Porter Chad K, Sorrell Tia, Mitra Indrani, Riddle Mark S
Naval Medical Research Center, Enteric Diseases Department, Silver Spring, MD, United States.
Naval Medical Research Center, Enteric Diseases Department, Silver Spring, MD, United States; Henry M. Jackson Foundation, Rockville, MD, United States.
Vaccine. 2017 Mar 27;35(14):1742-1748. doi: 10.1016/j.vaccine.2017.02.050. Epub 2017 Mar 6.
Vaccination against Salmonella Typhi is one of the leading public health interventions reducing the risk of typhoid fever. There are two available licensed vaccines, Vivotif, oral live-attenuated, and Typhim Vi, intramuscular Vi capsular polysaccharide. The US military is a high risk travel population commonly vaccinated for S. Typhi. We describe the use of S. Typhi vaccination in this population and the acute reactogenicity profile of these vaccines.
Data were obtained from the Defense Medical Surveillance System and vaccination identified between 1998 and 2011 from vaccination codes. Clinical outcomes were assessed for four weeks post vaccination. Adverse event rates and odds ratios were estimated across the two vaccine types.
A total of 1.9million predominately male military personnel received 3.6 million S. Typhi vaccinations with 94.3% of vaccinees receiving the Vi capsule vaccine though variability in the vaccine administered was observed. Receipt of other vaccinations in the 6months surrounding the S. Typhi vaccine was common. Rates of nausea (195 per 100,000 vaccinations), headache (13 per 100,000 vaccinations) and fever (40 per 100,000 vaccinations) were significantly higher following Vi capsule vaccination compared to receipt of Vivotif (130, 2, 10 per 100,000 vaccinations, respectively). In contrast the rates of rash and non-infectious diarrhea (186 and 426 per 100,000 vaccinations, respectively) were increased in those receiving Vivotif compared to the Vi capsule vaccine.
The US military is a major consumer of S. Typhi vaccines. The parenterally administered vaccine appears to be more amenable, though we were limited in our ability to assess the reasons for its higher usage. While we observed a higher rate of several adverse events in subjects receiving the intramuscular vaccination, the overall rate of these events was low. Future studies assessing more long-term health outcomes are warranted.
伤寒沙门氏菌疫苗接种是降低伤寒热风险的主要公共卫生干预措施之一。有两种已获许可的疫苗，口服减毒活疫苗Vivotif和肌肉注射Vi荚膜多糖疫苗Typhim Vi。美国军队是经常接种伤寒沙门氏菌疫苗的高风险旅行人群。我们描述了该人群中伤寒沙门氏菌疫苗的使用情况以及这些疫苗的急性反应原性特征。
数据来自国防医疗监测系统，通过疫苗接种代码确定1998年至2011年期间的疫苗接种情况。在接种疫苗后四周评估临床结果。估计了两种疫苗类型的不良事件发生率和比值比。
共有190万主要为男性的军事人员接种了360万剂伤寒沙门氏菌疫苗，94.3%的接种者接种了Vi胶囊疫苗，不过观察到所接种疫苗存在差异。在接种伤寒沙门氏菌疫苗前后6个月内接种其他疫苗的情况很常见。与接种Vivotif疫苗相比（分别为每10万次接种130例、2例、10例），接种Vi胶囊疫苗后恶心（每10万次接种195例）、头痛（每10万次接种13例）和发热（每10万次接种40例）的发生率显著更高。相比之下，接种Vivotif疫苗的人出现皮疹和非感染性腹泻的发生率（分别为每10万次接种186例和426例）高于接种Vi胶囊疫苗的人。
美国军队是伤寒沙门氏菌疫苗的主要消费者。虽然我们评估其更高使用率原因的能力有限，但注射用疫苗似乎更适用。虽然我们观察到接受肌肉注射疫苗的受试者中几种不良事件的发生率较高，但这些事件的总体发生率较低。有必要开展评估更多长期健康结果的未来研究。
