挪威儿童肠套叠：轮状病毒疫苗接种后会出现什么情况？

Intussusception among Norwegian children: What to expect after introduction of rotavirus vaccination?

机构信息

Norwegian Institute of Public Health, PO Box 222 Skøyen, N-0213 Oslo, Norway.

出版信息

Vaccine. 2019 Sep 10;37(38):5717-5723. doi: 10.1016/j.vaccine.2019.06.058. Epub 2019 Jun 26.

DOI:10.1016/j.vaccine.2019.06.058

PMID:31255303

Abstract

BACKGROUND

To reduce the risk of vaccine-associated intussusception, rotavirus vaccination in Norway was implemented under strict age limits (the first dose given by 12 weeks of age and the second dose by 16 weeks of age) in 2014. We estimated the incidence of intussusception in children <2 years old before vaccine introduction and the number of vaccine-associated cases under current and extended age limits for vaccine administration in Norway.

METHODS

To estimate the baseline incidence, we validated all diagnoses in children <2 years old registered in the national hospital registry during the pre-vaccine period of 2008-2013. Using national vaccine coverage data and international estimates of intussusception risk after rotavirus vaccination, we calculated the numbers of expected vaccine-associated intussusception cases to compare with the estimated numbers of averted rotavirus cases. Uncertainty was accounted for by several scenario analyses using current and extended age limits for vaccine administration.

RESULTS

The pre-vaccine incidence of intussusception was 26.7 (95% CI 23.1-30.6) cases/year per 100,000 children <2 years old and 37.1 (95% CI 31.2-43.8) cases/year per 100,000 children <1 year old. In the 2016 birth cohort (approx. 60,000) vaccinated under the current age limits, 1.3 (95% CI 0.7-2.0) vaccine-associated intussusception cases were expected to occur. If age limits were extended to 16 weeks for the first vaccine dose and 24 weeks for the second dose, leading to more children vaccinated at an older age, 2.2 (95% CI 1.2-3.5) excess cases would be expected in the same cohort. Simultaneously, an estimated 1768 rotavirus hospitalizations/year in children <5 years old would be averted under current age limits, with 98 additional rotavirus hospitalizations averted under extended age limits.

CONCLUSIONS

Administering rotavirus vaccines beyond current age limits in Norway would lead to a marginal increase in the number of intussusception cases, which would be offset by the benefits of vaccination.

摘要

背景

为降低疫苗相关肠套叠的风险，挪威于 2014 年对轮状病毒疫苗接种实行严格的年龄限制（第一剂在 12 周龄内接种，第二剂在 16 周龄内接种）。我们估计了疫苗引入前 2 岁以下儿童肠套叠的发病率和当前及延长疫苗接种年龄限制下挪威疫苗相关病例数。

方法

为了估计基线发病率，我们验证了 2008-2013 年疫苗前时期在国家医院登记册中登记的所有 2 岁以下儿童的诊断。利用国家疫苗接种覆盖率数据和轮状病毒疫苗接种后肠套叠风险的国际估计值，我们计算了预期的疫苗相关肠套叠病例数，以与估计的轮状病毒病例数进行比较。利用当前和延长的疫苗接种年龄限制进行了几次方案分析，以考虑不确定性。

结果

疫苗前肠套叠的发病率为每 100,000 名<2 岁儿童 26.7（95%CI 23.1-30.6）例，每 100,000 名<1 岁儿童 37.1（95%CI 31.2-43.8）例。在 2016 年出生的队列（约 60,000 人）中，按照当前年龄限制接种疫苗，预计将发生 1.3（95%CI 0.7-2.0）例疫苗相关肠套叠病例。如果将第一剂疫苗的年龄限制延长至 16 周，第二剂疫苗的年龄限制延长至 24 周，从而使更多的儿童在年龄较大时接种疫苗，在同一队列中预计将额外发生 2.2（95%CI 1.2-3.5）例病例。同时，在当前年龄限制下，预计每年将有 1768 名<5 岁儿童因轮状病毒住院，延长年龄限制后将额外有 98 名儿童因轮状病毒住院。