequent entrant cohorts; and (iii) administering Tdap to the entire high school but without continuing to immunize entrant cohorts.
A series of ecologic analyses of pertussis notifications during epidemic periods in relevant age cohorts were conducted. The primary outcome measure was the incidence rate ratio (IRR), calculated by dividing pertussis incidence after the introduction of Tdap delivery programmes by pertussis incidence during the most recent pre-programme epidemic.
During the epidemic period of 2008-2009, the national-level IRR among age cohorts targeted for Tdap was 0.6 (95% confidence interval, CI: 0.6-0.7), but among other age cohorts it was 1.1 (95% CI: 1.1-1.2). Only the jurisdiction that implemented strategy 2 (Western Australia) experienced sustained decreases in pertussis notifications in both adolescents and infants under 6 months of age (IRR: 0.4; 95% CI: 0.3-0.6) until 2009.
If confirmed by longer experience in Australia and elsewhere, a broad school-based catch-up programme followed by immunization of school entrants may be the optimum strategy for the implementation of adolescent Tdap programmes.
比较澳大利亚为青少年接种成人配方白喉-破伤风-百日咳（Tdap）疫苗加强针的三种策略的影响。这些策略包括：（i）为一年龄组接种 Tdap；（ii）为整个高中及后续入学队列接种 Tdap；（iii）为整个高中接种 Tdap，但不再为入学队列接种。
对相关年龄队列在流行期间百日咳发病情况进行了一系列生态学分析。主要观察指标是发病率比值比（IRR），通过将 Tdap 接种项目引入后的百日咳发病率除以最近一次流行前的百日咳发病率来计算。
在 2008-2009 年的流行期间，目标接种 Tdap 的年龄组的全国性 IRR 为 0.6（95%置信区间，CI：0.6-0.7），但其他年龄组的 IRR 为 1.1（95% CI：1.1-1.2）。只有实施策略 2（西澳大利亚州）的司法管辖区在青少年和 6 个月以下婴儿的百日咳发病率均持续下降（IRR：0.4；95% CI：0.3-0.6），直到 2009 年。
如果在澳大利亚和其他地方有更长的经验证实，广泛的基于学校的追赶计划，随后对入学学生进行免疫接种可能是实施青少年 Tdap 计划的最佳策略。
