哮喘联盟

   摘要
   背景：虽然儿童免疫接种率高，但是近年来发达国家报道的百日咳病例显著增加。健康机构建议采用对以下不同人群进行疫苗接种以降低儿童  发病率和死亡率：青少年和成人、孕妇、与新生儿接触人群（包覆策略）和健康护理工作者。本文章旨在对支持这些建议的科学依据进行回顾总结。
   方法：对旨在降低12个月以下婴儿百日咳发生率和死亡率的上述策略，我们进行效果和成本效果方面的系统综述。搜索1990年到2012年10月期间的电子Medline数据库、PreMedline, Embase, CRD, Cochrane Central和Trip数据库。使用GRADE系统对数据进行评估。
   结果：8项研究对上述策略的效果或安全性进行了分析，18项研究对其进行了经济评估。有关这些策略效果的直接证据非常少。经济评估表明对青少年和成人进行疫苗接种成本效果比较好，尽管使用的参数具有很大的不确切性。
   结论：从卫生技术评估的角度来看，对于上述已评估的疫苗接种策略，尚无足够证据可支持推广使用。
 

（刘国梁 审校）
Health Policy. 2014 Mar;115(1):82-91. doi: 10.1016/j.healthpol.2013.12.007. Epub 2013 Dec 28.

 

Effectiveness and cost-effectiveness of different immunization strategies against whooping cough to reduce child morbidity and mortality.
 

Rivero-Santana A1, Cuéllar-Pompa L2, Sánchez-Gómez LM3, Perestelo-Pérez L4, Serrano-Aguilar P4.
 

ABSTRACT
INTRODUCTION: In the last years there has been a significant increase in reported cases of pertussis in developed countries, in spite of high rates of childhood immunization. Health institutions have recommended different vaccination strategies to reduce child morbidity and mortality: vaccination of adolescents and adults, pregnant women, people in contact with the newborn (cocoon strategy) and health care workers. The aim of this paper is to review the scientific evidence supporting these recommendations.
METHODS: Systematic review on the effectiveness and cost-effectiveness of the above strategies for the reduction of morbidity and mortality from pertussis in infants under 12 months. The electronic databases Medline, PreMedline, Embase, CRD, Cochrane Central, and Trip Database were consulted from 1990 to October 2012. The evidence was assessed using the GRADE system.
RESULTS: There were eight studies on the efficacy or safety of the strategies analyzed, and 18 economic evaluations. Direct evidence on the efficacy of these strategies is scarce. Economic evaluations suggest that vaccination of adolescents and adults would be cost-effective, although there is major uncertainty over the parameters used.
CONCLUSIONS: From the perspective of health technology assessment, there is insufficient evidence to recommend the vaccination strategies evaluated.
 

Health Policy. 2014 Mar;115(1):82-91. doi: 10.1016/j.healthpol.2013.12.007. Epub 2013 Dec 28.