Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Guangdong Provincial Key Laboratory of Environmental Protection and Resources Utilization, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
Environ Res. 2020 Aug;187:109624. doi: 10.1016/j.envres.2020.109624. Epub 2020 May 7.
Ambient air pollution exposure and influenza virus infection have been documented to be independently associated with reduced lung function previously. Influenza vaccination plays an important role in protecting against influenza-induced severe diseases. However, no study to date has focused on whether influenza vaccination may modify the associations between ambient air pollution exposure and lung function.
We undertook a cross-sectional study of 6740 children aged 7-14 years into Seven Northeast Cities (SNEC) Study in China during 2012-2013. We collected information from parents/guardians about sociodemographic factors and influenza vaccination status in the past three years. Lung function was measured using portable electronic spirometers. Machine learning methods were used to predict 4-year average ambient air pollutant exposures to nitrogen dioxide (NO) and particulate matter with an aerodynamic diameter <1 μm (PM), <2.5 μm (PM) and <10 μm (PM). Two-level linear and logistic regression models were used to assess interactions between influenza vaccination and long-term ambient air pollutants exposure on lung function reduction, controlling for potential confounding factors.
Ambient air pollution were observed significantly associated with reductions in lung function among children. We found significant interactions between influenza vaccination and air pollutants on lung function, suggesting greater vulnerability to air pollution among unvaccinated children. For example, an interaction (p = 0.002) indicated a -283.44 mL (95% CI: -327.04, -239.83) reduction in forced vital capacity (FVC) per interquartile range (IQR) increase in PM concentrations among unvaccinated children, compared with the -108.24 mL (95%CI: -174.88, -41.60) reduction in FVC observed among vaccinated children. Results from logistic regression models also showed stronger associations between per IQR increase in PM and lung function reduction measured by FVC and peak expiratory flow (PEF) among unvaccinated children than the according ORs among vaccinated children [i.e., Odds Ratio (OR) for PM and impaired FVC: 2.33 (95%CI: 1.79, 3.03) vs 1.65 (95%CI: 1.20, 2.28); OR for PM and impaired PEF: 1.45 (95%CI: 1.12,1.87) vs 1.04 (95%CI: 0.76,1.43)]. The heterogeneity of the modification by influenza vaccination of the associations between air pollution exposure and lung function reduction appeared to be more substantial in girls than in boys.
Our results suggest that influenza vaccination may moderate the detrimental effects of ambient air pollution on lung function among children. This study provides new insights into the possible co-benefits of strengthening and promoting global influenza vaccination programs among children.
先前的研究已经证明，大气污染暴露和流感病毒感染与肺功能下降有关。流感疫苗在预防流感引起的严重疾病方面发挥着重要作用。然而，目前尚无研究关注流感疫苗接种是否可能改变大气污染暴露与肺功能之间的关联。
我们在中国 2012-2013 年的七个东北城市（SNEC）研究中对 6740 名 7-14 岁的儿童进行了一项横断面研究。我们从父母/监护人那里收集了有关社会人口因素和过去三年流感疫苗接种状况的信息。使用便携式电子肺活量计测量肺功能。使用机器学习方法来预测过去 4 年平均的二氧化氮（NO）和空气动力学直径<1μm（PM）、<2.5μm（PM）和<10μm（PM）的空气污染物暴露情况。使用两水平线性和逻辑回归模型，在控制潜在混杂因素的情况下，评估流感疫苗接种和长期大气污染物暴露对肺功能下降的相互作用。
大气污染物与儿童肺功能下降显著相关。我们发现流感疫苗接种和空气污染物之间存在显著的相互作用，表明未接种疫苗的儿童更容易受到空气污染的影响。例如，在未接种疫苗的儿童中，与 PM 浓度每增加一个四分位距（IQR）相比，FVC 减少 283.44mL（95%CI：-327.04，-239.83），而在接种疫苗的儿童中，FVC 减少 108.24mL（95%CI：-174.88，-41.60）。逻辑回归模型的结果也表明，与接种疫苗的儿童相比，PM 每增加一个 IQR 与 FVC 和呼气峰流速（PEF）下降之间的相关性更强，未接种疫苗的儿童肺功能下降的关联更强[即，PM 和 FVC 受损的 OR：2.33（95%CI：1.79，3.03）比接种疫苗的儿童的 1.65（95%CI：1.20，2.28）；PM 和 PEF 受损的 OR：1.45（95%CI：1.12，1.87）比接种疫苗的儿童的 1.04（95%CI：0.76，1.43）]。流感疫苗接种对大气污染暴露与肺功能下降之间关联的修饰作用的异质性在女孩中似乎比男孩更为显著。
我们的结果表明，流感疫苗接种可能会减轻大气污染对儿童肺功能的不利影响。本研究为加强和促进全球儿童流感疫苗接种计划提供了新的见解，可能会带来共同效益。
