國家衛生研究院 NHRI:Item 3990099045/14224
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    Please use this identifier to cite or link to this item: http://ir.nhri.org.tw/handle/3990099045/14224


    Title: Early-life antibiotic exposure associated with varicella occurrence and breakthrough infections: Evidence from nationwide pre-vaccination and post-vaccination cohorts
    Authors: Lin, TL;Fan, YH;Chang, YL;Ho, HJ;Liang, LL;Chen, YJ;Wu, CY
    Contributors: Institute of Population Health Sciences;National Institute of Cancer Research
    Abstract: Background: Antibiotic-driven dysbiosis may impair immune function and reduce vaccine-induced antibody titers. Objectives: This study aims to investigate the impacts of early-life antibiotic exposure on subsequent varicella and breakthrough infections. Methods: This is a nationwide matched cohort study. From Taiwan’s National Health Insurance Research Database, we initially enrolled 187,921 children born from 1997 to 2010. Since 2003, the Taiwan government has implemented a one-dose universal varicella vaccination program for children aged 1 year. We identified 82,716 children born during the period 1997 to 2003 (pre-vaccination era) and 48,254 children born from July 1, 2004, to 2009 (vaccination era). In the pre-vaccination era, 4,246 children exposed to antibiotics for at least 7 days within the first 2 years of life (Unvaccinated A-cohort) were compared with reference children not exposed to antibiotics (Unvaccinated R-cohort), with 1:1 matching for gender, propensity score, and non-antibiotic microbiota-altering medications. Using the same process, 9,531 children in the Vaccinated A-cohort and Vaccinated R-cohort were enrolled from the vaccination era and compared. The primary outcome was varicella. In each era, demographic characteristics were compared, and cumulative incidences of varicella were calculated. Cox proportional hazards model was used to examine associations. Results: In the pre-vaccination era, the 5-year cumulative incidence of varicella in the Unvaccinated A-cohort (23.45%, 95% CI 22.20% to 24.70%) was significantly higher than in the Unvaccinated R-cohort (16.72%, 95% CI 15.62% to 17.82%) (p<.001). In the vaccination era, a significantly higher 5-year cumulative incidence of varicella was observed in the Vaccinated A-cohort (1.63%, 95% 1.32% to 1.93%) than in the Vaccinated R-cohort (1.19%, 95% CI 0.90% to 0.45%) (p=0.006). On multivariate analyses, early-life antibiotic exposure was an independent risk factor for varicella occurrence in the pre-vaccination (adjusted hazard ratio [aHR] 1.92, 95% CI 1.74 to 2.12) and vaccination eras (aHR 1.66, 95% CI 1.24 to 2.23). The use of penicillins, cephalosporins, macrolides, or sulfonamides in infancy was all positively associated with childhood varicella regardless of vaccine administration. Conclusions: Antibiotic exposure in early life is associated with varicella occurrence and breakthrough infections.
    Date: 2022-03-31
    Relation: Frontiers in Immunology. 2022 Mar 31;13:Article number 848835.
    Link to: http://dx.doi.org/10.3389/fimmu.2022.848835
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1664-3224&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000787981300001
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85128419300
    Appears in Collections:[Others] Periodical Articles
    [Others] Periodical Articles

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