Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Pediatrics. 2015 Feb;135(2):331-43. doi: 10.1542/peds.2014-1729. Epub 2015 Jan 5.
Pertussis incidence is increasing, possibly due to the introduction of acellular vaccines, which may have decreased the durability of immune response. We sought to evaluate and compare the duration of protective immunity conferred by a childhood immunization series with 3 or 5 doses of diphtheria-tetanus-acellular pertussis (DTaP).
We searched Medline and Embase for articles published before October 10, 2013. Included studies contained a measure of long-term immunity to pertussis after 3 or 5 doses of DTaP. Twelve articles were eligible for inclusion; 11 of these were included in the meta-analysis. We assessed study quality and used meta-regression models to evaluate the relationship between the odds of pertussis and time since last dose of DTaP and to estimate the probability of vaccine failure through time.
We found no significant difference between the annual odds of pertussis for the 3- versus 5-dose DTaP regimens. For every additional year after the last dose of DTaP, the odds of pertussis increased by 1.33 times (95% confidence interval: 1.23-1.43). Assuming 85% vaccine efficacy, we estimated that 10% of children vaccinated with DTaP would be immune to pertussis 8.5 years after the last dose. Limitations included the statistical model extrapolated from data and the different study designs included, most of which were observational study designs.
Although acellular pertussis vaccines are considered safer, the adoption of these vaccines may necessitate earlier booster vaccination and repeated boosting strategies to achieve necessary "herd effects" to control the spread of pertussis.
百日咳发病率正在上升，这可能是由于使用了无细胞疫苗，而后者可能降低了免疫反应的持久性。我们试图评估和比较儿童免疫系列中 3 剂或 5 剂白喉-破伤风-无细胞百日咳（DTaP）疫苗接种所带来的保护免疫的持续时间。
我们检索了 Medline 和 Embase 数据库，以获取截至 2013 年 10 月 10 日前发表的文章。纳入的研究包含了 3 剂或 5 剂 DTaP 接种后对百日咳的长期免疫效果的衡量指标。有 12 篇文章符合纳入标准，其中 11 篇文章纳入了荟萃分析。我们评估了研究质量，并使用荟萃回归模型评估了 DTaP 最后一剂接种后时间与百日咳发病几率之间的关系，并估计了随着时间的推移疫苗失效的可能性。
我们没有发现 3 剂与 5 剂 DTaP 方案之间百日咳年发病几率存在显著差异。在 DTaP 最后一剂接种后，每增加一年，百日咳发病几率增加 1.33 倍（95%置信区间：1.23-1.43）。假设 85%的疫苗有效性，我们估计在 DTaP 接种后 8.5 年，有 10%的儿童对百日咳具有免疫力。局限性包括从数据中推断出的统计模型以及纳入的研究设计不同，其中大多数是观察性研究设计。
尽管无细胞百日咳疫苗被认为更安全，但采用这些疫苗可能需要更早地加强接种，并采取重复加强接种策略，以实现控制百日咳传播所需的“群体效应”。
