本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00850-X

摘要内容如下：

背景

世卫组织应其成员国的要求，于1974年启动了扩大免疫方案，向全球所有人提供拯救生命的疫苗。为了纪念扩大免疫方案50周年，我们试图量化自该方案启动以来全球疫苗接种对公共卫生的影响。

方法

在这项建模研究中，我们使用了一套数学和统计模型来估计50年来针对EPI中14种病原体的疫苗接种对全球和区域公共卫生的影响。对于模拟的病原体，我们考虑了自1974年以来接种的所有常规和补充疫苗的覆盖率，并估计了相对于历史上没有接种疫苗的假设情况，每个年龄组避免的死亡率和发病率。然后，我们使用这些模拟结果来估计在此期间疫苗接种对全球婴儿和儿童死亡率下降的贡献。

调查结果

自1974年以来，疫苗接种避免了1.54亿例死亡，包括1.46亿例5岁以下儿童，其中1.01亿例为1岁以下婴儿。每避免一例死亡，就平均获得66年的完全健康，相当于获得102亿年的完全健康。我们估计，在观察到的全球婴儿死亡率下降中，疫苗接种占40%，在非洲地区占52%。到2024年，相对于历史上没有接种疫苗的假设情况，10岁以下儿童活到下一个生日的可能性要高出40%。即使到了成年后期，也能观察到存活率的增加。

解释

自1974年以来，全球每个区域的儿童存活率都大幅提高。我们估计，在过去50年中，扩大免疫方案为提高婴儿存活率作出了最大的贡献。在加强初级卫生保健的背景下，我们的研究结果表明，公平普及免疫接种对于维持健康成果和继续从可预防的传染性死亡中拯救未来生命仍然至关重要。

英文原文如下：

Abstracts

BACKGROUND  WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception.

METHODS  In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period.

FINDINGS  Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood.

INTERPRETATION  Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality.

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