流感疫苗在预防妊娠期间与流感相关的住院方面的有效性：2010-2016 年多国回顾性阴性对照设计研究。

Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010-2016.

机构信息

Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.

Institute for Clinical Evaluative Sciences.

出版信息

Clin Infect Dis. 2019 Apr 24;68(9):1444-1453. doi: 10.1093/cid/ciy737.

DOI:10.1093/cid/ciy737

PMID:30307490

Abstract

BACKGROUND

To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy.

METHODS

The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions.

RESULTS

Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%-59%) against influenza-associated hospitalization during pregnancy.

CONCLUSION

Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs.

摘要

背景

迄今为止，尚无研究评估流感疫苗对妊娠期间实验室确诊的流感相关住院的有效性（IVE）。

方法

妊娠流感疫苗有效性网络（PREVENT）由澳大利亚、加拿大（艾伯塔省和安大略省）、以色列和美国（加利福尼亚州、俄勒冈州和华盛顿州）的公共卫生或医疗保健系统组成，这些系统具有整合的实验室、医疗和疫苗接种记录。研究地点确定了妊娠期间与当地流感季节重叠的 18 至 50 岁孕妇。使用行政数据来识别因急性呼吸道或发热性疾病（ARFI）住院的孕妇，以及临床医生开具的实时逆转录聚合酶链反应（rRT-PCR）检测流感病毒。使用阴性测试设计并调整地点、季节、季节时机和高危医疗条件，来估计总体 IVE。

结果

在 19450 例因 ARFI 出院诊断的住院病例（25 个特定地点研究季节）中，只有 1030 例（6%）孕妇接受了 rRT-PCR 检测流感病毒。这些孕妇中约有一半（54%）的人被诊断为肺炎或流感。在接受 rRT-PCR 检测的 1030 例 ARFI 住院患者中，检测到 598 例（58%）流感 A 或 B 病毒感染。在各研究地点和季节，13%的 rRT-PCR 确诊的流感阳性孕妇接种了疫苗，而 22%的流感阴性孕妇接种了疫苗；调整后的总体 IVE 为 40%（95%置信区间=12%-59%），可预防妊娠期间与流感相关的住院。