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首页> 外文期刊>Vaccine >Broadening the age restriction for initiating rotavirus vaccination in regions with high rotavirus mortality: benefits of mortality reduction versus risk of fatal intussusception
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Broadening the age restriction for initiating rotavirus vaccination in regions with high rotavirus mortality: benefits of mortality reduction versus risk of fatal intussusception

机译：扩大轮状病毒死亡率高的地区开始轮状病毒疫苗接种的年龄限制：降低死亡率与致命肠套叠的风险

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INTRODUCTION: Recently developed rotavirus vaccines have the potential to reduce diarrhea mortality in children in developing countries. Available data to date do not indicate risk of intussusception with these new vaccines. To avoid a potential unanticipated risk post-licensure, it is recommended that rotavirus immunization be initiated before 12 weeks of age when background intussusception rates are low. This policy could exclude a substantial number of children from vaccination, especially in developing countries where delays in vaccination are common. METHODS: We conducted a scenario analysis to assess the potential benefits of mortality reduction from rotavirus versus the risk of fatal intussusception when the first dose of the vaccine is strictly administered by 12 weeks of age compared with a free strategy with vaccine administered before 1 year of age using data on rotavirus disease, vaccine safety and efficacy, and current diphtheria-tetanus-pertussis vaccination rates, and by incorporating hypothetical risks of intussusception. RESULTS: In developing countries, assuming vaccine efficacy of 50% and 75% for doses 1 and 2, respectively, and a hypothetical sixfold and threefold increased relative risk of intussusception within 7 days of doses 1 and 2, respectively, initiating rotavirus immunization before 12 weeks of age would prevent 194,564 of the 517,959 annual rotavirus-associated deaths among children <5 years, while potentially resulting in 1106 fatal intussusception events. Administration of the first dose to infants up to 1 year of age would prevent an additional 54,087 rotavirus-associated deaths (total=248,651) while potentially resulting in an additional 1226 intussusception deaths (total=2332). CONCLUSION: In developing countries, the additional lives saved by broadening the age restrictions for initiation of rotavirus vaccination would far outnumber the hypothetical excess intussusception deaths that would accompany such an approach.
机译：引言：最近开发的轮状病毒疫苗具有降低发展中国家儿童腹泻死亡率的潜力。迄今为止的可用数据并未表明这些新疫苗有肠套叠的风险。为避免出现许可后潜在的意外风险，建议在背景肠套叠发生率较低时，在12周龄之前开始轮状病毒免疫。这项政策可以使大量儿童免于接种疫苗，尤其是在经常发生接种延迟的发展中国家。方法：我们进行了情景分析，以评估轮状病毒降低死亡率与致命肠套叠风险的潜在益处，与在接种前1年之前免费接种疫苗的严格策略相比，首次接种疫苗必须在12周龄之前接种通过使用轮状病毒疾病，疫苗安全性和有效性以及当前的白喉-破伤风-百日咳疫苗接种率数据，并结合假设的肠套叠风险来分析年龄。结果：在发展中国家，假设疫苗分别对剂量1和2分别为50％和75％，并且假设在剂量1和2的7天内分别有6倍和3倍的肠套叠相对风险增加，因此在12年前开始轮状病毒免疫在5岁以下的儿童中，每年517959例轮状病毒相关的年度死亡中，194周龄可预防194564例，同时可能导致1106例致命的肠套叠事件。对不超过1岁的婴儿进行首剂治疗将预防额外的5,087例轮状病毒相关死亡（总数= 248,651），同时可能导致另外的1226例肠套叠死亡（总数= 2332）。结论：在发展中国家，通过扩大轮状病毒疫苗接种年龄限制所节省的额外生命将远远超过这种方法所带来的假想的肠套叠死亡人数。

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