2008-2013 年厄瓜多尔农村地区儿童轮状病毒疫苗接种对社区轮状病毒流行率的影响。
Effect of childhood rotavirus vaccination on community rotavirus prevalence in rural Ecuador, 2008-13.
机构信息
Department of Epidemiology, University of Michigan-Ann Arbor, Ann Arbor, MI, USA.
Department of Statistics, University of Michigan-Ann Arbor, Ann Arbor, MI, USA.
出版信息
Int J Epidemiol. 2020 Oct 1;49(5):1691-1701. doi: 10.1093/ije/dyaa124.
BACKGROUND
Although live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is less clear. In this study, we estimate the impact of childhood Rotarix® vaccination on community rotavirus prevalence.
METHODS
We analyse 10 years of serial population-based diarrhoea case-control study, which also included testing for rotavirus infection (n = 3430), and 29 months of all-cause diarrhoea active surveillance from a child cohort (n = 376) from rural Ecuador during a period in which Rotarix vaccination was introduced. We use weighted logistic regression from the case-control data to assess changes in community rotavirus prevalence (both symptomatic and asymptomatic) and all-cause diarrhoea after the vaccine was introduced. We also assess changes in all-cause diarrhoea rates in the child cohort (born 2008-13) using Cox regression, comparing time to first all-cause diarrhoea case by vaccine status.
RESULTS
Overall, vaccine introduction among age-eligible children was associated with a 82.9% reduction [95% confidence interval (CI): 49.4%, 94.2%] in prevalence of rotavirus in participants without diarrhoea symptoms and a 46.0% reduction (95% CI: 6.2%, 68.9%) in prevalence of rotavirus infection among participants experiencing diarrhoea. Whereas all age groups benefited, this reduction was strongest among the youngest age groups. For young children, prevalence of symptomatic diarrhoea also decreased in the post-vaccine period in both the case-control study (reduction in prevalence for children <1 year of age = 69.3%, 95% CI: 8.7%, 89.7%) and the cohort study (reduction in hazard for receipt of two Rotarix doses among children aged 0.5-2 years = 57.1%, 95% CI: 16.6, 77.9%).
CONCLUSIONS
Rotarix vaccination may suppress transmission, including asymptomatic transmission, in low- and middle-income settings. It was highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.
背景
虽然已通过随机研究明确了单价活减毒人轮状病毒疫苗（Rotarix）的功效，但在非临床环境下，其效果尚不明确。本研究旨在评估儿童接种 Rotarix®疫苗对社区轮状病毒流行率的影响。
方法
我们分析了为期 10 年的基于人群的腹泻病例对照研究（共纳入 3430 例病例和对照，其中也包括轮状病毒感染检测），以及厄瓜多尔农村地区一个儿童队列的 29 个月全因腹泻主动监测数据（共纳入 376 例儿童）。在 Rotarix 疫苗接种引入期间，我们使用病例对照数据中的加权逻辑回归来评估疫苗引入后社区中（有症状和无症状）轮状病毒流行率和全因腹泻的变化。我们还使用 Cox 回归比较了疫苗接种状况下队列中（2008-13 年出生）儿童的全因腹泻发生率变化，以评估首次发生全因腹泻的时间。
结果
在符合接种年龄的儿童中，总体而言，疫苗接种与无腹泻症状参与者中轮状病毒流行率降低 82.9%（95%CI：49.4%，94.2%）和腹泻参与者中轮状病毒感染流行率降低 46.0%（95%CI：6.2%，68.9%）相关。虽然所有年龄组均受益，但这种降低在年龄最小的儿童中最强。对于幼儿，在病例对照研究（＜1 岁儿童的症状性腹泻流行率降低 69.3%，95%CI：8.7%，89.7%）和队列研究（0.5-2 岁儿童接种两剂 Rotarix 的风险降低 57.1%，95%CI：16.6%，77.9%）中，疫苗接种后有症状性腹泻的流行率也降低。
结论
Rotarix 疫苗接种可能会抑制低、中收入环境中的传播，包括无症状传播。在农村社区环境中，它对儿童非常有效，并通过成年人的间接保护提供了人群层面的效益。
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