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指南推荐使用减毒活流感疫苗作为儿童和青少年哮喘常规使用的安全性。

Safety of guidelines recommending live attenuated influenza vaccine for routine use in children and adolescents with asthma.

机构信息

HealthPartners Institute, Minneapolis, MN, United States.

HealthPartners Institute, Minneapolis, MN, United States.

出版信息

Vaccine. 2019 Jul 9;37(30):4055-4060. doi: 10.1016/j.vaccine.2019.05.081. Epub 2019 Jun 10.

Abstract

OBJECTIVE

Evaluate whether a guideline recommending Live Attenuated Influenza Vaccine (LAIV) for children 2 years and older with asthma increased risks for lower respiratory events (LREs), within 21 or 42 days of vaccination, as compared to standard guidelines to administer Inactivated Influenza Vaccine (IIV) in children with asthma.

METHODS

This was a pre/post guideline retrospective cohort study of children ages 2-17 years with asthma and receiving one or more influenza vaccines in two large medical groups from 2007 to 2016. Both groups recommended IIV in the pre-period; in 2010, one group implemented a guideline recommending LAIV for all children, including those with asthma. Main outcomes were medically attended LREs within 21 and 42 days after influenza immunization. Analysis used a generalized estimating equation regression to estimate the ratio of rate ratios (RORs) comparing pre/post events between LAIV guideline and control group.

RESULTS

The cohort included 7851 influenza vaccinations in 4771 children with asthma. Among patients in the LAIV guideline group, the proportion receiving LAIV increased from 23% to 68% post-guideline implementation, versus an increase from 7 to 11% in the control group. Age and baseline asthma severity adjusted ROR showed no increase in LREs, primarily asthma exacerbations, following implementation of the LAIV guideline: overall aROR (95% Confidence Interval): 0.74 (0.43-1.29) for LRE within 21 days of vaccination, 0.77 (0.53-1.14) for LRE within 42 days of vaccination. For the subset of children ages 2-4 years aROR: 0.92 (0.34-2.53) for LRE within 21 days of vaccination and 0.94 (0.49-1.82) for LRE within 42 days of vaccination; for children 5-18 years aROR (95% CI): 0.58 (0.26-1.30) for LRE within 21 days of vaccination and 0.67 (0.37-1.23) for LRE within 42 days.

CONCLUSION

In a large cohort of children with asthma, a guideline recommending LAIV rather than IIV did not increase LREs following vaccination.

摘要

目的

评估与标准指南相比,对于患有哮喘的 2 岁及以上儿童,推荐使用活减毒流感疫苗(LAIV)是否会增加接种后 21 天或 42 天内下呼吸道事件(LRE)的风险。

方法

这是一项针对使用两种大型医疗集团 2007 年至 2016 年期间为 2-17 岁患有哮喘并接种过一种或多种流感疫苗的儿童进行的前后指南回顾性队列研究。两组均在前期推荐接种灭活流感疫苗(IIV);2010 年,一组指南推荐所有儿童(包括哮喘儿童)接种 LAIV。主要结局是接种流感疫苗后 21 天和 42 天内有医疗记录的 LRE。分析采用广义估计方程回归来估计 LAIV 指南组与对照组之间前后事件的比率比(ROR)。

结果

该队列包括 7851 例流感疫苗接种和 4771 例哮喘患儿。在 LAIV 指南组中,接受 LAIV 的比例从指南实施前的 23%增加到实施后的 68%,而对照组从 7%增加到 11%。年龄和基线哮喘严重程度调整后的 ROR 显示,LAIV 指南实施后,LRE(主要是哮喘恶化)并未增加:总体 aROR(95%置信区间):接种后 21 天内 LRE 为 0.74(0.43-1.29),接种后 42 天内 LRE 为 0.77(0.53-1.14)。对于 2-4 岁儿童的亚组,aROR:接种后 21 天内 LRE 为 0.92(0.34-2.53),接种后 42 天内 LRE 为 0.94(0.49-1.82);对于 5-18 岁儿童,aROR(95%CI):接种后 21 天内 LRE 为 0.58(0.26-1.30),接种后 42 天内 LRE 为 0.67(0.37-1.23)。

结论

在患有哮喘的儿童大队列中,与标准指南相比,推荐使用 LAIV 而不是 IIV 并未增加接种后的 LRE。

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