Onorato I M, Orenstein W A, Hinman A R, Rogers M F, Koplan J P
Division of Immunization, Center for Prevention Services, Atlanta, Georgia 30333.
Med Decis Making. 1989 Apr-Jun;9(2):76-83. doi: 10.1177/0272989X8900900202.
Because HIV infection is associated with immunologic abnormalities, concerns have been expressed about the safety and efficacy of vaccination of infected children with live virus vaccines. The authors used decision analysis to assess the likely impacts of four alternative policies for immunization of asymptomatic HIV-infected children with measles vaccine. Probabilities for vaccine efficacy, vaccine-related adverse events, and measles complications in HIV-infected children and the prevalence of HIV infection in the birth cohort were obtained from a modified Delphi survey. Using median estimates from the Delphi survey, there were no major differences in outcomes under any proposed policy. Using the most extreme estimates, serologic testing and exclusion of seropositive children from vaccination or exclusion of all high-risk children decreased vaccine-associated adverse events without greatly increasing measles complications, primarily because of the current low incidence of measles. Under conditions assumed to exist in the United States today, alternate immunization policies have only minor differences in societal impact although costs would certainly differ.
由于HIV感染与免疫异常有关，人们对感染儿童接种活病毒疫苗的安全性和有效性表示担忧。作者使用决策分析来评估四种替代政策对无症状HIV感染儿童接种麻疹疫苗可能产生的影响。从一项经过修改的德尔菲调查中获得了HIV感染儿童中疫苗效力、疫苗相关不良事件和麻疹并发症的概率，以及出生队列中HIV感染的流行率。使用德尔菲调查的中位数估计值，任何提议政策下的结果都没有重大差异。使用最极端的估计值，血清学检测以及将血清阳性儿童排除在疫苗接种之外或排除所有高危儿童，可减少疫苗相关不良事件，而不会大幅增加麻疹并发症，这主要是因为目前麻疹发病率较低。在假设当今美国存在的条件下，尽管成本肯定会有所不同，但替代免疫政策在社会影响方面只有微小差异。
