孕期流感：法国基于网络的队列研究G-GrippeNet中的发病率、疫苗接种覆盖率及对疫苗接种的态度
Influenza during pregnancy: Incidence, vaccination coverage and attitudes toward vaccination in the French web-based cohort G-GrippeNet.
作者信息
Loubet Paul, Guerrisi Caroline, Turbelin Clément, Blondel Béatrice, Launay Odile, Bardou Marc, Goffinet François, Colizza Vittoria, Hanslik Thomas, Kernéis Solen
机构信息
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France; Department of Infectious Diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INSERM CIC 1417, Paris, France.
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
出版信息
Vaccine. 2016 Apr 29;34(20):2390-6. doi: 10.1016/j.vaccine.2016.03.034. Epub 2016 Mar 21.
INTRODUCTION
Pregnancy is a risk factor for severe influenza. However, data on influenza incidence during pregnancy are scarce. Likewise, no data are available on influenza vaccine coverage in France since national recommendation in 2012. We aimed to assess these points using a novel nationwide web-based surveillance system, G-GrippeNet.
METHODS
During the 2014/2015 influenza season, pregnant women living in metropolitan France were enrolled through a web platform (https://www.grippenet.fr/). Throughout the season, participants were asked to report, on a weekly basis, if they had experienced symptoms of influenza-like-illness (ILI). ILI episodes reported were used to calculate incidence density rates based on period of participation from each participant. Vaccination coverage was estimated after weighing on age and education level from national data on pregnant women. Factors associated with higher vaccination coverage were obtained through a logistic regression with Odds Ratio (OR) corrected with the Zhang and Yu method.
RESULTS
A total of 153 women were enrolled. ILI incidence density rate was 1.8 per 100 person-week (95% CI, 1.5-2.1). This rate was higher in women older than 40 years (RR = 3.0, 95% CI [1.1-8.3], p = 0.03) and during first/second trimesters compared to third trimester (RR = 4.0, 95% CI [1.4-12.0], p = 0.01). Crude vaccination coverage was 39% (95% CI, 31-47) and weighted vaccination coverage was estimated at 26% (95% CI, 20-34). Health care provider recommendation for vaccination (corrected OR = 7.8; 95% CI [3.0-17.1]) and non-smoking status (cOR = 2.1; 95% CI [1.2-6.9]) were associated with higher vaccine uptake.
CONCLUSION
This original web based longitudinal surveillance study design proved feasible in pregnant women population. First results are of interest and underline that public health policies should emphasize the vaccination promotion through health care providers.
引言
怀孕是患重症流感的一个风险因素。然而，关于孕期流感发病率的数据却很稀少。同样，自2012年法国发布全国性建议以来，尚无该国流感疫苗接种覆盖率的数据。我们旨在通过一个全新的全国性网络监测系统G-GrippeNet来评估这些情况。
方法
在2014/2015流感季期间，居住在法国本土的孕妇通过一个网络平台（https://www.grippenet.fr/）进行登记。在整个流感季中，要求参与者每周报告是否出现流感样疾病（ILI）症状。根据每位参与者的参与时长，用报告的ILI发病情况来计算发病密度率。根据全国孕妇数据，在考虑年龄和教育水平后估算疫苗接种覆盖率。通过逻辑回归分析得出与较高疫苗接种覆盖率相关的因素，并采用张和余方法校正比值比（OR）。
结果
共纳入153名女性。ILI发病密度率为每100人周1.8例（95%置信区间，1.5 - 2.1）。40岁以上女性的发病率更高（相对危险度 = 3.0，95%置信区间[1.1 - 8.3]，p = 0.03），与孕晚期相比，孕早期/中期的发病率更高（相对危险度 = 4.0，95%置信区间[1.4 - 12.0]，p = 0.01）。粗疫苗接种覆盖率为39%（95%置信区间，31 - 47），加权疫苗接种覆盖率估计为26%（95%置信区间，20 - 34）。医疗保健人员的疫苗接种建议（校正后OR = 7.8；95%置信区间[3.0 - 17.1]）和不吸烟状态（校正后OR = 2.1；95%置信区间[1.2 - 6.9]）与较高的疫苗接种率相关。
结论
这种基于网络的纵向监测研究设计在孕妇群体中被证明是可行的。初步结果很有意义，并强调公共卫生政策应通过医疗保健人员来加强疫苗接种推广。
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