Anders J F, Jacobson R M, Poland G A, Jacobsen S J, Wollan P C
Mayo Medical School, Rochester, MN, USA.
Pediatr Infect Dis J. 1996 Jan;15(1):62-6. doi: 10.1097/00006454-199601000-00014.
Recent measles outbreaks in highly vaccinated populations have highlighted the role of vaccine failure as a barrier to the elimination of measles. We sought to estimate the rate of secondary failure (clinical measles after vaccine-induced seroconversion) of measles vaccines using metaanalysis.
We identified 1411 studies of which 125 were relevant. From these we found 10 original studies of healthy subjects with sufficient details to calculate a pooled secondary failure rate. We performed a test for homogeneity before any pooling.
Although significant heterogeneity prevented their pooling as a single group, the studies fell into three homogeneous groups suitable for pooling. Group A studies used killed vaccine whereas the other two groups (Groups B and C) of studies used live vaccine. These latter groups differ in that the studies in Group B share higher failure rates and are difficult to interpret with respect to the lack of verification of vaccination, immunization before 12 months of age and a non-North American study site and vaccine manufacturer. Those studies in Group C, in which US subjects were older than 12 months at vaccination and received a live US-manufactured vaccine that was documented in a medical record, had a failure rate of 0 of 2031 with a 95% confidence interval of 0.0 to 0.147%.
Although reports of measles related to secondary failure exist, studies that permit the calculation of the rate of secondary failure demonstrate that the rate appears to be < 0.2%.
近期在高疫苗接种率人群中爆发的麻疹疫情凸显了疫苗失效作为消除麻疹障碍的作用。我们试图通过荟萃分析来估计麻疹疫苗的二次失效（疫苗诱导血清转化后出现临床麻疹）发生率。
我们识别出1411项研究，其中125项相关。从中我们找到了10项关于健康受试者的原始研究，这些研究有足够详细的信息来计算合并后的二次失效率。在进行任何合并之前，我们进行了同质性检验。
尽管显著的异质性使其无法合并为一个单一的组，但这些研究可分为三个适合合并的同质性组。A组研究使用的是灭活疫苗，而其他两组（B组和C组）研究使用的是活疫苗。后两组的不同之处在于，B组研究的失效率较高，且由于缺乏疫苗接种验证、12个月龄前免疫接种情况以及非北美研究地点和疫苗制造商等因素，难以进行解读。C组研究中的美国受试者在接种疫苗时年龄大于12个月，接种的是美国生产的有医疗记录的活疫苗，2031例中有0例失效，95%置信区间为0.0至0.147%。
尽管存在与二次失效相关的麻疹报告，但能够计算二次失效率的研究表明，该发生率似乎<0.2%。
