O'Neill T J, Sargeant J M, Poljak Z
Department of Population Medicine, Ontario Veterinary College, Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th Floor, Toronto, ON, M5T 3M7, Canada.
Zoonoses Public Health. 2014 Dec;61(8):519-33. doi: 10.1111/zph.12086. Epub 2013 Nov 19.
Q fever in humans and coxiellosis in livestock are both caused by Coxiella burnetii. The public health importance of vaccination against C. burnetii shedding from sheep and goats was evaluated using systematic review and meta-analysis to provide evidence for policy direction to prevent potential zoonotic spread. Publications reporting shedding of C. burnetii in vaginal and uterine secretions, milk, placenta and faeces were included. A single observational (one goat) and seven experimental (four goat and three sheep) vaccine studies were included in the review. No relevant publications on other interventions were identified. Random effects meta-analyses were performed for the risk of shedding in individuals in the control and vaccinated groups and for the mean difference in the level of bacterial shedding in sheep and goats stratified by age and previous exposure status. Limited data were available for further analytic evaluation. From the pooled analysis, an inactivated phase I vaccine significantly reduced the risk of shedding from uterine (RR = 0.10; 95%CI 0.05-0.20) secretions in previously sensitized goats. Individual studies reported significant risk reduction in milk (RR = 0.03; 95%CI 0.01-0.26), vaginal secretions (RR = 0.40; 95%CI 0.22-0.75) and faeces (RR = 0.79; 95%CI 0.63-0.97) from naïve goats. The pooled mean levels of bacteria shed from placental [mean difference (MD = -5.24 Log10 ; 95%CI -6.75 to -3.7)] and vaginal (MD = -1.78 Log10 ; 95%CI -2.19 to -1.38) routes were significantly decreased in vaccinated naïve goats compared with controls. Shedding through all other routes from vaccinated goats was not significantly different than shedding from control goats. No effect of vaccination was found on the risk of shedding or the mean level of shedding in vaccinated sheep compared with control sheep. Our conclusions are based on a limited amount of data with variable risk of systematic error.
人类的Q热和家畜的柯克斯体病均由伯氏考克斯体引起。通过系统评价和荟萃分析评估了针对绵羊和山羊排出的伯氏考克斯体进行疫苗接种对公共卫生的重要性，为预防潜在人畜共患病传播的政策方向提供证据。纳入了报告伯氏考克斯体在阴道和子宫分泌物、乳汁、胎盘和粪便中排出情况的出版物。该评价纳入了一项观察性研究（一只山羊）和七项实验性研究（四只山羊和三只绵羊）。未发现关于其他干预措施的相关出版物。对对照组和接种组个体的排出风险以及按年龄和既往暴露状态分层的绵羊和山羊细菌排出水平的平均差异进行了随机效应荟萃分析。可供进一步分析评估的数据有限。汇总分析显示，一种灭活的I期疫苗显著降低了先前致敏山羊子宫分泌物排出的风险（RR = 0.10；95%CI 0.05 - 0.20）。个别研究报告称，初免山羊乳汁（RR = 0.03；95%CI 0.01 - 0.26）、阴道分泌物（RR = 0.40；95%CI 0.22 - 0.75）和粪便（RR = 0.79；95%CI 0.63 - 0.97）的排出风险显著降低。与对照组相比，初免接种山羊胎盘（平均差异（MD = -5.24 Log10；95%CI -6.75至-3.7））和阴道（MD = -1.78 Log10；95%CI -2.19至-1.38）途径的细菌排出平均水平显著降低。接种山羊通过所有其他途径的排出与对照山羊的排出无显著差异。与对照绵羊相比，未发现疫苗接种对接种绵羊的排出风险或排出平均水平有影响。我们的结论基于数量有限的数据，存在系统误差的可变风险。
