水痘减毒活疫苗在小学生及学龄前儿童中保护效力相关文献的Meta分析

Meta-analysis of documents on vaccine effectiveness of live attenuated varicella vaccine in pupils and preschoolers

目的评价水痘减毒活疫苗(varicella vaccine,VarV)在小学生及学龄前儿童中的保护效力(vaccine effectiveness,VE)。方法检索中国知网、万方和维普中文期刊、PubMed和Embase等文献数据库,收集中国2017年以前所有国内病例对照研究和回顾性队列研究中VarV的VE文献,并应用RevMan 5. 1软件进行Meta分析。结果共纳入34篇文献,其中病例对照研究19篇,回顾性队列研究15篇。34篇文献VarV合并VE为69%(95%CI:64%～73%);接种2剂次VarV的VE(92%,95%CI:80%～97%)明显高于接种1剂次(60%,95%CI:42%～73%),差异有统计学意义(P <0. 000 01);学龄前儿童接种VarV的VE(78%,95%CI:60%～87%)明显高于小学(33%,95%CI:4%～54%),差异有统计学意义(P <0. 000 01);5岁以下儿童接种VarV的VE最高,为94%(95%CI:69%～99%),9岁及9岁以上儿童接种VarV的VE最低,为41%(95%CI:23%～54%)。结论 VarV具有一定的保护效力,随着接种年龄的增加而降低。建议全面推广VarV的2剂次免疫程序。

Objective To evaluate the vaccine effectiveness(VE) of live attenuated varicella vaccine(VarV) in pupils and preschoolers. Methods The literatures of case-control or cohort studies on VE of VarV in China before 2017 were collected from data bases such as CNKI,Wanfang,PubMed and Embase for Meta-analysis by using RevMan 5. 1 software.Results A total of 34 literatures were collected,of which 19 were those of case-control studies and 15 of retrospective cohort studies. The overall VE of VarV was 69%(95% CI: 64%~ 73%),while that of two doses of VarV(92%,95%CI: 80%~ 97%)was significantly higher than that of one dose(60%,95% CI: 42%~ 73%)(P < 0. 000 01). The VE of VarV in preschoolers(78%,95% CI: 60%~ 87%)was significantly higher than that in pupils(33%,95% CI: 4%~54%)(P < 0. 000 01). The VE was the highest in children at ages of less than 5 years(94%,95% CI: 69%~ 99%)while was the lowest in those at not less than 9 years(41%,95% CI: 23%~ 54%). Conclusion VarV showed a certain VE which decreased with the increasing age for vaccination. The authors propose to popularize the two-dose immunization schedule of VarV.