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Plos Med:疫苗接种,可将黄热病爆发风险降低了86%

2021-02-23 MedSci原创 MedSci原创

近年来,非洲和拉丁美洲再次爆发黄热病疫情。2020年仅在非洲发布了5地警报,包括乌干达、南苏丹、埃塞俄比亚、多哥和加蓬。

近年来,非洲和拉丁美洲再次爆发黄热病疫情。2020年仅在非洲发布了5地警报,包括乌干达、南苏丹、埃塞俄比亚、多哥和加蓬。针对2015-2016年安哥拉大规模疫情的回应,世界卫生组织(WHO)于2017年发起了消除黄热病疫情EYE)倡议,旨在防止零星病例引发城市疫情,进而导致国际传播。

目前,针对黄热病接种各种大规模的疫苗接种活动(PMVC),很少有研究量化PMVC对黄热病爆发风险的影响。近日,发表在Plos Med一项研究显示,PMVCs对黄热病爆发风险具有一定的预防作用,若大规模接种可降低86%的爆发风险,爆发数量减少34%

在这项研究中,研究人员通过自身对照的病例系列研究(Self Controlled Case Series,SCCS)方法,评估了非洲流行地区的黄热病爆发与PMVCs实施之间的关联。由于在SCCS方法中,所有的时间变量混杂因素都得到了隐性控制,因此,当残余混杂因素,特别是适应症的混杂因素风险较高时,该方法是经典队列或病例对照研究设计的替代方法。

研究人员评估了2005年至2018年间34个非洲国家的省级PMVC与黄热病爆发风险之间的关联。研究人员分别比较了每个省内PMVC之前和之后的时期黄热病发病情况。调查发现,在PMVCs前期,有26个(79%)省份首次爆发黄热病,7个(21%)省份在PMVC后期爆发黄热病。在省一级,与PMVC前相比,PMVCs后时期的爆发风险降低了86%95% CI 66%94%p <0.001)。在一系列敏感性分析中,特别是在使用疫苗接种覆盖率的定量估计作为替代性暴露测量时,都能稳健地观察到暴露于PMVCs和爆发之间的这种负相关。相反,队列式分析的结果对模型中包含的协变量的选择高度敏感。

基于SCCS的结果,研究人员估计PMVCs后,2005年至2018年非洲疫情爆发数量减少34%95% CI 22%45%)。然而,该研究也有一定的局限性,没有考虑到潜在的时间变化的混杂因素,如黄热病的环境驱动因素的变化等。

综上,这些结果PMVCs对黄热病爆发具有较高的预防作用,且SCCS研究方法可有利地应用于不同人群级别,以评估公共卫生干预措施的影响。

原始出处

Kévin Jean et al.Assessing the impact of preventive mass vaccination campaigns on yellow fever outbreaks in Africa: A population-level self-controlled case series study.Plos Med.2021 https://doi.org/10.1371/journal.pmed.1003523

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    2021-02-23 jyzxjiangqin

    好文章!

    0

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    2021-02-23 jyzxjiangqin

    好文章!

    0

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