接近群体免疫阈值时拒绝疫苗接种的危害：建模研究。

Dangers of vaccine refusal near the herd immunity threshold: a modelling study.

机构信息

Department of Ecology, Evolution, and Natural Resources, Rutgers University, New Brunswick, NJ, USA; Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA.

Center for Discrete Mathematics and Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts University, Medford, MA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.

出版信息

Lancet Infect Dis. 2015 Aug;15(8):922-6. doi: 10.1016/S1473-3099(15)00053-5. Epub 2015 May 14.

DOI:10.1016/S1473-3099(15)00053-5

PMID:25981883

Abstract

BACKGROUND

Childhood vaccination remains the focus of heated public debate. Parents struggle to understand the potential risks associated with vaccination but both parents and physicians assume that they understand the risks associated with infection. This study was done to characterise how modern vaccination practices have altered patient risks from infection.

METHODS

In this modelling study, we use mathematical analysis to explore how modern-era vaccination practices have changed the risks of severe outcomes for some infections by changing the landscape for disease transmission. We show these effects using published data from outbreaks in the USA for measles, chickenpox, and rubella. Calculation of risk estimation was the main outcome of this study.

FINDINGS

Our calculations show that negative outcomes are 4·5 times worse for measles, 2·2 times worse for chickenpox, and 5·8 times worse for rubella than would be expected in a pre-vaccine era in which the average age at infection would have been lower.

INTERPRETATION

As vaccination makes preventable illness rarer, for some diseases, it also increases the expected severity of each case. Because estimates of case risks rely on data for severity generated during a pre-vaccine era they underestimate negative outcomes in the modern post-vaccine epidemiological landscape. Physicians and parents should understand when making decisions about their children's health and safety that remaining unvaccinated in a predominantly vaccine-protected community exposes their children to the most severe possible outcomes for many preventable diseases.

FUNDING

None.

摘要

背景

儿童疫苗接种仍然是公众激烈辩论的焦点。家长们努力理解与接种相关的潜在风险，但家长和医生都认为他们了解与感染相关的风险。本研究旨在描述现代疫苗接种实践如何改变了感染的患者风险。

方法

在这项建模研究中，我们使用数学分析来探索现代疫苗接种实践如何通过改变疾病传播的格局来改变某些感染的严重后果风险。我们使用美国麻疹、水痘和风疹爆发的已发表数据来展示这些影响。风险估计的计算是本研究的主要结果。

发现

我们的计算表明，与疫苗接种前时代相比，麻疹的不良后果严重 4.5 倍，水痘严重 2.2 倍，风疹严重 5.8 倍，在疫苗接种前时代，感染的平均年龄较低。

解释

由于疫苗接种使可预防的疾病变得罕见，对于某些疾病，它也会增加每个病例的预期严重程度。由于病例风险的估计依赖于疫苗前时代生成的严重程度数据，因此它们低估了现代疫苗接种后流行病学环境中不良后果的发生。在为孩子的健康和安全做出决策时，医生和家长应该明白，在主要由疫苗保护的社区中未接种疫苗会使他们的孩子面临许多可预防疾病的最严重后果。