母亲RSV疫苗接种对南非死亡率的益处和风险:一项建模研究
Ayaka Monoi1,2,3,4, Akira Endo1,2,3,5, Simon R Procter1,2
1Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine, London, United Kingdom.
在南非,母体呼吸道同胞病毒 (RSV) 疫苗接种可能会增加早产风险. 益处与风险的分析表明,从怀孕27周开始接种疫苗比风险更有利于益处,可能改善婴儿RSV死亡率.
科学领域:
- 孕产妇和儿童的健康
- 疫苗学 疫苗学 疫苗学
- 流行病学 流行病学
背景情况:
- 母亲RSV预注射F蛋白疫苗 (RSVpreF) 显示出有效性,但引起了南非过早分娩的担忧.
- 后期分析表明,母亲接种RSVpreF疫苗和早产增加之间存在潜在联系,特别是在南非.
研究的目的:
- 权衡母体RSVpreF疫苗接种的死亡率益处与南非疫苗相关的早产的潜在风险.
- 评估RSVpreF疫苗接种对婴儿死亡率的影响,与早产所带来的新生儿死亡风险相比.
主要方法:
- 估计的RSV相关婴儿死亡被避免 (益处) 与新生儿死亡风险因早产 (风险) 在南非进行了比较.
- 利用了RSV疾病负担数据,减弱的疫苗保护模型和妊娠年龄特定的死亡率数据.
- 基于不同的妊娠年龄窗口进行疫苗接种 (24-36周和27-36周) 建模的风险.
主要成果:
- 据估计,接种疫苗可以避免每10万活产婴儿中有31例RSV相关的婴儿死亡.
- 如果RSVpreF导致早产,新生儿死亡率可能会增加44/100,000,每预防RSV死亡有1.4个新生儿死亡 (24-36周GA).
- 使用27-36周的GA窗口,在97%的模拟中,好处超过风险,结果对妊娠年龄窗口敏感.
结论:
- 在南非,从24-36周的GA开始对母亲进行RSVpreF疫苗接种并没有明确证明其益处超过了早产风险.
- 从27周开始的GA疫苗接种有利于比较风险的益处,这表明在孕期第三季度进行疫苗接种时的潜在安全性和有效性.
- 由于早产数量少,分析的不确定性凸显了进一步调查的必要性.
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