Dartmouth College Department of Physics and Astronomy, Hanover, New Hampshire.
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Epidemiol Rev. 2019 Jan 31;41(1):13-27. doi: 10.1093/epirev/mxz014.
We searched the PubMed database for clinical trials and observational human studies about postexposure vaccination effects, targeting infections with approved vaccines and vaccines licensed outside the United States against dengue, hepatitis E, malaria, and tick-borne encephalitis. Studies of animal models, serologic testing, and pipeline vaccines were excluded. Eligible studies were evaluated by definition of exposure; attempts to distinguish pre- and postexposure effects were rated on a scale of 1 to 4. We screened 4,518 articles and ultimately identified for this review 14 clinical trials and 31 observational studies spanning 7 of the 28 vaccine-preventable diseases. For secondary attack rate, the following medians were found for postexposure vaccination effectiveness: hepatitis A, 85% (interquartile range (IQR), 28; n = 5 sources); hepatitis B, 85% (IQR, 22; n = 5 sources); measles, 83% (IQR, 21; n = 8 sources); varicella, 67% (IQR: 48; n = 9 sources); smallpox, 45% (IQR, 39; n = 4 sources); and mumps, 38% (IQR, 7; n = 2 sources). For case fatality proportions resulting from rabies and smallpox, the median vaccine postexposure efficacies were 100% (IQR, 0; n = 6 sources) and 63% (IQR, 50; n = 8 sources), respectively. Many available vaccines can modify or preclude disease if administered after exposure. This postexposure effectiveness could be important to consider during vaccine trials and while developing new vaccines.
我们在 PubMed 数据库中搜索了关于暴露后疫苗接种效果的临床试验和观察性人类研究，针对的是已批准用于预防登革热、戊型肝炎、疟疾和蜱传脑炎的疫苗以及美国以外获得许可的疫苗针对的感染。排除了动物模型研究、血清学检测和疫苗研发管道的研究。根据暴露定义评估合格研究；区分暴露前和暴露后效果的尝试按 1 到 4 级进行评分。我们筛选了 4518 篇文章，最终确定了 14 项临床试验和 31 项观察性研究，涵盖了 28 种可预防疾病中的 7 种。对于二次攻击率，以下是暴露后疫苗接种有效性的中位数：甲型肝炎，85%（四分位距 (IQR)，28；n=5 个来源）；乙型肝炎，85%（IQR，22；n=5 个来源）；麻疹，83%（IQR，21；n=8 个来源）；水痘，67%（IQR：48；n=9 个来源）；天花，45%（IQR，39；n=4 个来源）；和腮腺炎，38%（IQR，7；n=2 个来源）。对于狂犬病和天花导致的病死率比例，中位数疫苗暴露后效力分别为 100%（IQR，0；n=6 个来源）和 63%（IQR，50；n=8 个来源）。许多现有的疫苗如果在暴露后使用，可以改变或预防疾病。在疫苗试验和开发新疫苗时，这种暴露后效果可能很重要。
