接种麻疹活疫苗后再接种非活五价疫苗可能会增加死亡率。
Non-live pentavalent vaccines after live measles vaccine may increase mortality.
机构信息
Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark.
Bandim Health Project, Indepth Network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau; Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; Center for Global Health, Department of Public Health, Aarhus University, 8000 Aarhus C, Denmark.
出版信息
Vaccine. 2018 Oct 1;36(41):6039-6042. doi: 10.1016/j.vaccine.2018.08.083. Epub 2018 Sep 5.
Live measles vaccine (MV) may have beneficial off-target/non-specific effects (NSEs) reducing child mortality beyond prevention of measles infection. In contrast, the non-live pentavalent (Diphtheria-Tetanus-Pertussis-H. influenzae Type B-Hepatitis B) vaccine has no beneficial NSEs. The NSEs are strongest for the most recent vaccine. Hence, sequence of vaccination may affect survival. In Guinea-Bissau, we followed 7094 measles-vaccinated children prospectively from first home visit after 9 months (when MV is scheduled) to 5 years of age. We compared survival by sequence of MV and third Pentavalent vaccine (Penta3; scheduled at 3½ months) in Cox proportional-hazards models. Compared with being vaccinated in-sequence (Penta3-then-MV), having received out-of-sequence Penta3-after-MV before the visit was associated with an adjusted Hazard Ratio (aHR) of 1.19 (95%CI: 0.84-1.69); Receiving missing Penta doses on the visit date tended to be associated with higher mortality (aHR = 1.87 (0.96-3.65)) while not receiving missing doses of Penta was not (aHR = 0.93 (0.57-1.54)), test for interaction p = 0.09.
活麻疹疫苗（MV）可能具有有益的非靶向/非特异性效应（NSEs），除了预防麻疹感染外，还能降低儿童死亡率。相比之下，非活五价疫苗（白喉-破伤风-百日咳-Hib-乙肝）没有有益的 NSEs。最新的疫苗的 NSEs 最强。因此，疫苗接种的顺序可能会影响生存。在几内亚比绍，我们前瞻性地随访了 7094 名接受麻疹疫苗接种的儿童，从 9 个月（MV 计划接种时）的第一次家访开始，直到 5 岁。我们在 Cox 比例风险模型中比较了 MV 和第三剂五价疫苗（Penta3；计划在 3 个半月接种）的接种顺序对生存的影响。与按顺序接种（Penta3 后接种 MV）相比，在就诊前先接种非顺序 Penta3 后接种 MV 的调整后的危险比（aHR）为 1.19（95%CI：0.84-1.69）；在就诊日期时漏种 Penta 剂次与死亡率较高相关（aHR=1.87（0.96-3.65）），而未漏种 Penta 剂次则不相关（aHR=0.93（0.57-1.54）），交互检验 p=0.09。
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