2012-2016 年美国高危医疗条件患者的流感疫苗有效性。
Influenza vaccine effectiveness among patients with high-risk medical conditions in the United States, 2012-2016.
机构信息
Epidemic Intelligence Service, CDC, United States; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States.
Influenza Division, National Center for Immunization and Respiratory Diseases, CDC, United States.
出版信息
Vaccine. 2018 Dec 18;36(52):8047-8053. doi: 10.1016/j.vaccine.2018.10.093. Epub 2018 Nov 9.
BACKGROUND
Annual influenza vaccination has been recommended for persons with high-risk conditions since the 1960s. However, few estimates of influenza vaccine effectiveness (VE) for persons with high-risk conditions are available.
METHODS
Data from the U.S. Influenza Vaccine Effectiveness Network from 2012 to 2016 were analyzed to compare VE of standard-dose inactivated vaccines against medically-attended influenza among patients aged ≥6 months with and without high-risk medical conditions. Patients with acute respiratory illness were tested for influenza by RT-PCR. Presence of high-risk conditions and vaccination status were obtained from medical records. VE by influenza virus type/subtype and age group was calculated for patients with and without high-risk conditions using the test-negative design. Interaction terms were used to test for differences in VE by high-risk conditions.
RESULTS
Overall, 9643 (38%) of 25,369 patients enrolled during four influenza seasons had high-risk conditions; 2213 (23%) tested positive for influenza infection. For all ages, VE against any influenza was lower among patients with high-risk conditions (41%, 95% CI: 35-47%) than those without (48%, 95% CI: 43-52%; P-for-interaction = 0.02). For children aged <18 years, VE against any influenza was 51% (95% CI: 39-61%) and 52% (95% CI: 39-61%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.54). For adults aged ≥18 years, VE against any influenza was 38% (95% CI: 30-45%) and 44% (95% CI: 38-50%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.21). For both children aged <18 and adults aged ≥18 years, VEs against illness related to influenza A(H3N2), A(H1N1)pdm09, and influenza B virus infection were similar among those with and without high-risk conditions.
CONCLUSIONS
Influenza vaccination provided protection against medically-attended influenza among patients with high-risk conditions, at levels approaching those observed among patients without high-risk conditions. Results from our analysis support recommendations of annual vaccination for patients with high-risk conditions.
背景
自 20 世纪 60 年代以来，人们一直建议高危人群每年接种流感疫苗。然而，目前可获得的高危人群流感疫苗有效性（VE）的估计数据很少。
方法
对 2012 年至 2016 年美国流感疫苗有效性网络的数据进行了分析，以比较≥6 月龄有和无高危医疗条件的患者中标准剂量灭活疫苗对有医疗服务需求的流感的 VE。通过 RT-PCR 对急性呼吸道疾病患者进行流感检测。从病历中获得高危条件和疫苗接种情况。使用阴性检测设计，计算有和无高危条件的患者中按流感病毒类型/亚型和年龄组的 VE。使用交互项检验高危条件对 VE 的影响。
结果
在四个流感季节中，共有 25369 名患者中有 9643 名（38%）患有高危疾病；2213 名（23%）患者流感检测呈阳性。在所有年龄段中，患有高危疾病的患者的任何流感 VE 均低于无高危疾病的患者（41%，95%CI：35-47%）（P-for-interaction=0.02）。对于年龄<18 岁的儿童，有和无高危疾病的患者中任何流感的 VE 分别为 51%（95%CI：39-61%）和 52%（95%CI：39-61%）（P-for-interaction=0.54）。对于年龄≥18 岁的成年人，有和无高危疾病的患者中任何流感的 VE 分别为 38%（95%CI：30-45%）和 44%（95%CI：38-50%）（P-for-interaction=0.21）。对于年龄<18 岁的儿童和年龄≥18 岁的成年人，有和无高危疾病的患者中与流感 A(H3N2)、A(H1N1)pdm09 和流感 B 病毒感染相关的疾病的 VE 相似。
结论
流感疫苗为高危人群提供了对有医疗服务需求的流感的保护，其保护水平接近无高危人群的保护水平。我们分析的结果支持对高危人群进行年度接种的建议。
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