孕妇接种破伤风、白喉、无细胞百日咳疫苗与美国公共和私人保险母婴对子中新生儿百日咳风险。

Tetanus, Diphtheria, Acellular Pertussis Vaccination During Pregnancy and Risk of Pertussis in the Newborn in Publicly and Privately Insured Mother-infant Pairs in the United States.

机构信息

From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

出版信息

Pediatr Infect Dis J. 2021 Jul 1;40(7):681-687. doi: 10.1097/INF.0000000000003099.

DOI:10.1097/INF.0000000000003099

PMID:33657597

Abstract

BACKGROUND

In the United States, pertussis circulation persists and primarily infects infants and children, despite routine vaccinations. To minimize infant morbidity and mortality from the disease before the first DTaP dose, the Advisory Committee on Immunization Practices recommends maternal Tdap vaccination in weeks 27-36 of pregnancy.

METHODS

Cohorts of mother-infant pairs in the Medicaid Analytic eXtract (MAX) (2010-2014) and IBM MarketScan (2011-2015) databases were analyzed to estimate the effectiveness of prenatal Tdap vaccination compared with no vaccination to prevent infant pertussis in the first 6 months. Hazard ratios were estimated with Cox proportional hazards models and adjusted for potential confounders via inverse probability weights. The impact of preterm delivery on the risk of pertussis was analyzed. Results from the 2 databases were pooled.

RESULTS

In MarketScan, women received Tdap vaccination before delivery in 114,067 (25.6%) of 445,638 pregnancies and in MAX, 33,286 (4.8%) of 695,262 pregnancies. Among pregnancies with preterm delivery, only 21.2% and 3.8% in MarketScan and MAX had been vaccinated. The risk of pertussis in unvaccinated term infants was 3.5 (MarketScan) and 17 (MAX) per 10,000; and in preterm infants, it was 8.4 (MarketScan) and 19.8 (MAX) per 10,000. The pooled hazard ratio for Tdap vaccination any time before delivery versus no vaccination was 0.64 [95% confidence interval (CI): 0.41-1.00]. The hazard ratio was 0.11 (95% CI: 0.03-0.36) for preterm and 0.78 (95% CI: 0.48-1.29) for term infants vaccinated before 37 weeks. The incidence of pertussis was higher and the protective hazard ratio stronger during pertussis outbreaks.

CONCLUSIONS

Prenatal Tdap vaccination reduces the risk of pertussis infections in the infants' first 6 months by 36%. Vaccination soon after 27 weeks of pregnancy, before when deliveries began, ensures vaccination includes those born preterm, who are at highest risk for pertussis and benefit particularly from this vaccination.

摘要

背景

在美国，尽管进行了常规疫苗接种，但百日咳仍在持续传播，主要感染婴儿和儿童。为了在首剂 DTaP 疫苗接种前将疾病对婴儿的发病率和死亡率降至最低，免疫实践咨询委员会建议在妊娠 27-36 周时对孕妇进行 Tdap 疫苗接种。

方法

在 Medicaid Analytic eXtract（MAX）（2010-2014 年）和 IBM MarketScan（2011-2015 年）数据库中的母亲-婴儿队列中进行分析，以估计产前 Tdap 疫苗接种与未接种疫苗相比，预防婴儿在头 6 个月内发生百日咳的有效性。使用 Cox 比例风险模型估计风险比，并通过逆概率权重对潜在混杂因素进行调整。分析早产对百日咳风险的影响。合并来自 2 个数据库的结果。

结果

在 MarketScan 中，445638 例妊娠中有 114067 例（25.6%）在分娩前接受了 Tdap 疫苗接种，而在 MAX 中，695262 例妊娠中有 33286 例（4.8%）接受了 Tdap 疫苗接种。在早产妊娠中，只有 21.2%和 3.8%的孕妇在 MarketScan 和 MAX 中接种了疫苗。未接种疫苗的足月婴儿患百日咳的风险为每 10000 例 3.5 例（MarketScan）和 17 例（MAX），而早产婴儿的风险为每 10000 例 8.4 例（MarketScan）和 19.8 例（MAX）。在任何时间进行产前 Tdap 疫苗接种与未接种疫苗相比，全因死亡风险比为 0.64[95%置信区间（CI）：0.41-1.00]。对于 27 周前接种疫苗的早产和足月婴儿，风险比分别为 0.11（95%CI：0.03-0.36）和 0.78（95%CI：0.48-1.29）。百日咳爆发期间，百日咳的发病率更高，保护风险比更强。