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PLoS Medicine：霍乱可通过口服疫苗进行控制
西雅图弗雷德-哈钦森癌症研究中心 (Fred Hutchinson Cancer Research Center) 疫苗与传染病机构 (Vaccine and Infectious Disease Institute) 的生物统计学家 Ira M. Longini Jr. 博士带领的国际研究员队伍的最新发现表明，全球最贫穷地区发现的潜在致命腹泻疾病地方病霍乱可通过每两年口服受感染人群一半剂量的疫苗（每剂只需几个便士）就能够得到有效控制。Longini 和其同事将于11月27日在《公共科学图书馆-医学》(PLoS Medicine) 在线公布他们的发现结果。
尽管口服霍乱疫苗已经被推出来保护旅行者达10多年之久，但是由于该疫苗的保护潜力被低估因此尚未用于部分有霍乱倾向地区该疾病的广泛控制。事实上，Longini和其同事基于一个来自涉及孟加拉国 Matlab 200,000人的大规模霍乱疫苗试验数据使用一个计算机模拟模型表明，国际授权的停止的全细胞霍乱疫苗 (OCV) 当通过强化免疫给药时可以非常有效地控制霍乱。
Longini 和其同事预计，如果只有50%的人每半年接受一次口服疫苗，那么未进行预防接种的人群中霍乱病例就可以减少近90%。每两年只对30%的人群进行预防将使总霍乱率减少76%。在那些患霍乱人数比 Matlab 少的人群中，至少70%将需要接种疫苗来控制这一疾病。
还担任华盛顿大学 (University of Washington) 公共卫生和社区医学院 (School of Public Health and Community Medicine) 生物统计学教授的 Longini 表示：“这是表明我们如何在全球范围内控制霍乱的首个科学研究。一旦你使约50%的人群接种疫苗之后，这一传染病就不再可怕了。”（新华美通）
原始出处:
PLoS Medicine
Received: March 5, 2007; Accepted: October 15, 2007; Published: November 27, 2007
Controlling Endemic Cholera with Oral Vaccines1 Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America, 2 Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, United States of America, 3 Department of Biostatistics, The Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America, 4 International Vaccine Institute, Seoul, Korea, 5 International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
Background
Although advances in rehydration therapy have made cholera a treatable disease with low case-fatality in settings with appropriate medical care, cholera continues to impose considerable mortality in the world's most impoverished populations. Internationally licensed, killed whole-cell based oral cholera vaccines (OCVs) have been available for over a decade, but have not been used for the control of cholera. Recently, these vaccines were shown to confer significant levels of herd protection, suggesting that the protective potential of these vaccines has been underestimated and that these vaccines may be highly effective in cholera control when deployed in mass immunization programs. We used a large-scale stochastic simulation model to investigate the possibility of controlling endemic cholera with OCVs.
Methods and Findings
We construct a large-scale, stochastic cholera transmission model of Matlab, Bangladesh. We find that cholera transmission could be controlled in endemic areas with 50% coverage with OCVs. At this level of coverage, the model predicts that there would be an 89% (95% confidence interval [CI] 72%–98%) reduction in cholera cases among the unvaccinated, and a 93% (95% CI 82%–99%) reduction overall in the entire population. Even a more modest coverage of 30% would result in a 76% (95% CI 44%–95%) reduction in cholera incidence for the population area covered. For populations that have less natural immunity than the population of Matlab, 70% coverage would probably be necessary for cholera control, i.e., an annual incidence rate of 
1 case per 1,000 people in the population.
Conclusions
Endemic cholera could be reduced to an annual incidence rate of 1 case per 1,000 people in endemic areas with biennial vaccination with OCVs if coverage could reach 50%–70% depending on the level of prior immunity in the population. These vaccination efforts could be targeted with careful use of ecological data.
全文链接：
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040336
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