水痘疫苗接种与儿科动脉缺血性脑卒中有关吗？基于人群的队列研究。

Is varicella vaccination associated with pediatric arterial ischemic stroke? A population-based cohort study.

机构信息

University of Alberta, Faculty of Nursing, 5-308 Edmonton Clinic Health Academic, Edmonton, AB T6G 1C9, Canada; University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.

Analytics and Performance Reporting, Alberta Health, P.O. Box 1360, Station Main, Edmonton, AB T5J 2N3, Canada; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405- 87 Ave, Edmonton, Alberta T6G 1C9, Canada.

出版信息

Vaccine. 2018 May 11;36(20):2764-2767. doi: 10.1016/j.vaccine.2018.04.012. Epub 2018 Apr 11.

DOI:10.1016/j.vaccine.2018.04.012

PMID:29655630

Abstract

BACKGROUND AND PURPOSE

Varicella disease is a risk factor for pediatric Arterial Ischemic Stroke (AIS). Isolated case reports have emerged suggesting that varicella vaccination may also pose a risk for AIS.

METHODS

This retrospective population-based cohort study assessed the risk of AIS in children who received a varicella-containing vaccine, as compared to those who did not. The study cohort consisted of children born between January 1, 2006 and December 31, 2013, in the Canadian province of Alberta, where all routine childhood vaccinations are publicly-funded, and recorded in a central immunization repository. These data were linked with hospital discharge abstract data to identify children diagnosed with AIS. A Cox proportional hazard model assessed the risk of AIS in the 12 months following vaccination for children receiving a varicella vaccine between 11 and 23 months of age, as compared to non-vaccinated children.

RESULTS

Of the 368,992 children in the cohort, 325,729 were vaccinated with a varicella-containing vaccine between 11 and 23 months of age. The rate of AIS was 7.8 (95% CI 4.8-10.9) per 100,000 person years at risk in the 12 months following varicella vaccination, as compared to 6.8 (95% CI 1.3-12.2) for children who did not receive a varicella vaccine. The adjusted Hazard Ratio for the risk of AIS, controlling for other AIS risk factors, in vaccinated children as compared to non-vaccinated children was 1.6 (95% CI 0.7-3.7) in the 12 months following vaccination and 1.7 (95% CI 0.5-4.9) in the 30 days following vaccination.

CONCLUSIONS

Our study found no evidence of an increased risk of AIS following varicella vaccination. This population-based cohort study provides reassurance to parents and clinicians regarding the safety of varicella vaccination.

摘要

背景与目的

水痘疾病是小儿动脉缺血性脑卒中（AIS）的一个危险因素。有孤立的病例报告表明，水痘疫苗接种也可能对 AIS 构成风险。

方法

本回顾性基于人群的队列研究评估了接种水痘疫苗的儿童与未接种疫苗的儿童相比，患 AIS 的风险。研究队列包括 2006 年 1 月 1 日至 2013 年 12 月 31 日期间在加拿大艾伯塔省出生的儿童，在该省，所有常规儿童疫苗接种均由公共资金提供，并在中央免疫储存库中记录。这些数据与医院出院摘要数据相关联，以确定诊断为 AIS 的儿童。Cox 比例风险模型评估了在 11 至 23 个月龄时接种水痘疫苗的儿童在接种疫苗后 12 个月内发生 AIS 的风险，与未接种疫苗的儿童相比。

结果

在队列中的 368992 名儿童中，有 325729 名儿童在 11 至 23 个月龄时接种了含有水痘疫苗的疫苗。在接种水痘疫苗后的 12 个月内，AIS 的发生率为每 100000 人年 7.8（95%CI 4.8-10.9），而未接种水痘疫苗的儿童为每 100000 人年 6.8（95%CI 1.3-12.2）。在调整了其他 AIS 风险因素后，与未接种疫苗的儿童相比，接种疫苗的儿童在接种疫苗后的 12 个月内 AIS 的风险调整后的 Hazard Ratio 为 1.6（95%CI 0.7-3.7），在接种疫苗后的 30 天内为 1.7（95%CI 0.5-4.9）。