2013 - 2017年南美洲儿童和老年人流感疫苗预防住院的有效性：一项检测阴性设计的数据
Influenza vaccine effectiveness against hospitalizations in children and older adults-Data from South America, 2013-2017. A test negative design.
作者信息
Sofia Arriola Carmen, El Omeiri Nathalie, Azziz-Baumgartner Eduardo, Thompson Mark G, Sotomayor-Proschle Viviana, Fasce Rodrigo A, Von Horoch Martha, Enrique Carrizo Olalla José, Aparecida Ferreira de Almeida Walquíria, Palacios Jacqueline, Palekar Rakhee, Couto Paula, Descalzo Miguel, María Ropero-Álvarez Alba
机构信息
Influenza Division, US Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Department of Family Gender and Life Course/Immunization, Pan American Health Organization/World Health Organization (PAHO/WHO), Washington, DC, USA.
出版信息
Vaccine X. 2019 Nov 2;3:100047. doi: 10.1016/j.jvacx.2019.100047. eCollection 2019 Dec 10.
BACKGROUND
In 2013, the Pan American Health Organization established a multi-site, multi-country network to evaluate influenza vaccine effectiveness (VE). We pooled data from five consecutive seasons in five countries to conduct an analysis of southern hemisphere VE against laboratory-confirmed influenza hospitalizations in young children and older adults.
METHODS
We used a test-negative design to estimate VE against laboratory-confirmed influenza in hospitalized young children (aged 6─24 months) and older adults (aged ≥60 years) in Argentina, Brazil, Chile, Colombia, and Paraguay. Following country-specific influenza surveillance protocol, hospitalized persons with severe acute respiratory infections (SARI) at 48 sentinel hospitals (March 2013-December 2017) were tested for influenza virus infection by rRT-PCR. VE was estimated for young children and older adults using logistic random effects models accounting for cluster (country), adjusting for sex, age (months for children, and age-in-year categories for adults), calendar year, country, preexisting conditions, month of illness onset and prior vaccination as an effect modifier for the analysis in adults.
RESULTS
We included 8426 SARI cases (2389 children and 6037 adults) in the VE analyses. Among young children, VE against SARI hospitalization associated with any influenza virus was 43% (95%CI: 33%, 51%) for children who received two doses, but was 20% (95%CI: -16%, 45%) and not statistically significant for those who received one dose in a given season. Among older adults, overall VE against SARI hospitalization associated with any influenza virus was 41% (95%CI: 28%, 52%), 45% (95%CI: 34%, 53%) against A(H3N2), 40% (95%CI: 18%, 56%) against A(H1N1)pdm09, and 20% (95%CI: -40%, 54%) against influenza B viruses.
CONCLUSIONS
Our results suggest that over the five-year study period, influenza vaccination programs in five South American countries prevented more than one-third of laboratory confirmed influenza-associated hospitalizations in young children receiving the recommended two doses and vaccinated older adults.
背景
2013年，泛美卫生组织建立了一个多地点、多国网络来评估流感疫苗效力（VE）。我们汇总了五个国家连续五个季节的数据，以分析南半球针对幼儿和老年人实验室确诊流感住院病例的疫苗效力。
方法
我们采用检测阴性设计来估计阿根廷、巴西、智利、哥伦比亚和巴拉圭住院幼儿（6至24个月）和老年人（≥60岁）中针对实验室确诊流感的疫苗效力。按照各国特定的流感监测方案，对48家哨点医院（2013年3月至2017年12月）中患有严重急性呼吸道感染（SARI）的住院患者进行逆转录聚合酶链反应（rRT-PCR）检测流感病毒感染情况。使用逻辑随机效应模型估计幼儿和老年人的疫苗效力，该模型考虑了聚类（国家）因素，并对性别、年龄（儿童为月龄，成人为年龄组）、日历年、国家、既往疾病、发病月份以及成人分析中作为效应修饰因素的既往疫苗接种情况进行了调整。
结果
我们在疫苗效力分析中纳入了8426例SARI病例（2389名儿童和6037名成人）。在幼儿中，接种两剂疫苗的儿童针对与任何流感病毒相关的SARI住院的疫苗效力为43%（95%置信区间：33%，51%），但在特定季节接种一剂疫苗的儿童疫苗效力为20%（95%置信区间：-16%，45%），且无统计学意义。在老年人中，针对与任何流感病毒相关的SARI住院的总体疫苗效力为41%（95%置信区间：28%，52%），针对甲型（H3N2）流感为45%（95%置信区间：34%，53%），针对甲型（H1N1）pdm09流感为40%（95%置信区间：18%，56%），针对乙型流感病毒为20%（95%置信区间：-40%，54%）。
结论
我们的结果表明，在为期五年的研究期间，五个南美国家的流感疫苗接种计划预防了超过三分之一的实验室确诊流感相关住院病例，这些病例发生在接受推荐两剂疫苗的幼儿和接种疫苗的老年人中。
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