Open AccessPostexposure Effects of Vaccines on Infectious Diseases
Author(s) -
Tara E Gallagher,
Marc Lipsitch
Publication year - 2019
Publication title -
epidemiologic reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.253
H-Index - 106
eISSN - 1478-6729
pISSN - 0193-936X
DOI - 10.1093/epirev/mxz014
Subject(s) - medicine , interquartile range , vaccination , hepatitis a , hepatitis a vaccine , rabies , measles , hepatitis b , observational study , clinical trial , post exposure prophylaxis , dengue fever , virology , hepatitis
We searched the PubMed database for clinical trials and observational human studies about postexposure vaccination effects, targeting infections with approved vaccines and vaccines licensed outside the United States against dengue, hepatitis E, malaria, and tick-borne encephalitis. Studies of animal models, serologic testing, and pipeline vaccines were excluded. Eligible studies were evaluated by definition of exposure; attempts to distinguish pre- and postexposure effects were rated on a scale of 1 to 4. We screened 4,518 articles and ultimately identified for this review 14 clinical trials and 31 observational studies spanning 7 of the 28 vaccine-preventable diseases. For secondary attack rate, the following medians were found for postexposure vaccination effectiveness: hepatitis A, 85% (interquartile range (IQR), 28; n = 5 sources); hepatitis B, 85% (IQR, 22; n = 5 sources); measles, 83% (IQR, 21; n = 8 sources); varicella, 67% (IQR: 48; n = 9 sources); smallpox, 45% (IQR, 39; n = 4 sources); and mumps, 38% (IQR, 7; n = 2 sources). For case fatality proportions resulting from rabies and smallpox, the median vaccine postexposure efficacies were 100% (IQR, 0; n = 6 sources) and 63% (IQR, 50; n = 8 sources), respectively. Many available vaccines can modify or preclude disease if administered after exposure. This postexposure effectiveness could be important to consider during vaccine trials and while developing new vaccines.