百日咳住院患儿中足月和早产儿的临床过程和疫苗有效性。
Pertussis hospitalizations among term and preterm infants: clinical course and vaccine effectiveness.
机构信息
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PObox 1, 3720BA, Bilthoven, The Netherlands.
Department of Paediatric Immunology and Infectious Diseases, University Medical Hospital Utrecht, Utrecht, the Netherlands.
出版信息
BMC Infect Dis. 2019 Oct 29;19(1):919. doi: 10.1186/s12879-019-4563-5.
BACKGROUND
Pertussis causes severe disease in young unvaccinated infants, with preterms potentially at highest risk. We studied pertussis in hospitalized infants as related to gestational age (GA) and vaccination history.
METHODS
Medical record data of 0-2y old patients hospitalized for pertussis during 2005-2014 were linked to vaccination data. Multivariable logistic regression was used to study the association between GA and vaccination history on the clinical disease course. We compared vaccine effectiveness (VE) against hospitalization for pertussis between term and preterm infants (i.e., <37w GA) using the screening method as developed by Farrington.
RESULTS
Of 1187 records, medical data from 676 were retrieved. Of these, 12% concerned preterms, whereas they are 8% of Dutch birth cohorts. Median age at admission was 3 m for preterms and 2 m for terms (p < 0.001). Preterms more often had received pertussis vaccination (62% vs 44%; p = 0.01) and more often had coinfections (37% vs 21%; p = 0.01). Preterms tended more often to have complications, to require artificial respiration or to need admittance to the intensive care unit (ICU). Preterms had longer ICU stays (15d vs 9d; p = 0.004). Vaccinated preterms and terms had a lower median length of hospital stay and lower crude risks of apneas and the need for artificial respiration, additional oxygen, and ICU admittance than those not vaccinated. After adjustment for presence of coinfections and age at admittance, these differences were not significant, except the lower need of oxygen treatment in vaccinated terms. Effectiveness of the first vaccination against pertussis hospitalizations was 95% (95% CI 93-96%) and 73% (95% CI 20-91%) in terms and preterms, respectively. Effectiveness of the second dose of the primary vaccination series was comparable in both groups (86 and 99%, respectively).
CONCLUSIONS
Infants hospitalized for pertussis suffer from severe disease. Preterms were overrepresented, with higher need for intensive treatment and less VE of first vaccination. These findings stress the need for alternative prevention, in particular prenatal vaccination of mothers, to reduce pertussis in both groups.
背景
百日咳会导致未接种疫苗的婴幼儿重病，早产儿的风险可能最高。我们研究了与住院婴儿相关的百日咳与胎龄（GA）和疫苗接种史的关系。
方法
将 2005-2014 年期间因百日咳住院的 0-2 岁患者的病历数据与疫苗接种数据进行了关联。使用多变量逻辑回归来研究 GA 和疫苗接种史对临床疾病过程的关联。我们使用 Farrington 开发的筛选方法比较了足月和早产儿（即<37 周 GA）因百日咳住院的疫苗有效性（VE）。
结果
在 1187 份记录中，有 676 份的医疗数据被检索到。其中，早产儿占 12%，而荷兰出生队列的早产儿占 8%。早产儿的入院中位年龄为 3 个月，足月婴儿为 2 个月（p<0.001）。早产儿接受百日咳疫苗接种的比例更高（62% vs 44%；p=0.01），合并感染的比例更高（37% vs 21%；p=0.01）。早产儿更常出现并发症，需要人工呼吸或入住重症监护病房（ICU）。早产儿在 ICU 的停留时间更长（15 天 vs 9 天；p=0.004）。接种疫苗的早产儿和足月婴儿的中位住院时间更短，呼吸暂停和需要人工呼吸、额外吸氧和 ICU 入院的风险也更低，而未接种疫苗的婴儿则更高。在调整合并感染和入院年龄后，这些差异不再显著，除了接种疫苗的足月婴儿需要更少的吸氧治疗。首剂百日咳疫苗对住院的保护效力分别为 95%（95%CI 93-96%）和 73%（95%CI 20-91%），早产儿和足月婴儿分别为 86%和 99%。
结论
因百日咳住院的婴儿病情严重。早产儿的发病率更高，需要更强化的治疗，首剂疫苗的保护效力更低。这些发现强调需要替代预防措施，特别是对母亲进行产前接种，以降低两组的百日咳发病率。
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