Gessner Bradford D, Halloran M Elizabeth, Khan Imran
Agence de Médecine Preventive, 13 Chemin du Levant, 01210 Ferney-Voltaire, France.
Center for Inference and Dynamics of Infectious Diseases, Fred Hutchinson Cancer Research Center and Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
Vaccine. 2015 Jun 19;33 Suppl 3(0 3):C30-5. doi: 10.1016/j.vaccine.2015.03.085. Epub 2015 Apr 23.
Recent advances in typhoid vaccine, and consideration of support from Gavi, the Vaccine Alliance, raise the possibility that some endemic countries will introduce typhoid vaccine into public immunization programs. This decision, however, is limited by lack of definitive information on disease burden. We propose use of a vaccine probe study approach. This approach would more clearly assess the total burden of typhoid across different syndromic groups and account for lack of access to care, poor diagnostics, incomplete laboratory testing, lack of mortality and intestinal perforation surveillance, and increasing antibiotic resistance. We propose a cluster randomized trial design using a mass immunization campaign among all age groups, with monitoring over a 4-year period of a variety of outcomes. The primary outcome would be the vaccine preventable disease incidence of prolonged fever hospitalization. Sample size calculations suggest that such a study would be feasible over a reasonable set of assumptions.
伤寒疫苗的最新进展，以及对来自疫苗免疫联盟（Gavi）支持的考量，增加了一些伤寒流行国家将伤寒疫苗引入公共免疫规划的可能性。然而，这一决定受到疾病负担方面缺乏确切信息的限制。我们建议采用疫苗探索性研究方法。这种方法将更清楚地评估不同症状组中伤寒的总体负担，并考虑到难以获得医疗服务、诊断不佳、实验室检测不完整、缺乏死亡率和肠穿孔监测以及抗生素耐药性增加等因素。我们建议采用整群随机试验设计，在所有年龄组中开展大规模免疫运动，并在4年期间监测各种结果。主要结果将是疫苗可预防的长期发热住院疾病发病率。样本量计算表明，在合理的假设条件下，这样一项研究是可行的。
