Gessner Bradford D, Knobel Darryn L, Conan Anne, Finn Adam
Agence de Médecine Preventive, Paris, France.
Ross University School of Veterinary Medicine, Island Main Road, West Farm, Saint Kitts and Nevis.
Vaccine. 2017 Feb 1;35(5):716-721. doi: 10.1016/j.vaccine.2016.12.067. Epub 2017 Jan 5.
The RTS,S/AS01 malaria vaccine has been associated with meningitis and cerebral malaria safety signals. Key characteristics of the meningitis signal include presence, in the 5-17month but not the 6-12week age group, of delayed and variable meningitis onset after vaccination, and multiple etiologies. For both meningitis and cerebral malaria, the 5-17month old age group control arm had abnormally low incidences while other arms in both age groups had meningitis and cerebral malaria incidences similar to background rates. No single hypothesis postulating an adverse effect from RTS,S/AS01 unites these observations. Unlike the 6-12week group, the control population in the 5-17month old age group received rabies vaccine. This raises the possibility that non-specific rabies vaccine effects had a protective effect against central nervous system infection, a hypothesis consistent with the epidemiologic data. The lack of a confirmed biologic mechanism for such an effect emphasizes the need for additional studies.
RTS,S/AS01疟疾疫苗已出现与脑膜炎和脑型疟疾相关的安全信号。脑膜炎信号的关键特征包括：在5至17个月龄而非6至12周龄的年龄组中，接种疫苗后脑膜炎发病延迟且情况不一，病因多样。对于脑膜炎和脑型疟疾，5至17个月龄年龄组的对照组发病率异常低，而两个年龄组的其他组脑膜炎和脑型疟疾发病率与背景发病率相似。没有一个假设能统一解释这些观察结果，即RTS,S/AS01会产生不良影响。与6至12周龄组不同，5至17个月龄年龄组的对照人群接种了狂犬病疫苗。这增加了一种可能性，即非特异性狂犬病疫苗效应具有预防中枢神经系统感染的保护作用，这一假设与流行病学数据一致。这种效应缺乏已证实的生物学机制，这凸显了开展更多研究的必要性。
