儿童接种五剂无细胞百日咳疫苗后的保护作用减弱。

Waning protection after fifth dose of acellular pertussis vaccine in children.

机构信息

Kaiser Permanente Vaccine Study Center, Oakland, CA 94612, USA.

出版信息

N Engl J Med. 2012 Sep 13;367(11):1012-9. doi: 10.1056/NEJMoa1200850.

DOI:10.1056/NEJMoa1200850

PMID:22970945

Abstract

BACKGROUND

In the United States, children receive five doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine before 7 years of age. The duration of protection after five doses of DTaP is unknown.

METHODS

We assessed the risk of pertussis in children in California relative to the time since the fifth dose of DTaP from 2006 to 2011. This period included a large outbreak in 2010. We conducted a case-control study involving members of Kaiser Permanente Northern California who were vaccinated with DTaP at 47 to 84 months of age. We compared children with pertussis confirmed by a positive polymerase-chain-reaction (PCR) assay with two sets of controls: those who were PCR-negative for pertussis and closely matched controls from the general population of health-plan members. We used logistic regression to examine the risk of pertussis in relation to the duration of time since the fifth DTaP dose. Children who received whole-cell pertussis vaccine during infancy or who received any pertussis-containing vaccine after their fifth dose of DTaP were excluded.

RESULTS

We compared 277 children, 4 to 12 years of age, who were PCR-positive for pertussis with 3318 PCR-negative controls and 6086 matched controls. PCR-positive children were more likely to have received the fifth DTaP dose earlier than PCR-negative controls (P<0.001) or matched controls (P=0.005). Comparison with PCR-negative controls yielded an odds ratio of 1.42 (95% confidence interval, 1.21 to 1.66), indicating that after the fifth dose of DTaP, the odds of acquiring pertussis increased by an average of 42% per year.

CONCLUSIONS

Protection against pertussis waned during the 5 years after the fifth dose of DTaP. (Funded by Kaiser Permanente).

摘要

背景

在美国，儿童在 7 岁之前要接受五剂白喉、破伤风和无细胞百日咳（DTaP）疫苗。接种五剂 DTaP 后的保护持续时间尚不清楚。

方法

我们评估了 2006 年至 2011 年期间加利福尼亚州儿童在接种五剂 DTaP 后与第五剂 DTaP 接种时间相关的百日咳发病风险。这一时期包括 2010 年的一次大爆发。我们进行了一项病例对照研究，涉及 Kaiser Permanente Northern California 的成员，他们在 47 至 84 个月龄时接种了 DTaP。我们将经聚合酶链反应（PCR）检测确诊为百日咳的儿童与两组对照进行了比较：一组为 PCR 检测阴性的百日咳患者，另一组为健康计划成员普通人群中匹配的对照。我们使用逻辑回归分析了第五剂 DTaP 接种后时间与百日咳发病风险之间的关系。排除了在婴儿期接种全细胞百日咳疫苗或在第五剂 DTaP 后接种任何含百日咳疫苗的儿童。

结果

我们比较了 277 名 4 至 12 岁 PCR 检测阳性的儿童与 3318 名 PCR 检测阴性对照和 6086 名匹配对照。PCR 阳性儿童第五剂 DTaP 接种时间早于 PCR 阴性对照（P<0.001）或匹配对照（P=0.005）。与 PCR 阴性对照相比，优势比为 1.42（95%置信区间，1.21 至 1.66），这表明接种第五剂 DTaP 后，每年感染百日咳的几率平均增加 42%。