Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, WA, Australia.
PLoS One. 2021 Dec 7;16(12):e0260388. doi: 10.1371/journal.pone.0260388. eCollection 2021.
The burden of IgE-mediated food allergy in Australian born children is reported to be among the highest globally. This illness shares risk factors and frequently coexists with asthma, one of the most common noncommunicable diseases of childhood. Findings from a case-control study suggest that compared to immunisation with acellular pertussis vaccine, early priming of infants with whole-cell pertussis vaccine may be associated with a lower risk of subsequent IgE-mediated food allergy. If whole-cell vaccination is protective of food allergy and other atopic diseases, especially if protective against childhood asthma, the population-level effects could justify its preferential recommendation. However, the potential beneficial effects of whole-cell pertussis vaccination for the prevention of atopic diseases at a population-scale are yet to be investigated.
Analyses of population-based record linkage data will be undertaken to compare the rates of admissions to hospital for asthma in children aged between 5 and 15 years old, who were born in Western Australia (WA) or New South Wales (NSW) between 1997 and 1999 (329,831) when pertussis immunisation in Australia transitioned from whole-cell to acellular only schedules. In the primary analysis we will estimate hazard ratios and 95% confidence intervals for the time-to-first-event (hospital admissions as above) using Cox proportional hazard models in recipients of a first dose of whole-cell versus acellular pertussis-containing vaccine before 112 days old (~4 months of age). Similarly, we will also fit time-to-recurrent events analyses using Andersen-Gill models, and robust variance estimates to account for potential within-child dependence. Hospitalisations for all-cause anaphylaxis, food anaphylaxis, venom, all-cause urticaria and atopic dermatitis will also be examined in children who received at least one dose of pertussis-containing vaccine by the time of the cohort entry, using analogous statistical methods. Presentations to the emergency departments will be assessed separately using the same statistical approach.
据报道，在澳大利亚出生的儿童中，IgE 介导的食物过敏负担是全球最高的。这种疾病与哮喘有共同的危险因素，并且常常与哮喘共存，哮喘是儿童中最常见的非传染性疾病之一。一项病例对照研究的结果表明，与使用无细胞百日咳疫苗免疫相比，早期用全细胞百日咳疫苗对婴儿进行初级免疫可能与随后 IgE 介导的食物过敏风险降低有关。如果全细胞疫苗对食物过敏和其他特应性疾病有保护作用，特别是对儿童哮喘有保护作用，那么人群层面的效果可能证明其优先推荐是合理的。然而，全细胞百日咳疫苗预防特应性疾病的人群效果仍有待研究。
将对基于人群的记录链接数据进行分析，以比较在澳大利亚 1997 年至 1999 年期间，出生于西澳大利亚州（WA）或新南威尔士州（NSW）的 5 至 15 岁儿童因哮喘住院的比率，当时澳大利亚的百日咳免疫从全细胞向仅无细胞转变。在主要分析中，我们将使用 Cox 比例风险模型估计 Cox 比例风险模型在 112 天之前（~4 个月大）接受全细胞与无细胞百日咳疫苗的第一剂之间的首次事件（上述住院）的风险比和 95%置信区间。同样，我们也将使用 Andersen-Gill 模型和稳健方差估计来拟合复发性事件的时间，并考虑潜在的个体内相关性。对于在队列入组时至少接受过一剂含百日咳疫苗的儿童，我们还将使用类似的统计方法检查因所有原因过敏、食物过敏、毒液、所有原因荨麻疹和特应性皮炎而住院的情况。使用相同的统计方法，我们将分别评估对急诊部门的就诊情况。
