荷兰的社会经济地位与婴幼儿免疫接种反应之间是否存在关联？
Is there an association between socioeconomic status and immune response to infant and childhood vaccination in the Netherlands?
机构信息
National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
出版信息
Vaccine. 2020 Apr 16;38(18):3480-3488. doi: 10.1016/j.vaccine.2020.01.071. Epub 2020 Feb 14.
INTRODUCTION
Socioeconomic status (SES) is a well-known determinant of health, but its relation with vaccine-induced immunity is less documented. We explored the association between SES and immunoglobulin G (IgG) levels against vaccine-preventable diseases in vaccinated children in the Dutch National Immunization Programme.
METHODS
Data from a population-wide cross-sectional serosurvey in the Netherlands (2006-2007) were used. We compared geometric mean IgG concentrations/titers (GMC/T ratios) against measles, mumps, rubella, Haemophilus influenzae type b (Hib), Neisseria meningococcus type C, diphtheria, tetanus, poliovirus types 1,2,3 and pertussis in children of high versus low SES by linear regression analysis. We included 894 children (0-12 years) at one of two timeframes: 1 month to 1 year, or 1-3 years after vaccination. Mother's educational level and net household income served as binary indicators of SES.
RESULTS
Of 58 possible associations of vaccine-induced antibody responses with educational level and 58 with income, 10 (9%) were statistically significant: 2 favouring (that is, with higher IgG levels at) high educational level (for Hib 1 m-1y after vaccination (GMC/T ratio: 2.99, 95%CI: 1.42-6.30) and polio 2 1 m-1y after the 9-year booster dose (1.14, 1.01-1.27)) and 8 favouring low income (polio 1, 2 and 3 1 m-1y after the 11-month booster (0.74, 0.58-0.94; 0.79, 0.64-0.97; 0.72, 0.55-0.95), polio 3 and pertussis 1-3y after the 11-month booster (0.70, 0.56-0.88; pertussis-prn: 0.60, 0.37-0.98; pertussis-ptx: 0.66, 0.47-0.95), mumps and rubella 1-3y after first vaccination (0.73, 0.55-0.97; 0.70, 0.55-0.90), and rubella 1 m-1y after second vaccination (0.83, 0.55-0.90)). After adjustment for multiple testing, none of the differences remained significant. There was no association between SES and proportion of children with protective IgG levels.
CONCLUSION
In this explorative study, we found no consistent association between SES and immune response to vaccination in the Netherlands and no association with protective IgG levels. Additional studies in other settings should confirm this finding.
简介
社会经济地位（SES）是健康的已知决定因素，但它与疫苗诱导免疫的关系记录较少。我们探讨了 SES 与荷兰国家免疫计划中接种疫苗儿童对可预防疾病的免疫球蛋白 G（IgG）水平之间的关系。
方法
使用荷兰人群横断面血清学调查（2006-2007 年）的数据。我们通过线性回归分析比较了高 SES 与低 SES 儿童接种疫苗后 1 个月至 1 年或 1 至 3 年内针对麻疹、腮腺炎、风疹、b 型流感嗜血杆菌（Hib）、脑膜炎奈瑟球菌 C 型、白喉、破伤风、脊髓灰质炎 1、2、3 型和百日咳的 IgG 浓度/滴度（GMC/T 比值）。母亲的教育水平和家庭净收入是 SES 的二项指标。
结果
在与教育水平和收入相关的 58 种疫苗诱导抗体反应中，有 10 种（9%）具有统计学意义：2 种有利于（即 IgG 水平更高）高教育水平（Hib 在接种后 1 个月至 1 年，GMC/T 比值：2.99，95%CI：1.42-6.30）和脊髓灰质炎 2 型在接种后 9 年加强剂量后 1 个月至 1 年（1.14，1.01-1.27））和 8 种有利于低收入（脊髓灰质炎 1、2 和 3 型在接种后 11 个月加强剂量后 1 个月至 1 年，0.74，0.58-0.94；0.79，0.64-0.97；0.72，0.55-0.95），脊髓灰质炎 3 型和百日咳在接种后 11 个月加强剂量后 1 年至 3 年，0.70，0.56-0.88；百日咳-随机：0.60，0.37-0.98；百日咳-PTX：0.66，0.47-0.95），腮腺炎和风疹在首次接种后 1 年至 3 年，0.73，0.55-0.97；0.70，0.55-0.90）和风疹在第二次接种后 1 个月至 1 年，0.83，0.55-0.90）。在进行多次检验调整后，没有差异仍然具有统计学意义。SES 与保护性 IgG 水平的免疫反应之间没有关联。在其他环境中进行的进一步研究应该证实这一发现。
结论
在这项探索性研究中，我们没有发现 SES 与荷兰疫苗接种免疫反应之间存在一致的关系，也没有发现与保护性 IgG 水平之间存在关联。
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