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- Zhang, L, et al.
(författare)
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Acellular vaccines for preventing whooping cough in children
- 2012
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Ingår i: Cochrane Database of Systematic Reviews. - : Wiley-Blackwell. - 1469-493X .- 1469-493X. ; :3
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Forskningsöversikt (refereegranskat)abstract
- A B S T R A C TBackgroundRoutine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following such action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. pertussis) antigens, were developed in the hope that they would be as effective, but less reactogenic than the whole-cell vaccines.ObjectivesTo assess the efficacy and safety of acellular pertussis vaccines in children.Search methodsWe searched theCochrane Register ofControlledTrials (CENTRAL) (TheCochrane Library 2011, Issue 4)which contains theCochrane Acute Respiratory Infections Group’s Specialised Register, MEDLINE (1950 to December week 4, 2011), EMBASE (1974 to January 2012), Biosis Previews (2009 to January 2012), and CINAHL (2009 to January 2012).Selection criteriaWe selected double-blind randomised efficacy and safety trials of aP vaccines in children up to six years old, with active follow-up of participants and laboratory verification of pertussis cases.Data collection and analysisTwo review authors independently extracted data and assessed the risk of bias in the studies. Differences in trial design precluded a meta-analysis of the efficacy data. We pooled the safety data from individual trials using a random-effects meta-analysis model.Main resultsWe included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. Most of the safety trials did not report the methods for random sequence generation, allocation concealment and blinding, which made it difficult to assess the risk of bias in the studies. The efficacy of multi-component (three) vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis), and from 71% to 78% in Acellular vaccines for preventing whooping cough in children (Review) preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). In contrast, the efficacy of one- and two-component vaccines varied from 59% to 75% against typical whooping cough and from 13% to 54% against mild pertussis disease. Multi-component acellular vaccines are more effective than low-efficacy whole-cell vaccines, but may be less effective than the highest-efficacy whole-cell vaccines. Most systemic and local adverse events were significantly less common with aP vaccines than with wP vaccines for the primary series as well as for the booster dose.Authors’ conclusionsMulti-component (three) aP vaccines are effective and show less adverse effects than wP vaccines for the primary series as well as for booster doses.P L A I N L A N G U A G E S U M M A R YAcellular vaccines for preventing whooping cough in childrenWhooping cough (pertussis) can be a serious respiratory infection. Vaccines made from killed whole Bordetella pertussis (B. pertussis) were developed but they could cause severe neurologic disorders such as convulsions, encephalopathy and hypotonic-hyporesponsive episodes, as well as minor adverse events, such as anorexia, drowsiness, fever, irritability and fretfulness, prolonged crying, vomiting, and injection site pain/redness/swelling/induration. This led to a fall in immunisation rates, which resulted in an increase in the incidence of whooping cough. Acellular pertussis (aP) vaccines (containing purified or recombinant B. pertussis antigens) were developed in the hope that they would be as effective but less reactogenic than the whole-cell pertussis (wP) vaccines.This updated review included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. The efficacy of multi-component (three) acellular vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis) and from 71% to 78% in preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). One- and two-component acellular vaccines were less effective. Most systemic and local adverse events were significantly less common with aP than with wP vaccines for the primary series as well as for the booster dose. This review found that multi-component vaccines which contain three or more aP components are effective, with less adverse effects than wP vaccines.
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