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医者、男
医者、男

インフルエンザワクチンの効果について~「前橋レポート」を読む

研究医

インフルエンザワクチンの接種を受けるかどうか迷っている方は、たくさんいらっしゃるのではないでしょうか?迷う理由には、インフルエンザワクチンの接種にかかる費用、病院に行く時間がない、といったこともあるでしょう。しかし、インフルエンザワクチンの接種について迷ってしまう大きな原因のひとつに、「そもそも、インフルエンザワクチンの効果ってどうなの?」という疑問があるのではないでしょうか?

現在、インフルエンザワクチンの効果については、肯定派と否定派、両方の意見が飛び交っています。このような状況のなかで、インフルエンザワクチンを接種するかどうかは、様々な情報を集めて個人で判断することとなります。

本記事では、インフルエンザワクチンの効果についての議論において外すことのできない「前橋レポート」を軸に、インフルエンザワクチンの効果について、ご一緒に考えてみましょう。

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インフルエンザワクチンの効果を検証する「前橋レポート」

医者

「インフルエンザワクチンは効果があるのか、ないのか」これについて調べているとよく目にするのが、「前橋レポート」です。この「前橋レポート」とは、どのようなものなのか、次にご紹介しましょう。

前橋レポートは、5年間に渡る調査の後、1987年に前橋市インフルエンザ研究班によってまとめられたインフルエンザワクチンに関する報告です。

1970年代、インフルエンザワクチンの接種は、学童に対する集団予防接種という形で行われていました。しかし、1979年に前橋市の小学生の男の子が、インフルエンザワクチンの接種を行った夜にひきつけの発作を起こすという事象が発生し、前橋市医師会はインフルエンザワクチンの集団接種を中止しました。そして、この中止の判断への責任を取るために、その後のインフルエンザ流行の実態を調査、検証したものがこの「前橋レポート」です。

前橋レポートでは、「インフルエンザワクチンの学童への集団接種は、インフルエンザの流行防止には効果がない」という内容が報告され、これは1994年にインフルエンザワクチンの集団接種が廃止され、任意接種に切り替わるきっかけとなりました。

このように、インフルエンザワクチンの接種に大きな影響を及ぼした前橋レポート、内容はどのようなものか、まとめてみましょう。
【調査方法】

  • 前橋市内の全市立小学校、在籍児童25000人~26000人に対して年間を通して登校日の欠席者数を調査。このとき明らかな慢性疾患や特殊な長期欠席、外傷、忌引きによる欠席者は除外
  • 指定した5校の生徒について、5年間連続してインフルエンザHI抗体価を検査

【総括】

  • 学童集団接種実施の有無は、小学校のインフルエンザ流行に影響を及ぼさない
  • 学童集団接種実地によって地域内流行の抑止しようとする考え方はすでに破たんしている
  • ワクチン有効率(*1)は良くても30%と、言われているよりも低い
  • インフルエンザワクチンの接種が症状軽減に効果があるとするならば、この効果により、インフルエンザウイルスに感染していても学校を欠席しない児童が、インフルエンザの感染源となることが考えられる
  • 自然にインフルエンザに感染して得た免疫は、極めてよく保持されている

(*1)ワクチン有効率とは:ワクチンを非接種で発病した人のうち、ワクチンを接種していれば発病を避けられたと考えられる割合。

【インフルエンザワクチン集団接種に関する見解】

  • 不活性化ワクチンであるインフルエンザワクチンでは、感染防止に必要なIgAを作ることはできないため、集団接種の目的であるインフルエンザの流行阻止には役立たない
  • 激しい変異を繰り返すインフルエンザウイルスに、不活性化ワクチンで対応することは困難
  • 自然感染による免疫の役割は大きく、インフルエンザワクチン接種は利益にならない
  • 学童へのインフルエンザワクチンの集団接種が、ハイリスクグループ(乳幼児や高齢者)を守り得るという保証は得難い
  • インフルエンザワクチンの接種には罹患時の症状を軽減させる効果があるため、ハイリスクグループを対象に接種を行う、という意見は傾聴に値する
  • インフルエンザワクチン接種の副作用は決して少ない数とは言えない

インフルエンザワクチンの効果って??

前橋レポートで前述のような評価を受け、学童への集団接種が廃止されインフルエンザワクチンの接種率は急激に低下しました。しかし、近年高齢者へのインフルエンザワクチンの接種が推奨されるようになり、2000年ごろからはインフルエンザワクチンの接種率が急増に転じています。

現在でも、インフルエンザワクチンの効果に対する評価は、肯定派、否定派の両者の意見が対立し、前橋レポートにたいする反論も数多く見られます。それでは、前橋レポートに対する反論とはどのようなものか、次にみてみましょう。

前橋レポートへの反論

前橋レポートに異論を唱え、インフルエンザワクチンの効果を肯定する意見には、次のようなものがあります。

  • 前橋レポートは、発熱や欠席をインフルエンザへの罹患とみなすなど、調査方法に問題があり、データの統計的な解析も不十分で、これをもってインフルエンザワクチンの効果を否定することはできない
  • 学童への集団接種が中止された前後の研究で、集団接種開始後に超過死亡(*2)
    が減少し、集団接種を中止したころから再び超過死亡が急激に増加していることが分かった。超過死亡のほとんどは高齢者であり、このことから、学童集団接種には社会、高齢者へのインフルエンザの感染を防ぐ機能があったといえる
  • インフルエンザワクチンは、インフルエンザを完全に予防することはできないが、60%程度の予防効果を得ることができる
  • 前橋レポートの後、インフルエンザワクチンの集団予防効果を裏付ける論文が発表されている

超過死亡とは:肺炎などインフルエンザが直接の死因でなくても、インフルエンザが原因となって死亡したケース

インフルエンザ・ワクチンは打たないで!
母里 啓子
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まとめ:インフルエンザワクチンの効果~個人の判断が大切

インフルエンザワクチンの効果について考えるとき、一方の意見のみを鵜呑みにするのではなく、肯定派、否定派、両方の主張を理解して、自分なりの結論を出すことが大切になります。

本記事では、前橋レポートを軸にインフルエンザワクチンの効果に対する肯定派、否定派の主張をご紹介しました。インフルエンザワクチンの効果について考えるときには、他にも軸となるテーマがたくさんあります。
【インフルエンザワクチンの効果についてご紹介している記事】

以上の記事とともに、本記事がインフルエンザワクチンの接種を受けるかどうかの判断をするときの参考となれば幸いです。

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