JAMA Netw Open:美国新诊断为HIV感染者中脑膜炎球菌疫苗接种率

2022-07-25 从医路漫漫 MedSci原创

HIV

感染艾滋病毒的人患脑膜炎球菌病的风险增加4.5%到12.9倍。

景:侵袭性脑膜炎球菌病很罕见,但与严重的发病率和死亡率有关。来自美国、英国和南非的研究表明,感染艾滋病毒的人患脑膜炎球菌病的风险增加4.5%到12.9倍。 2016年2月,美国免疫实践咨询委员会建议为艾滋病毒感染者推荐A、C、W和Y群脑膜炎球菌(MenACWY)疫苗。在2016年6月一致投票后,7这项建议于2016.8年11月发表。该疫苗通常作为两剂初级疫苗,随后常规加强免疫接种。

目的:调查新诊断为HIV的人群对MenACWY疫苗的接受率和接受时间。

设计、设置和参与者:这项队列研究使用了2016年1月1日至2018年3月31日美国Optum研究数据库中的健康保险数据,以回顾性方式确定了1208名年龄在2岁或2岁以上的个人,这些个人具有1项或更多住院索赔或2项或更多门诊索赔,证明了新的HIV感染诊断,并且在诊断前12个月或更多月以及诊断后6个月或更多月连续投保。随访6 ~ 33个月。统计分析时间为2019年3月7日至2022年1月5日。梅纳威疫苗的暴露收据。

主要结果和测量:主要结果是在新的HIV诊断后接受1剂或多剂MenACWY疫苗的摄取和时间。次要结果包括摄取和接受2剂或更多剂MenACWY疫苗的时间。通过Kaplan-Meier分析评估疫苗接种率和接受率;使用多变量Cox比例风险回归分析确定了与接受1剂或多剂MenACWY疫苗相关的因素。1208名符合接种条件的个体的结果(1024名男性患者[84.8%];平均[SD]年龄,38.8 [12.5]岁;35名[2.9%]亚裔;273【22.6%】黑人;西班牙裔204人[16.9%];442名[36.6%]白人),16.3%估计在新的艾滋病毒诊断后的2年内接受了第一剂MenACWY疫苗。在接受第一剂疫苗注射的个体中,在第一剂疫苗注射后1年或更长时间内,估计有66.2%的个体在第一剂疫苗注射后1年内接受了第二剂疫苗注射。与接受梅纳威疫苗显著相关的因素包括接受肺炎球菌疫苗(危险比[HR],23.03;95%可信区间为13.93-38.09),参加健康护理访视(风险比为3.67;95% CI,1.11-12.12),西部或中西部地理区域(西部:HR,2.24;95% CI,1.443 . 47;中西部:HR,1.78;95% CI,1.16-2.71),和男性性别(HR,2.72;95% CI,1.18-6.26),而56岁或以上的年龄与梅纳威疫苗摄入减少显著相关(HR,0.42;95% CI,0.18-0.97)。

图 脑膜炎双球菌A、C、W、Y(MenACWY)疫苗的摄取

表1 在COX比例风险回归分析中,与接种1剂或更多剂量的MenACWY疫苗的可能性有统计学意义的相关因素

结论:这项队列研究表明,在新诊断为艾滋病毒的人中,MenACWY疫苗的接种率很低,这突显了有必要教育患者和临床医生有关艾滋病毒感染等增加高危人群脑膜炎双球菌疾病风险的疾病的建议。

原文出处: Ghaswalla PK,  Marshall GS,  Bengtson LGS, et al.Meningococcal Vaccination Rates Among People With a New Diagnosis of HIV Infection in the US.JAMA Netw Open 2022 Apr 01;5(4)

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    2022-12-26 canlab
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    2023-05-10 feather89
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    2022-08-27 rgjl
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    2022-11-11 gous
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    2022-07-25 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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