论文标题：Efficacy and safety of pertussis vaccination for pregnant women – a systematic review of randomised controlled trials and observational studies

期刊：BMC Pregnancy and Childbirth

作者：Marie Furuta et al

发表时间： 2017/12/22

数字识别码：10.1186/s12884-017-1559-2

原文链接：https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1559-2?utm_source=WeChat&utm_medium=Social_media_organic&utm_content=DaiDen-BMC-BMC_Pregnancy_and_Childbirth-Preventive_Medicine-China&utm_campaign=BMCS_USG_BSCN_DD_SO_BMCPregnancy_and_Childbirth

百日咳目前仍是威胁全球儿童健康的主要疾病之一。在最近暴发的百日咳疫情中，部分工业化国家开始对孕产妇进行产前免疫接种，以保护婴儿免受百日咳感染。

BMC Pregnancy and Childbirth期刊发表的文章Efficacy and safety of per tussis vaccination for pregnant women-a systematic review of randomised controlled trials and observational studies探讨了百日咳疫苗对孕妇的功效性和安全性。本次系统评价旨在汇总为孕妇接种百日咳疫苗的有效性和安全性的相关证据。

来自日本京都大学的Marie Furuta及其团队检索了Cochrane临床对照试验中心注册数据库、Medline、Embase和OpenGrey中自各数据库建立之日起至2016年5月16日期间的相关文献。检索关键词包括“百日咳（pertussis& whooping cough）”、“百日咳疫苗（pertussis vaccine ）”、“破伤风、白喉和百日咳疫苗（tetanus, diphtheria and pertussis vaccines）”、“妊娠（pregnancy）”和“围产期（perinatal）”。

此次综述中纳入了15篇文献，代表了12组研究人群，共涉及来自美国、英国、比利时、以色列和越南的203,835对母婴。这些研究中，有两项为随机对照试验（RCTs），其余为观察性研究。现有证据表明，与安慰剂或无疫苗接种相比，在妊娠19-37周期间接种疫苗与出生时母亲及其新生儿的血液中抗体水平显著增加相关。然而，尚缺乏有力证据表明这些增加的抗体是否能降低婴儿中百日咳的发生率（一项随机对照试验，n = 48，两组均无人患百日咳）及百日咳相关严重并发症的发生率（一项观察性研究）或死亡率（无研究对此进行评估）。同时，尚无证据表明严重并发症如死产（一项随机对照试验，n=103，风险比= 0，意味着疫苗接种组中无死亡病例）或早产（两项随机对照试验，n=151，风险比= 0.86，95%置信区间：0.14-5.21）与妊娠期间接种疫苗有关。

鉴于在许多国家百日咳感染患者日益增多，且新生儿患百日咳严重并发症的风险最大，因此在妊娠晚期阶段对孕妇接种疫苗的做法应得到支持，但同时还需开展进一步的研究来填补知识空白，补充可验证这项措施有效性和安全性的相关证据。

摘要：

Background

Worldwide, pertussis remains a major health problem among children. During the recent outbreaks of pertussis, maternal antenatal immunisation was introduced in several industrial countries. This systematic review aimed to synthesize evidence for the efficacy and safety of the pertussis vaccination that was given to pregnant women to protect infants from pertussis infection.

Methods

We searched literature in the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey between inception of the various databases and 16 May 2016. The search terms included ‘pertussis’, ‘whooping cough’, ‘pertussis vaccine,’ ‘tetanus, diphtheria and pertussis vaccines’ and ‘pregnancy’ and ‘perinatal’.

Results

We included 15 articles in this review, which represented 12 study populations, involving a total of 203,835 mother-infant pairs from the US, the UK, Belgium, Israel, and Vietnam. Of the included studies, there were two randomised controlled trials (RCTs) and the rest were observational studies. Existing evidence suggests that vaccinations administered during 19–37 weeks of gestation are associated with significantly increased antibody levels in the blood of both mothers and their newborns at birth compared to placebo or no vaccination. However, there is a lack of robust evidence to suggest whether these increased antibodies can also reduce the incidence of pertussis (one RCT, n = 48, no incidence in either group) and pertussis-related severe complications (one observational study) or mortality (no study) in infants. Meanwhile, there is no evidence of increased risk of serious complications such as stillbirth (e.g. one RCT, n = 103, RR = 0, meaning no case in the vaccine group), or preterm birth (two RCTs, n = 151, RR = 0.86, 95%CI: 0.14–5.21) related to administration of the vaccine during pregnancy.

Conclusion

Given that pertussis infection is increasing in many countries and that newborn babies are at greatest risk of developing severe complications from pertussis, maternal vaccination in the later stages of pregnancy should continue to be supported while further research should fill knowledge gaps and strengthen evidence of its efficacy and safety.

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期刊介绍：BMC Pregnancy & Childbirth is an open access, peer-reviewed journal that considers articles on all aspects of pregnancy and childbirth. The journal welcomes submissions on the biomedical aspects of pregnancy, breastfeeding, labor, maternal health, maternity care, trends and sociological aspects of pregnancy and childbirth.

2017 Journal Metrics

Citation Impact

2.331 - 2-year Impact Factor

2.927 - 5-year Impact Factor

1.342 - Source Normalized Impact per Paper (SNIP)

（来源：科学网）