基于倾向性评分匹配对深圳市某区2022-2023年度中小学生三价灭活流感疫苗保护效果的真实世界回顾性队列研究

Effectiveness of trivalent inactivated influenza vaccine in primary and secondary school students in a district of Shenzhen:a real-world retrospective cohort study using propensity score matching

目的评价中小学生接种三价灭活流感疫苗(Trivalent influenza vaccine,inactivated,TIV)的保护效果(Vaccine effectiveness,VE)。方法通过深圳市学生健康监测信息系统、深圳市免疫规划信息管理系统和中国疾病预防控制信息系统匹配并收集深圳市某区2022-2023年度中小学生流感疫苗(Influenza vaccine,InfV)接种和流感发病信息,根据2022年8-11月是否接种TIV分为接种组和未接种组,采用倾向性评分匹配方法建立1∶1回顾性队列,分析随访300 d内TIV预防流感的VE。结果研究对象TIV接种后30 d、60 d、90 d、120 d、150 d、180 d、300 d预防流感的VE(95%CI)分别为94.44%(82.23%-98.26%)、84.48%(68.68%-92.31%)、81.03%(63.87%-90.05%)、62.68%(51.59%-71.23%)、27.55%(24.55%-30.44%)、15.26%(13.05%-17.42%)、15.70%(13.64%-17.71%)。Logistic回归模型分析显示,6-11岁者TIV接种后180 d的调整后VE显著高于12-19岁者,上年度流感发病者显著高于未发病者,上年度接种四价灭活InfV者显著高于上年度接种TIV者和未接种InfV者。结论中小学生TIV接种3个月内预防流感的VE较高,接种后300 d的VE仍具有显著性。建议中小学生无论既往InfV接种史或流感发病史在流感流行季节前尽早接种InfV。

Objective To evaluate vaccine effectiveness(VE)of trivalent influenza vaccine,inactivated(TIV)in primary and secondary school students.Methods We collected data on influenza vaccination and influenza incidences in primary and secondary school students from a district of Shenzhen during the 2022-2023 academic year through individual-level matching Shenzhen Student Health Monitoring Information System,Shenzhen Immunization Program Information Management System,and China Disease Prevention and Control Information System.We divided subjects into vaccination and novaccination groups according to their TIV vaccination histories during August to November 2022,and established a 1∶1 matched retrospective cohort using propensity score matching to determine TIV VEs against influenza within 300 days of follow-up.Results TIV VEs(95%CI)against influenza 30,60,90,120,150,180,and 300 days after TIV vaccination were 94.44%(82.23%-98.26%),84.48%(68.68%-92.31%),81.03%(63.87%-90.05%),62.68%(51.59%-71.23%),27.55%(24.55%-30.44%),15.26%(13.05%-17.42%),and 15.70%(13.64%-17.71%),respectively.Logistic regression analysis showed that adjusted VE 180 days after vaccination was significantly higher among 6-11-year-olds than among 12-19-year-olds,among subjects who had had influenza in the last year than among subjects who had not had influenza,and among subjects who had received quadrivalent inactivated influenza vaccine in the last year than among subjects who had received TIV or had not received any InfV.Conclusions VE against influenza was high within three months after TIV vaccination among primary and secondary school students,and protection remained significant 300 days after vaccination.We recommended InfV vaccination for primary and secondary school students as early as possible before the influenza season,regardless of their prior-year vaccination or influenza history.