疫苗运动对综合医院入院率和儿童死亡率的影响 (RE-CAMP)
一项关于麻疹疫苗和口服脊髓灰质炎疫苗对综合医院入院率和儿童死亡率影响的整群随机对照试验
世界致力于在未来十年内根除麻疹和脊髓灰质炎感染。 一旦这两种感染都得到控制,麻疹和口服脊髓灰质炎疫苗的运动将逐步停止。 对于低收入国家的儿童生存来说,这可能弊大于利。 几内亚比绍和其他地方的 Bandim 健康项目的研究表明,活麻疹和口服脊髓灰质炎疫苗具有有益的非特异性作用,即与预防目标疾病无关的儿童发病率和死亡率的影响。
这些活动被认为对常规疫苗接种计划未覆盖的儿童最有益,因为他们尚未受到保护。 然而,研究表明,先前的常规或运动疫苗接种可能会增强对无关感染的抵抗力。 如果我们在根除目标感染后逐步停止麻疹和口服脊髓灰质炎运动,而不考虑对儿童生存的影响,那么自 1990 年以来儿童死亡率的急剧下降可能会改变方向。 我们将开展首个整群随机对照试验,以通过 Bandim 健康项目评估麻疹和口服脊髓灰质炎运动对一般儿童发病率和死亡率的影响。 Bandim Health Project 自 1978 年起在几内亚比绍运行健康和人口统计监测系统,并通过持续登记对所有儿童实施的所有干预措施以及对个人进行跟进,评估儿童健康干预措施对现实生活的影响。 我们将在几内亚比绍农村开展试验,监测所有九个卫生区域。
假设是:
RECAMP-MV:在麻疹感染有限的情况下,几内亚比绍的麻疹疫苗接种运动在随后的 18 个月内将 9 至 59 个月大儿童的发病率和死亡率降低了 80%。
RECAMP-OPV:几内亚比绍的口服脊髓灰质炎疫苗接种运动在没有脊髓灰质炎感染的情况下,在随后的 12 个月内将 0 至 8 个月大的儿童的发病率和死亡率降低了 25%。
最初,这些试验打算在 182 个集群中实施,招募 21000 名儿童。 在修改样本量计算并与数据安全和监测委员会讨论后,集群数量增加到 222 个,计划的入学人数从 21,000 人增加到 28,000 人(RECAMP-MV:18000,RECAMP-OPV:10000)。
为了探索 OPV 的至少部分有益非特异性作用是由肠道和/或呼吸道微生物组的变化驱动的假设,我们将收集一个子组中的微生物组样本:
从分配到干预组的 50 名婴儿和分配到对照组的 50 名婴儿中收集鼻拭子和直肠拭子。 将为每个婴儿收集两个样本,一个是在为 RECAMP-OPV 招募时收集的,另一个是两个月后。
研究概览
研究类型
注册 (预期的)
阶段
- 第四阶段
联系人和位置
学习地点
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Bissau、几内亚比绍
- Bandim Health Project
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:在父母/监护人同意的情况下,与在农村 Bandim 健康项目健康和人口监测站登记的家庭一起生活的 0-59 个月的儿童被包括在内。
排除标准:
- 孩子体温 > 39.0°C 或检查护士定义的严重急性疾病
或者
- 孩子的中上臂周长 < 110 毫米且年龄超过 6 个月(艾滋病和慢性免疫抑制疾病最可行的局部指标)
或者
- 孩子在之前接种疫苗、药物或食物后经历过严重的过敏反应。
或者
- 孩子参加了一项正在进行的卡介苗疫苗研究,并且小于 2 个月大
或者
- 对于 RECAMP-MV 试验:孩子参加了 RECAMP-OPV
学习计划
研究是如何设计的?
设计细节
- 主要用途:预防
- 分配:随机化
- 介入模型:平行线
- 屏蔽:单身的
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:麻疹疫苗
在干预村,如果儿童年龄在 9-59 个月之间,他们将被称重并接种一剂标准麻疹疫苗。
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由世界卫生组织预审的麻疹疫苗将由当地护士通过深皮下注射到左侧肩胛下区域进行一剂接种。
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实验性的:口服脊髓灰质炎疫苗
在干预村,如果 0-8 个月大,儿童将被称重并接种一剂或两剂标准口服脊髓灰质炎疫苗。
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经世界卫生组织预审的二价口服脊髓灰质炎疫苗将由当地护士分一剂或两剂直接注射到接种者的口中,每剂两滴。
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NO_INTERVENTION:称重-MV
在对照村庄中,作为 MV 干预臂对照的 9-59 个月的儿童将仅称重。
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NO_INTERVENTION:称重-OPV
在对照村中,作为 OPV 干预组对照的 0-8 个月大的儿童将仅称重。
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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综合结果:死亡率和住院率(以比率衡量)
大体时间:从入学到研究结束(最长随访 2 年)
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死亡(通过随访登记,通过口头尸检证实)或首次入院(在随访时通过面谈登记在医院过夜)
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从入学到研究结束(最长随访 2 年)
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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死亡
大体时间:从入学到研究结束(最长随访 2 年)
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死亡(通过随访登记,口头尸检证实)
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从入学到研究结束(最长随访 2 年)
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入院
大体时间:从入学到研究结束(最长随访 2 年)
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入院(在随访时通过面谈登记在医院过夜)
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从入学到研究结束(最长随访 2 年)
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营养状况
大体时间:从入学到研究结束(最长随访 2 年)
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根据联合国儿童基金会的建议,用卷尺记录上臂中围
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从入学到研究结束(最长随访 2 年)
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其他结果措施
结果测量 |
措施说明 |
大体时间 |
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急性不良反应
大体时间:孩子被纳入研究后一两个月
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保健中心咨询和通过随访登记的疾病
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孩子被纳入研究后一两个月
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呼吸系统和肠道微生物组的变化
大体时间:孩子被纳入研究两个月后
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在参加 OPV 或相应对照组(称重 OPV)的 100 名儿童中,将在入学时和 2 个月后收集鼻拭子和直肠拭子,以评估运动 OPV 对微生物组的影响。
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孩子被纳入研究两个月后
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合作者和调查者
调查人员
- 首席研究员:Ane Fisker, MD, PhD、Bandim Health Project, Guinea-Bissau and Statens Serum Institute, Research Center for Vitamins and Vaccines, Bandim Health Project
- 首席研究员:Peter Aaby, DMSc,Professor、Bandim Health Project, Guinea-Bissau and Statens Serum Institute, Research Center for Vitamins and Vaccines, Bandim Health Project
- 首席研究员:Aksel Jensen, PhD、Statens Serum Institute, Research Center for Vitamins and Vaccines, Bandim Health Project
- 首席研究员:Anshu Varma, MSc、Statens Serum Institute, Research Center for Vitamins and Vaccines, Bandim Health Project
- 首席研究员:Amabelia Rodrigues, Ph、Bandim Health Project, Guinea-Bissau
出版物和有用的链接
一般刊物
- Aaby P, Martins CL, Garly ML, Bale C, Andersen A, Rodrigues A, Ravn H, Lisse IM, Benn CS, Whittle HC. Non-specific effects of standard measles vaccine at 4.5 and 9 months of age on childhood mortality: randomised controlled trial. BMJ. 2010 Nov 30;341:c6495. doi: 10.1136/bmj.c6495.
- World Health Organization. Global measles and rubella strategic plan: 2012-2020. 2012.
- World Health Organization. Polio eradication and endgame strategic plan: 2013-2018. 2013.
- Meeting of the Strategic Advisory Group of Experts on immunization, October 2015 - conclusions and recommendations. Wkly Epidemiol Rec. 2015 Dec 11;90(50):681-99. No abstract available. English, French.
- Kristensen I, Aaby P, Jensen H. Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa. BMJ. 2000 Dec 9;321(7274):1435-8. doi: 10.1136/bmj.321.7274.1435.
- Aaby P, Samb B, Simondon F, Seck AM, Knudsen K, Whittle H. Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries. BMJ. 1995 Aug 19;311(7003):481-5. doi: 10.1136/bmj.311.7003.481.
- Aaby P, Garly ML, Bale C, Martins C, Jensen H, Lisse I, Whittle H. Survival of previously measles-vaccinated and measles-unvaccinated children in an emergency situation: an unplanned study. Pediatr Infect Dis J. 2003 Sep;22(9):798-805. doi: 10.1097/01.inf.0000083821.33187.b5.
- Lund N, Andersen A, Hansen AS, Jepsen FS, Barbosa A, Biering-Sorensen S, Rodrigues A, Ravn H, Aaby P, Benn CS. The Effect of Oral Polio Vaccine at Birth on Infant Mortality: A Randomized Trial. Clin Infect Dis. 2015 Nov 15;61(10):1504-11. doi: 10.1093/cid/civ617. Epub 2015 Jul 28.
- Lund N, Biering-Sorensen S, Andersen A, Monteiro I, Camala L, Jorgensen MJ, Aaby P, Benn CS. Neonatal vitamin A supplementation associated with a cluster of deaths and poor early growth in a randomised trial among low-birth-weight boys of vitamin A versus oral polio vaccine at birth. BMC Pediatr. 2014 Aug 28;14:214. doi: 10.1186/1471-2431-14-214.
- Martins CL, Benn CS, Andersen A, Bale C, Schaltz-Buchholzer F, Do VA, Rodrigues A, Aaby P, Ravn H, Whittle H, Garly ML. A randomized trial of a standard dose of Edmonston-Zagreb measles vaccine given at 4.5 months of age: effect on total hospital admissions. J Infect Dis. 2014 Jun 1;209(11):1731-8. doi: 10.1093/infdis/jit804. Epub 2014 Jan 16.
- Sorup S, Benn CS, Poulsen A, Krause TG, Aaby P, Ravn H. Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections. JAMA. 2014 Feb 26;311(8):826-35. doi: 10.1001/jama.2014.470.
- Sorup S, Stensballe LG, Krause TG, Aaby P, Benn CS, Ravn H. Oral Polio Vaccination and Hospital Admissions With Non-Polio Infections in Denmark: Nationwide Retrospective Cohort Study. Open Forum Infect Dis. 2015 Dec 17;3(1):ofv204. doi: 10.1093/ofid/ofv204. eCollection 2016 Jan.
- Aaby P, Hedegaard K, Sodemann M, Nhante E, Veirum JE, Jakobsen M, Lisse I, Jensen H, Sandstrom A. Childhood mortality after oral polio immunisation campaign in Guinea-Bissau. Vaccine. 2005 Feb 25;23(14):1746-51. doi: 10.1016/j.vaccine.2004.02.054.
- Andersen A, Fisker AB, Rodrigues A, et al. National immunization campaigns with oral polio vaccine (OPV) reduce the general all-cause mortality rate: An analysis of the effect of campaign-OPV on child mortality within seven randomised trials (submitted). 2016.
- Fisker AB, Rodrigues A, Martins C, Ravn H, Byberg S, Thysen S, Storgaard L, Pedersen M, Fernandes M, Benn CS, Aaby P. Reduced All-cause Child Mortality After General Measles Vaccination Campaign in Rural Guinea-Bissau. Pediatr Infect Dis J. 2015 Dec;34(12):1369-76. doi: 10.1097/INF.0000000000000896.
- Benn CS, Netea MG, Selin LK, Aaby P. A small jab - a big effect: nonspecific immunomodulation by vaccines. Trends Immunol. 2013 Sep;34(9):431-9. doi: 10.1016/j.it.2013.04.004. Epub 2013 May 14.
- Byberg S., Thysen SM, Rodrigues A et al. A general measles vaccination campaign and subsequent child mortality in urban Guinea-Bissau (manuscript).
- Aaby P, Andersen M, Sodemann M, Jakobsen M, Gomes J, Fernandes M. Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. BMJ. 1993 Nov 20;307(6915):1308-11. doi: 10.1136/bmj.307.6915.1308.
- World Bank. World Bank Countries and Lending Groups. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519 (accessed 01-07-2016).
- United Nations Inter-agency Group for Child Mortality Estimation. http://www.childmortality.org/index.php?r=site/graph#ID=GNB_Guinea-Bissau (accessed 01-07-2016)
- INDEPTH network. Indepth Verbal Autopsy. http://www.indepth-network.org/resources/tools (accessed 25-07-2016).
- Desgrees du Lou A, Pison G, Aaby P. Role of immunizations in the recent decline in childhood mortality and the changes in the female/male mortality ratio in rural Senegal. Am J Epidemiol. 1995 Sep 15;142(6):643-52. doi: 10.1093/oxfordjournals.aje.a117688.
- Aaby P, Jensen H, Samb B, Cisse B, Sodemann M, Jakobsen M, Poulsen A, Rodrigues A, Lisse IM, Simondon F, Whittle H. Differences in female-male mortality after high-titre measles vaccine and association with subsequent vaccination with diphtheria-tetanus-pertussis and inactivated poliovirus: reanalysis of West African studies. Lancet. 2003 Jun 28;361(9376):2183-8. doi: 10.1016/S0140-6736(03)13771-3.
- Benn CS, Rodrigues A, Yazdanbakhsh M, Fisker AB, Ravn H, Whittle H, Aaby P. The effect of high-dose vitamin A supplementation administered with BCG vaccine at birth may be modified by subsequent DTP vaccination. Vaccine. 2009 May 11;27(21):2891-8. doi: 10.1016/j.vaccine.2009.02.080. Epub 2009 Mar 9.
- Benn CS, Fisker AB, Whittle HC, Aaby P. Revaccination with Live Attenuated Vaccines Confer Additional Beneficial Nonspecific Effects on Overall Survival: A Review. EBioMedicine. 2016 Aug;10:312-7. doi: 10.1016/j.ebiom.2016.07.016. Epub 2016 Jul 15.
- World Health Organization. Information Sheet Observed Rate of Vaccine Reactions Measles, Mumps and Rubella Vaccines. 2014. http://www.who.int/vaccine_safety/initiative/tools/MMR_vaccine_rates_ information_sheet.pdf (accessed 01-07-2016).
- World Health Organization. Information Sheet Observed Rate of Vaccine Reactions Polio Vaccines. 2014. http://www.who.int/vaccine_safety/initiative/tools/Polio_vaccine_rates_information_sheet.pdf (accessed 01-07-2016).
- Chuang SK, Lau YL, Lim WL, Chow CB, Tsang T, Tse LY. Mass measles immunization campaign: experience in the Hong Kong Special Administrative Region of China. Bull World Health Organ. 2002;80(7):585-91. Epub 2002 Jul 30.
- Abedi GR, Mutuc JD, Lawler J, Leroy ZC, Hudson JM, Blog DS, Schulte CR, Rausch-Phung E, Ogbuanu IU, Gallagher K, Kutty PK. Adverse events following a third dose of measles, mumps, and rubella vaccine in a mumps outbreak. Vaccine. 2012 Nov 19;30(49):7052-8. doi: 10.1016/j.vaccine.2012.09.053. Epub 2012 Oct 3.
- Arruda WO, Kondageski C. Aseptic meningitis in a large MMR vaccine campaign (590,609 people) in Curitiba, Parana, Brazil, 1998. Rev Inst Med Trop Sao Paulo. 2001 Sep-Oct;43(5):301-2. doi: 10.1590/s0036-46652001000500012.
- Roberts RJ, Sandifer QD, Evans MR, Nolan-Farrell MZ, Davis PM. Reasons for non-uptake of measles, mumps, and rubella catch up immunisation in a measles epidemic and side effects of the vaccine. BMJ. 1995 Jun 24;310(6995):1629-32. doi: 10.1136/bmj.310.6995.1629.
- Strebel PM, Papania MJ, Dayan GH, Halsey NA. Measles Vaccine. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines: Saunders; 2008: 353-98.
- Fisker AB, Bale C, Jorgensen MJ, Balde I, Hornshoj L, Bibby BM, Aaby P, Benn CS. High-dose vitamin A supplementation administered with vaccinations after 6 months of age: sex-differential adverse reactions and morbidity. Vaccine. 2013 Jun 28;31(31):3191-8. doi: 10.1016/j.vaccine.2013.04.072. Epub 2013 May 14.
- Sugawara T, Ohsuka Y, Taya K, Yasui Y, Wada N, Sakano M, Koshida R, Fujii F, Shibata S, Hashimoto G, Utsumi H, Sumitomo M, Ishihara M, Kondo H, Sato H, Ueno K, Araki K, Okabe N. Diarrhea as a minor adverse effect due to oral polio vaccine. Jpn J Infect Dis. 2009 Jan;62(1):51-3.
- Meeting of the Strategic Advisory Group of Experts on immunization, April 2013 - conclusions and recommendations. Wkly Epidemiol Rec. 2013 May 17;88(20):201-6. No abstract available. English, French.
- Higgins JPT, Soares-Weiser K, Reingold A. Systematic review of the non-specific effects of BCG, DTP and measles containing vaccines . Available at: http://www.who.int/immunization/sage/meetings /2014/april/3_NSE_Epidemiology_review_Report_to_SAGE_14_Mar_FINAL.pdf?ua=1, 2014.
- Meeting of the Strategic Advisory Group of Experts on immunization, April 2014 -- conclusions and recommendations. Wkly Epidemiol Rec. 2014 May 23;89(21):221-36. No abstract available. English, French.
- Aaby P, Gustafson P, Roth A, Rodrigues A, Fernandes M, Sodemann M, Holmgren B, Benn CS, Garly ML, Lisse IM, Jensen H. Vaccinia scars associated with better survival for adults. An observational study from Guinea-Bissau. Vaccine. 2006 Jul 17;24(29-30):5718-25. doi: 10.1016/j.vaccine.2006.04.045. Epub 2006 May 6.
- Jensen ML, Dave S, Schim van der Loeff M, da Costa C, Vincent T, Leligdowicz A, Benn CS, Roth A, Ravn H, Lisse IM, Whittle H, Aaby P. Vaccinia scars associated with improved survival among adults in rural Guinea-Bissau. PLoS One. 2006 Dec 20;1(1):e101. doi: 10.1371/journal.pone.0000101.
- Rieckmann A, Villumsen M, Sorup S, Haugaard LK, Ravn H, Roth A, Baker JL, Benn CS, Aaby P. Vaccinations against smallpox and tuberculosis are associated with better long-term survival: a Danish case-cohort study 1971-2010. Int J Epidemiol. 2017 Apr 1;46(2):695-705. doi: 10.1093/ije/dyw120.
- Varma A, Aaby P, Thysen SM, Jensen AKG, Fisker AB. Reduction in Short-term Outpatient Consultations After a Campaign With Measles Vaccine in Children Aged 9-59 Months: Substudy Within a Cluster-Randomized Trial. J Pediatric Infect Dis Soc. 2020 Nov 10;9(5):535-543. doi: 10.1093/jpids/piaa091.
- Varma A, Jensen AKG, Thysen SM, Pedersen LM, Aaby P, Fisker AB. Research protocol of two concurrent cluster-randomized trials: Real-life Effect of a CAMPaign with Measles Vaccination (RECAMP-MV) and Real-life Effect of a CAMPaign with Oral Polio Vaccination (RECAMP-OPV) on mortality and morbidity among children in rural Guinea-Bissau. BMC Public Health. 2019 Nov 11;19(1):1506. doi: 10.1186/s12889-019-7813-y.
研究记录日期
研究主要日期
学习开始
初级完成 (预期的)
研究完成 (预期的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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麻疹疫苗的临床试验
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SENAI CIMATEC招聘中
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Federal Budgetary Research Institution State Research...完全的
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Sidney Kimmel Comprehensive Cancer Center at Johns...招聘中