期刊
LANCET CHILD & ADOLESCENT HEALTH
卷 3, 期 10, 页码 697-704出版社
ELSEVIER SCI LTD
DOI: 10.1016/S2352-4642(19)30185-3
关键词
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类别
资金
- National Science Fund for Distinguished Young Scholars [81525023]
- Emergency Response Mechanism Operation Programme
- Chinese Centre for Disease Control and Prevention [131031001000015001]
- Harvard Center for Communicable Disease Dynamics
- Research Grants Council of the Hong Kong Special Administrative Region, China [T11-705/14N]
- National Natural Science Foundation of China [81473031]
- Natural Science Foundation of Shanghai [14ZR1444500]
- Li Ka Shing Oxford Global Health Programme [B9RST00-B900.57]
- National Science and Technology Major Project of China [2017ZX10103009-005, 2018ZX10713001-007]
- National Institute for Health Research (NIHR) using Official Development Assistance [16/137/109]
- Total Foundation [2015-099]
- National Institute of General Medical Sciences [U54 GM088558]
Background Inactivated monovalent enterovirus A71 (EV-A71) vaccines are now available in China to reduce the substantial public health burden of hand, foot, and mouth disease. However, post-licensure monitoring of vaccine effectiveness is important. We did an observational test-negative study of EV-A71 vaccine effectiveness. Methods Children with hand, foot, and mouth disease who were admitted to Henan Children's Hospital (Zhengzhou, China) within 7 days of illness onset were invited to participate in this test-negative case-control study. Participant vaccination history with EV-A71, including the number of doses received and the date of each dose of vaccination, was elicited from parents or legal guardians of participants with a standardised questionnaire. Children must have received two doses before hospitalisation to be counted as fully vaccinated. Patients who had received a single dose before hospitalisation were classified as partly vaccinated. Children who had received no EV-A71 vaccine before hospitalisation were classified as unvaccinated. Throat swabs and stool samples collected from patients were tested by RT-PCR to identify EV-A71 and other enteroviruses. The primary outcome of the study was paediatric hand, foot, and mouth disease associated with EV-A71 requiring hospitalisation. We estimated vaccine effectiveness with conditional logistic regression models adjusted for potential confounders. Findings Between Feb 15, 2017, and Feb 15, 2018, we enrolled 1803 children aged 6-71 months with hand, foot, and mouth disease. 234 (13%) children tested positive for EV-A71, 1529 (85%) tested positive for other enteroviruses-528 (29%) were positive for Coxsackievirus (CV)-A6 and 342 (19%) were positive for CV-A16-and 29 (2%) tested negative for all enteroviruses. 11 (1%) children with neither throat swab nor stool testing results were excluded from further analyses. Overall vaccine effectiveness was estimated to be 85.4% (95% CI 53.2 to 95.4) for fully vaccinated children and 63.1% (13.1 to 84.3) for partly vaccinated children. The vaccine effectiveness for full vaccination was estimated to be 91.1% (35.1 to 98.8) among non-severe cases compared with 73.3% (-32.6 to 94.6) in severe cases. The vaccine effectiveness for partial vaccination was 77.9% (4.3 to 94.9) in children aged 24-71 months and 40.8% (-71.1 to 79.5) in children aged 6-23 months. We found no significant association between full or partial vaccination and CV-A6 or CV-A16-related hand, foot, and mouth disease. Interpretation EV-A71 vaccination was effective in preventing non-severe hand, foot, and mouth disease associated with EV-A71 virus infection in children aged 6-71 months, and we found evidence that one dose of vaccination provided partial protection for children aged 24-71 months. Introduction of multivalent vaccines could further reduce the burden of hand, foot, and mouth disease. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
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