比较中等或高滴度麻疹疫苗后接种灭活疫苗与灭活疫苗后接种标准滴度麻疹疫苗的随机试验：一项荟萃分析。

Randomized Trials Comparing Inactivated Vaccine After Medium- or High-titer Measles Vaccine With Standard Titer Measles Vaccine After Inactivated Vaccine: A Meta-analysis.

作者信息

Aaby Peter, Ravn Henrik, Benn Christine S, Rodrigues Amabelia, Samb Badara, Ibrahim Salah A, Libman Michael D, Whittle Hilton C

机构信息

From the *Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau; †Research Centre for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark; ‡OPEN, Institute of Clinical Research, University of Southern Denmark and Odense University Hospital; §Institut de Recherche pour le Développement (IRD), Dakar, Senegal; ¶Department of Paediatrics, University of Khartoum, Khartoum, Sudan; ‖The J.D. MacLean Centre for Tropical Medicine, McGill University, Montreal, Quebec, Canada; and **The London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom.

出版信息

Pediatr Infect Dis J. 2016 Nov;35(11):1232-1241. doi: 10.1097/INF.0000000000001300.

DOI:10.1097/INF.0000000000001300

PMID:27753769

Abstract

BACKGROUND

Observational studies have suggested that girls have higher mortality if their most recent immunization is an inactivated vaccine rather than a live vaccine. We therefore reanalyzed 5 randomized trials of early measles vaccine (MV) in which it was possible to compare an inactivated vaccines [after medium-titer MV (MTMV) or high-titer MV (HTMV)] and a live standard titer MV (after an initial inactivated vaccine).

METHODS

The trials were conducted in Sudan, Senegal, The Gambia and Guinea-Bissau. The intervention group received live MTMV or HTMV from 4 to 5 months and then an inactivated vaccine from 9 to 10 months of age; the control children received inactivated vaccine/placebo from 4 to 5 months and standard titer MV from 9 to 10 months of age. We compared mortality from 9 months until end of study at 3 to 5 years of age for children who received inactivated vaccine (after MTMV or HTMV) and standard titer MV (after inactivated vaccine), respectively. The original datasets were analyzed using a Cox proportional hazards model stratified by trial.

RESULTS

The mortality rate ratio (MRR) was 1.38 (95% confidence interval: 1.05-1.83) after an inactivated vaccine (after MTMV or HTMV) compared with a standard titer MV (after inactivated vaccine). Girls had a MRR of 1.89 (1.27-2.80), whereas there was no effect for boys, the sex-differential effect being significant (P = 0.02). Excluding measles cases did not alter these conclusions, the MRR after inactivated vaccines (after MTMV or HTMV) being 1.40 (1.06-1.86) higher overall and 1.92 (1.29-2.86) for girls. Control for variations in national immunization schedules for other vaccines did not modify these results.

CONCLUSIONS

After 9 months of age, all children had been immunized against measles, and mortality in girls was higher when they had received inactivated vaccines (after MTMV or HTMV) rather than live standard titer MV (after an inactivated vaccine).

摘要

背景

观察性研究表明，如果女孩最近接种的是灭活疫苗而非活疫苗，其死亡率会更高。因此，我们重新分析了5项早期麻疹疫苗（MV）随机试验，在这些试验中可以比较灭活疫苗（中等滴度MV（MTMV）或高滴度MV（HTMV）之后）和标准滴度活MV（在初始灭活疫苗之后）。

方法

这些试验在苏丹、塞内加尔、冈比亚和几内亚比绍进行。干预组在4至5个月时接种MTMV或HTMV活疫苗，然后在9至10个月时接种灭活疫苗；对照儿童在4至5个月时接种灭活疫苗/安慰剂，在9至10个月时接种标准滴度MV。我们比较了分别接种灭活疫苗（MTMV或HTMV之后）和标准滴度MV（灭活疫苗之后）的儿童从9个月到3至5岁研究结束时的死亡率。使用按试验分层的Cox比例风险模型分析原始数据集。

结果

与标准滴度MV（灭活疫苗之后）相比，接种灭活疫苗（MTMV或HTMV之后）后的死亡率比（MRR）为1.38（95%置信区间：1.05 - 1.83）。女孩的MRR为1.89（1.27 - 2.80），而男孩没有影响，性别差异效应显著（P = 0.02）。排除麻疹病例并没有改变这些结论，灭活疫苗（MTMV或HTMV之后）后的总体MRR高出1.40（1.06 - 1.86），女孩为1.92（1.29 - 2.86）。对其他疫苗国家免疫规划差异进行控制并没有改变这些结果。