Mohammed Anaam, Immergluck Lilly, Parker Trisha Chan, Jain Shabnam, Leong Traci, Anderson Evan J, Jerris Robert C
Pediatric Emergency Medicine Associates, Atlanta, GA, USA.
Morehouse School of Medicine, Departments of Microbiology/Biochemistry/Immunology and Pediatrics, Atlanta, GA, USA; Emory University, Department of Pediatrics, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA.
Vaccine. 2015 Oct 13;33(42):5670-5677. doi: 10.1016/j.vaccine.2015.08.027. Epub 2015 Aug 29.
Rotavirus remains the leading cause of severe diarrhea in children under 5 years worldwide. In the US, Rotarix (RV1) and RotaTeq (RV5), have been associated with reductions in and severity of rotavirus disease. Studies have evaluated the impact of RV1 or RV5 but little is known about the impact of incomplete or mixed vaccination upon vaccine effectiveness.
Case control study to examine association of combined RV1 and RV5 and rotavirus acute gastroenteritis, factoring severity of diarrheal disease. Children born after March 1, 2009 with acute gastroenteritis from three pediatric hospitals in Atlanta, Georgia were approached for enrollment. Survey was administered, stool specimen was collected, and vaccination records were obtained.
891 of 1127 children with acute gastroenteritis were enrolled. Stool specimens were collected from 708 for rotavirus testing; 215 stool samples tested positively for rotavirus. Children >12 months of age were more likely to have rotavirus. Children categorized with Vesikari score of >11 were almost twice as likely to be rotavirus positive. Prior rotavirus vaccination decreased the mean Vesikari score, p<0.0001. Children with complete single type vaccination were protected against rotavirus (OR 0.21, 95% CI: 0.14-0.31, p<0.0001).
Complete rotavirus vaccination with a single vaccine type resulted in protection against rotavirus diarrhea and decrease in severity of rotavirus gastroenteritis. Incomplete rotavirus vaccination either with a single vaccine or mixed vaccination types also provided some protection.
轮状病毒仍然是全球5岁以下儿童严重腹泻的主要病因。在美国，Rotarix（RV1）和RotaTeq（RV5）与轮状病毒疾病的减少及严重程度降低有关。已有研究评估了RV1或RV5的影响，但对于不完全或混合接种疫苗对疫苗效力的影响知之甚少。
进行病例对照研究，以检验联合使用RV1和RV5与轮状病毒急性胃肠炎之间的关联，并考虑腹泻疾病的严重程度。研究对象为2009年3月1日之后出生、来自佐治亚州亚特兰大市三家儿科医院且患有急性胃肠炎的儿童。进行了调查，采集了粪便样本，并获取了疫苗接种记录。
1127例患有急性胃肠炎的儿童中有891例入组。从708例儿童中采集了粪便样本进行轮状病毒检测；215份粪便样本轮状病毒检测呈阳性。12个月以上的儿童感染轮状病毒的可能性更大。Vesikari评分>11分的儿童轮状病毒检测呈阳性的可能性几乎是其他儿童的两倍。先前接种轮状病毒疫苗可降低平均Vesikari评分，p<0.0001。完全接种单一类型疫苗的儿童可预防轮状病毒感染（比值比0.21，95%置信区间：0.14-0.31，p<0.0001）。
完全接种单一类型的轮状病毒疫苗可预防轮状病毒腹泻，并降低轮状病毒胃肠炎的严重程度。不完全接种单一疫苗或混合疫苗类型也能提供一定的保护作用。
