Centers for Disease Control and Prevention, Atlanta, Georgia.
Universite Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
Clin Infect Dis. 2016 May 1;62 Suppl 2(Suppl 2):S208-12. doi: 10.1093/cid/civ1016.
Rotavirus vaccine efficacy is lower in low-income countries than in high-income countries. Rwanda was one of the first low-income countries in sub-Saharan Africa to introduce rotavirus vaccine into its national immunization program. We sought to evaluate rotavirus vaccine effectiveness (VE) in this setting.
VE was assessed using a case-control design. Cases and test-negative controls were children who presented with a diarrheal illness to 1 of 8 sentinel district hospitals and 10 associated health centers and had a stool specimen that tested positive (cases) or negative (controls) for rotavirus by enzyme immunoassay. Due to high vaccine coverage almost immediately after vaccine introduction, the analysis was restricted to children 7-18 weeks of age at time of rotavirus vaccine introduction. VE was calculated as (1 - odds ratio) × 100, where the odds ratio was the adjusted odds ratio for the rotavirus vaccination rate among case-patients compared with controls.
Forty-eight rotavirus-positive and 152 rotavirus-negative children were enrolled. Rotavirus-positive children were significantly less likely to have received rotavirus vaccine (33/44 [73%] unvaccinated) compared with rotavirus-negative children (81/136 [59%] unvaccinated) (P= .002). A full 3-dose series was 75% (95% confidence interval [CI], 31%-91%) effective against rotavirus gastroenteritis requiring hospitalization or a health center visit and was 65% (95% CI, -80% to 93%) in children 6-11 months of age and 81% (95% CI, 25%-95%) in children ≥12 months of age.
Rotavirus vaccine is effective in preventing rotavirus disease in Rwandan children who began their rotavirus vaccine series from 7 to 18 weeks of age. Protection from vaccination was sustained after the first year of life.
轮状病毒疫苗在低收入国家的效果低于高收入国家。卢旺达是撒哈拉以南非洲首批将轮状病毒疫苗纳入国家免疫计划的低收入国家之一。我们试图评估该背景下轮状病毒疫苗的有效性（VE）。
使用病例对照设计评估 VE。病例和阴性对照测试病例是在 8 家定点区医院和 10 家相关保健中心就诊的患有腹泻病且粪便标本通过酶联免疫吸附试验检测轮状病毒呈阳性（病例）或阴性（对照）的儿童。由于疫苗推出后几乎立即就有很高的疫苗覆盖率，因此分析仅限于轮状病毒疫苗推出时年龄为 7-18 周的儿童。VE 计算为（1-比值比）×100，其中比值比为病例组中轮状病毒疫苗接种率与对照组相比的调整比值比。
共纳入 48 例轮状病毒阳性和 152 例轮状病毒阴性儿童。轮状病毒阳性儿童未接种轮状病毒疫苗的比例明显低于轮状病毒阴性儿童（33/44 [73%]未接种）（P=.002）。完整的 3 剂系列对需要住院或去保健中心就诊的轮状病毒胃肠炎的有效性为 75%（95%置信区间 [CI]，31%-91%），对 6-11 月龄儿童的有效性为 65%（95% CI，-80%至 93%），对≥12 月龄儿童的有效性为 81%（95% CI，25%-95%）。
在从 7 至 18 周龄开始轮状病毒疫苗系列的卢旺达儿童中，轮状病毒疫苗对预防轮状病毒病有效。疫苗接种后的保护作用可持续到 1 岁以后。
