Fine P E, Clarkson J A
Ross Institute, London School of Hygiene and Tropical Medicine, United Kingdom.
Rev Infect Dis. 1987 Sep-Oct;9(5):866-83. doi: 10.1093/clinids/9.5.866.
The literature on the protection imparted by conventional whole-cell pertussis vaccines was reviewed, and the extent to which the great variation in estimates of vaccine efficacy is attributable to methodologic problems in study design and analysis or to biologic features of the natural history of pertussis was explored. The protection against disease imparted by pertussis vaccines may be greater than that against infection. Estimates of vaccine efficacy from case-control studies are higher than those from studies of household secondary-attack rates; likewise, estimates of efficacy are higher when based on clinically severe or bacteriologically positive cases rather than simply on notified cases. Some of the reported differences in protection by different vaccines may be attributable to relations between the antigenic composition of the vaccine used and that of the circulating strain of Bordetella pertussis. Failure to consider age trends has sometimes led to spuriously high estimates of efficacy. Many biases can affect efficacy studies, and it is usually difficult to assess whether the net effect has been to underestimate or to overestimate "true" efficacy. The immunity imparted by conventional pertussis vaccines may be neither as solid nor as stable as that imparted by many live-virus vaccines. These issues must be considered during the evaluation of acellular pertussis vaccines.
回顾了关于传统全细胞百日咳疫苗所提供保护作用的文献，并探讨了疫苗效力估计值存在巨大差异在多大程度上归因于研究设计和分析中的方法学问题，或百日咳自然史的生物学特征。百日咳疫苗对疾病的保护作用可能大于对感染的保护作用。病例对照研究得出的疫苗效力估计值高于家庭二代发病率研究得出的估计值；同样，基于临床严重或细菌学阳性病例得出的效力估计值高于仅基于报告病例得出的估计值。不同疫苗所报告的保护作用差异部分可能归因于所用疫苗的抗原组成与循环的百日咳博德特氏菌菌株的抗原组成之间的关系。未考虑年龄趋势有时会导致效力估计值过高。许多偏倚会影响效力研究，而且通常很难评估净效应是低估还是高估了“真实”效力。传统百日咳疫苗所赋予的免疫力可能不像许多活病毒疫苗所赋予的免疫力那样牢固和稳定。在评估无细胞百日咳疫苗时必须考虑这些问题。
