Aaby Peter, Nielsen Sebastian, Fisker Ane B, Pedersen Line M, Welaga Paul, Hanifi Syed M A, Martins Cesario L, Rodrigues Amabelia, Chumakov Konstantin, Benn Christine S
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
Navrongo Health Research Centre, Navrongo, Ghana.
Open Forum Infect Dis. 2022 Jul 27;9(8):ofac340. doi: 10.1093/ofid/ofac340. eCollection 2022 Aug.
The live vaccines bacille Calmette-Guérin (BCG) and measles vaccine have beneficial nonspecific effects (NSEs) reducing mortality, more than can be explained by prevention of tuberculosis or measles infection. Live oral polio vaccine (OPV) will be stopped after polio eradication; we therefore reviewed the potential NSEs of OPV.
OPV has been provided in 3 contexts: (1) coadministration of OPV and diphtheria-tetanus-pertussis (DTP) vaccine at 6, 10, and 14 weeks of age; (2) at birth (OPV0) with BCG; and (3) in OPV campaigns (C-OPVs) initiated to eradicate polio infection. We searched PubMed and Embase for studies of OPV with mortality as an outcome. We used meta-analysis to obtain the combined relative risk (RR) of mortality associated with different uses of OPV.
First, in natural experiments when DTP was missing, OPV-only compared with DTP + OPV was associated with 3-fold lower mortality in community studies (RR, 0.33 [95% confidence interval {CI}, .14-.75]) and a hospital study (RR, 0.29 [95% CI, .11-.77]). Conversely, when OPV was missing, DTP-only was associated with 3-fold higher mortality than DTP + OPV (RR, 3.23 [95% CI, 1.27-8.21]). Second, in a randomized controlled trial, BCG + OPV0 vs BCG + no OPV0 was associated with 32% (95% CI, 0-55%) lower infant mortality. Beneficial NSEs were stronger with early use of OPV0. Third, in 5 population-based studies from Guinea-Bissau and Bangladesh, the mortality rate was 24% (95% CI, 17%-31%) lower after C-OPVs than before C-OPVs.
There have been few clinical polio cases reported in this century, and no confounding factors or bias would explain all these patterns. The only consistent interpretation is that OPV has beneficial NSEs, reducing nonpolio child mortality.
减毒活疫苗卡介苗（BCG）和麻疹疫苗具有有益的非特异性效应（NSEs），可降低死亡率，其作用超过预防结核病或麻疹感染所能解释的范围。脊髓灰质炎根除后，口服脊髓灰质炎减毒活疫苗（OPV）将停用；因此，我们综述了OPV潜在的NSEs。
OPV已在3种情况下使用：（1）在6、10和14周龄时同时接种OPV和白喉-破伤风-百日咳（DTP）疫苗；（2）出生时（OPV0）与BCG同时接种；（3）在为根除脊髓灰质炎感染而发起的OPV强化免疫活动（C-OPV）中使用。我们在PubMed和Embase上检索以死亡率为结局指标的OPV研究。我们使用荟萃分析来获得与不同使用方式的OPV相关的合并相对风险（RR）。
首先，在自然实验中，当未接种DTP时，在社区研究（RR，0.33[95%置信区间{CI}，0.14 - 0.75]）和一项医院研究（RR，0.29[95%CI，0.11 - 0.77]）中，仅接种OPV与接种DTP + OPV相比，死亡率降低了3倍。相反，当未接种OPV时，仅接种DTP与接种DTP + OPV相比，死亡率高出3倍（RR，3.23[95%CI，1.27 - 8.21]）。其次，在一项随机对照试验中，接种BCG + OPV0与接种BCG + 未接种OPV0相比，婴儿死亡率降低了32%（95%CI，0 - 55%）。早期使用OPV0时，有益的NSEs更强。第三，在来自几内亚比绍和孟加拉国的5项基于人群的研究中，C-OPV强化免疫活动后死亡率比活动前降低了24%（95%CI，17% - 31%）。
本世纪报告的临床脊髓灰质炎病例很少，没有混杂因素或偏倚能够解释所有这些模式。唯一一致的解释是OPV具有有益的NSEs，可降低非脊髓灰质炎儿童的死亡率。
