加拿大安大略省婴儿接种推荐疫苗后急诊就诊率和急性住院率的季节性变化：一项自我对照病例系列分析

Seasonal variation in rates of emergency room visits and acute admissions following recommended infant vaccinations in Ontario, Canada: a self-controlled case series analysis.

作者信息

Hawken Steven, Potter Beth K, Benchimol Eric I, Little Julian, Ducharme Robin, Wilson Kumanan

机构信息

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, University of Ottawa, Ottawa, Canada; Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

Vaccine. 2014 Dec 12;32(52):7148-53. doi: 10.1016/j.vaccine.2014.09.059. Epub 2014 Nov 1.

DOI:10.1016/j.vaccine.2014.09.059

PMID:25446834

Abstract

OBJECTIVES

To determine if birth month has an effect on the incidence of adverse events following the 2- and 12-month recommended vaccinations.

STUDY DESIGN

Using health administrative databases, we conducted a population-based retrospective cohort study and employed a self-controlled case series analysis approach. We included children born in Ontario, Canada between April 1st 2002 and March 31st 2010 who received the diphtheria, tetanus, pertussis, inactivated poliovirus and Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine recommended at 2 months and/or the measles, mumps, and rubella vaccine recommended at 12 months. We calculated the relative incidence (RI) of hospitalizations and emergency room visits within a pre-specified risk period compared to a control period following vaccination. We measured the effect of birth month using relative incidence ratios (RIRs) to compare the RI for infants born in each month to that for the month having the lowest RI.

RESULTS

For the 2-month vaccination, we observed the lowest and highest RIs for infants born in October and April, respectively. The RIR (95% CI) for April compared to October was 2.06 (1.59-2.67, p<0.0001), consistent with a strong seasonal effect. For the 12-month vaccination, November births had the lowest RI, whereas August births had the highest. The RIR (95% CI) for August compared to November was 1.52 (1.30-1.77, p<0.0001).

CONCLUSIONS

Our findings suggest a seasonal effect on susceptibility to adverse events following vaccination exists. Further study will be important to elucidate potential biological and/or behavioral explanations for the seasonal effect we observed.

摘要

目的

确定出生月份是否对2月龄和12月龄推荐疫苗接种后不良事件的发生率有影响。

研究设计

利用卫生行政数据库，我们开展了一项基于人群的回顾性队列研究，并采用自我对照病例系列分析方法。我们纳入了2002年4月1日至2010年3月31日在加拿大安大略省出生、接种了2月龄推荐的白喉、破伤风、百日咳、灭活脊髓灰质炎病毒和b型流感嗜血杆菌（DTaP-IPV-Hib）疫苗和/或12月龄推荐的麻疹、腮腺炎和风疹疫苗的儿童。我们计算了在预先指定的风险期内与接种后的对照期相比住院和急诊就诊的相对发生率（RI）。我们使用相对发生率比（RIR）来衡量出生月份的影响，以比较每个月出生婴儿的RI与RI最低月份的婴儿的RI。

结果

对于2月龄疫苗接种，10月出生的婴儿RI最低，4月出生的婴儿RI最高。4月与10月相比的RIR（95%CI）为2.06（1.59 - 2.67，p<0.0001），这与强烈的季节效应一致。对于12月龄疫苗接种，11月出生的婴儿RI最低，而8月出生的婴儿RI最高。8月与11月相比的RIR（95%CI）为1.52（1.30 - 1.77，p<0.0001）。