新生儿5μg和10μg重组酵母乙型肝炎疫苗初免后抗体免疫应答比较

目的 比较新生儿接种5 μg和10 μg重组酵母乙型肝炎(乙肝)疫苗后抗-HBs血清应答状况.方法 以山东、江苏、上海、广西、北京5省(自治区、直辖市)为研究现场,采用5 μg重组啤酒酵母乙肝疫苗(HepB-SC)和l0μg重组汉逊酵母乙肝疫苗(HepB-HP),按照“0-1-6”免疫程序完成初免的7～ 12月龄健康婴儿.调查对象采用问卷调查并采集静脉血,应用化学发光微粒子免疫分析法(CMIA)定量检测抗-HBs.抗-HBs＜ 10 mIU/ml者采用CMIA检测HBsAg,HBsAg阴性者采用巢式PCR方法检测HBV-DNA.比较不同HepB初免后的抗体应答率和抗体水平,采用多因素分析方法确定HepB种类对抗体阳转率和抗体水平的影响.结果 共观察8947名5μgHepB-SC初免(5μg组)和4576名10 μg HepB-HP初免(10μg组)婴儿.5μg组无应答、低应答、正常应答和高应答率分别为1.88％、15.18％、61.42％和21.52％,10μg组分别为0.15％、2.16％、29.42％和68.26％;5 μg组无应答、低应答和正常应答率高于10μg组,高应答率低于10 μg组,各应答率之间差异均有统计学意义(P＜0.01).5 μg组和10μg组初免后抗-HBs几何平均浓度分别为354.81mIU/ml(95％CI:338.84～363.08 mIU/ml)和1778.28mIU/ml(95％CI:1698.24～1819.70mIU/ml),差异有统计学意义(F=4517.17,P＜0.001).多因素分析显示,排除采血月龄、性别、出生体重、早产、母亲分娩前HBsAg状态等因素影响,两种HepB初免后抗体阳性率和抗体水平的差异仍有统计学意义.结论 新生儿使用10 μg HepB-HP初免抗体应答优于5μg HepB-SC.     

乙型肝炎疫苗初次免疫正常应答和高应答新生儿在幼儿期加强免疫对免疫保护持久性影响的配对病例对照研究

目的 探讨乙型肝炎(乙肝)疫苗加强免疫对初次免疫(初免)正常应答和高应答新生儿免疫持久性的影响。方法 选择乙肝疫苗初免正常应答和高应答新生儿,在其幼儿期(2~3岁)时加强免疫3剂次者作为加强免疫组,按照1:1匹配原则随机选择性别、居住乡镇相同的未加强免疫者作为未加强免疫组;于初免5年后采血检测抗-HBs和抗-HBc。结果 加强免疫组和未加强免疫组初免5年后抗-HBs阳性率分别为97.39%(224/230,95%CI:94.41%~99.04%)和53.91%(124/230,95%CI:47.24%~60.48%),几何平均抗体浓度(GMC)分别为1140.02(95%CI:887.46~1464.46) mIU/ml和11.53(95%CI:8.73~15.23) mIU/ml;两组5年随访抗体阳性率和GMC值的差异均有统计学意义(P<0.05)。两组HBV突破性感染率分别为0.87%(2/230)和2.17%(5/230),差异无统计学意义(P>0.05)。多因素分析表明,初免5年后抗-HBs阳性率与是否加强免疫和初免时抗-HBs水平独立相关,OR值分别为38.75(95%CI:16.23~92.54)和3.06(95%CI:1.51~6.17)(P值均<0.05)。结论 乙肝疫苗初免正常应答或高应答儿童在幼儿期加强免疫可有效提高抗体持久性,但对预防HBV感染可能无明显作用。     

乙型肝炎疫苗初次免疫正常应答和高应答婴儿初次免疫5年后免疫记忆持久性随访观察

目的 探讨乙型肝炎(乙肝)疫苗初次免疫(初免)正常应答和高应答新生儿在初免后5年免疫记忆情况及其影响因素。方法 对初免正常应答和高应答新生儿于初免后5年检测其抗-HBs,其中低于保护水平(10 mIU/ml)者接种1剂次乙肝疫苗(激发剂次)并于接种后14 d采集血标本,再次检测抗-HBs,并计算激发剂次后抗-HBs阳转率(≥10 mIU/ml)和GMT。将检测的初免抗体、随访抗体和激发剂次后抗体均从低到高分成不同等级,分析激发剂次后抗体的影响因素。结果 37.98%(980/2 580)初免正常应答和高应答新生儿在初免后5年抗-HBs已降至保护水平以下,其中激发剂次后98.95%(757/765)出现抗体阳转,GMT为2 811.69(95%CI:2 513.55～3 145.19) mIU/ml。激发剂次后抗体滴度随初免抗体水平和随访抗体水平的升高而升高(F值分别为5.46、10.23,均P<0.000 1)。多因素分析显示,激发剂次后抗体滴度与性别、出生体重、早产等无关(P>0.05),而与初免抗体和随访抗体水平独立相关(OR=1.001,95%CI:1.000～1.002,P<0.001;OR=1.28,95%CI:1.81～1.39,P<0.001)。结论 新生儿乙肝疫苗初免后5年存在较强的免疫记忆;免疫记忆的强度与初免抗体及激发剂次前抗体水平有关。     

5μg和10μg重组乙型肝炎疫苗初次免疫正常应答和高应答新生儿5年抗体持久性比较

目的 比较5 μg和10 μg乙型肝炎疫苗（HepB）初次免疫（初免）正常应答和高应答新生儿初免后5年的抗体持久性。方法 选用5 μg（重组啤酒酵母）和10 μg（重组汉逊酵母）HepB,按照"0-1-6"程序完成3剂次初免的新生儿,并在接种第3剂次后1~6个月（T₀）和5年（T₁）后分别采集静脉血,采用化学发光微粒子免疫分析法（CMIA）定量检测抗-HBs,比较两剂量接种后正常应答和高应答（T₀时抗-HBs ≥ 100 mIU/ml）者T₁时的抗体阳性率（抗-HBs ≥ 10 mIU/ml）和平均抗体浓度（GMC）;通过多因素分析探讨接种剂量与抗体持久性的关系。结果 HepB 5 μg组和10 μg组分别共有1 883名和1 495名观察对象纳入分析,T₁时抗-HBs阳性率分别为49.92%（943/1 883）和75.92%（1 135/1 495）,差异有统计学意义（χ²=237.75,P<0.001）;GMC分别为10.23（95%CI：9.38~11.16）mIU/ml和28.91（95%CI：26.65~31.35）mIU/ml,差异有统计学意义（F=280.36,P<0.001）。10 μg组T₁时抗-HBs阴转者抗-HBs滴度分布与5 μg组的差异有统计学意义（χ²=39.75,P<0.001）。多因素分析显示,排除其他因素影响后,HepB初免剂量与T₁时抗-HBs阳性率和抗-HBs滴度均独立相关[P<0.001,OR=1.44（95%CI：1.20~1.73）;P<0.001,β=0.27（95%CI：0.14~0.40）]。结论 新生儿使用10 μg重组HepB初免后5年抗-HBs持久性优于5 μg重组HepB。     

新生儿乙肝疫苗免疫效果及影响因素评价

目的评价新生儿乙肝疫苗初免及低/无免疫应答者再免效果,分析影响因素。方法化学发光微粒子免疫分析法(CMIA)检测抗-HBs。结果新生儿首针乙肝疫苗(HepB1)及时接种率97.19%,未种者中早产、低体重儿占53.54%。初免乙肝表面抗体(抗-HBs)保护率80.75%,低、无应答分别占17.56%、1.69%。性别不同、顺产与剖腹产、早产与足月儿应答率差异无统计学意义。县级及以上医院出生、父母乙肝表面抗原(HBsAg)阴性儿童应答率较高。各组抗体几何平均滴度(GMC)差异均无统计学意义。对低/无免疫应答者再免1剂次,有82.71%儿童达到正常应答;再免3剂次,有96.06%儿童达到正常应答。10μg汉逊酵母组GMC高于5μg啤酒酵母组。结论剖腹产、早产儿能产生良好应答。对低/无应答者,再免能取得较高应答,且3剂次效果优于1剂次。需加强孕妇筛查,制订低/无应答儿童补充免疫策略。     

乙型肝炎疫苗无应答成年人再次免疫后8年抗体持久性观察

目的 评价成年人乙型肝炎（乙肝）疫苗（HepB）初次免疫（初免）无应答者再次免疫（再免）后8年的抗体持久性。方法 2009年8-9月选择济南市章丘区农村社区作为研究现场。研究对象纳入标准为18~49岁、本地常住人口、既往无HBV感染史和HepB接种史、健康状况良好者。按照"0-1-6"程序完成3剂次HepB初免的无应答成年人进行3剂次再免，分别于再免后1个月（T₁）、2年、4年和8年采集静脉血，采用化学发光微粒子免疫分析法（CMIA）检测抗-HBs、HBsAg和抗-HBc。结果 再免后T₁、2年、4年和8年时抗-HBs阳性率分别为85.12%（549/645）、60.60%（283/467）、55.90%（199/356）和55.09%（222/403），其中前2年、3~4年和5~8年的年均递减率分别为15.62%、3.96%和0.36%；抗-HBs几何平均浓度（GMC）分别为153.92、21.43、15.02和13.68 mIU/ml，其中，前2年、3~4年和5~8年的年均递减率分别为62.69%、16.28%和2.31%。多因素分析结果显示，再免后8年抗-HBs阳性率和GMC均与T₁时抗-HBs水平独立相关，与T₁时抗-HBs GMC<100 mIU/ml者相比，T₁时GMC为100~和≥ 1 000 mIU/ml者再免后8年抗-HBs阳性率（OR值分别为14.13和62.91）和GMC（β值分别为1.88和3.24）均较高（均P<0.001）。再免后8年无HBsAg阳转者，抗-HBc阳转率为14.14%（57/403）。结论 成年人HepB初免无应答者3剂次再免后，抗体在前4年衰减较快，5年后进入稳定状态，再免后8年多数人抗-HBs仍维持在保护水平之上；抗体持久性主要与再免1个月时的抗体水平有关。     

乙型肝炎疫苗初次免疫正常应答和高应答成人9年抗体持久性观察

目的探讨乙型肝炎(乙肝)疫苗(HepB)初次免疫(初免)正常应答和高应答者成人初免后9年的抗体持久性及其影响因素。方法选择成人按照0-1-6程序不同种类HepB初免后的正常应答和高应答者[初免后1月(T1)抗-HBs≥100 mIU/ml],于初免后9年(T2)采血定量检测抗-HBs、HBsAg和抗-HBc;采用多因素非条件Logistic回归模型和多因素线性回归模型分析抗体持久性的影响因素。结果 4 022名随访对象中,抗-HBs阳性率由T1时的100%降为T2时的78.37%;抗-HBs几何平均浓度(GMC)由T1时的1 551.83(95%CI:1 488.30～1 618.07)mIU/ml下降为48.16(95%CI:45.52～50.95)mIU/ml。与初免接种20μg重组酿酒酵母HepB(HepB-SC)者相比,接种20μg重组中国仓鼠卵巢细胞HepB(HepB-CHO)者T2时抗-HBs阳性率和GMC均较高,其OR(95%CI)值和b(95%CI)值分别为1.52(1.19～1.95)和0.36(0.23～0.48)。与T1时抗-HBs GMC为100～999 mIU/ml者相比,T1时抗-HBs GMC为1 000～1 999、2 000～9 999和≥10 000 mIU/ml者T2时抗-HBs阳性率和GMC均较高,其OR(95%CI)值分别为4.64(3.62～5.95)、12.55(9.63～16.36)和16.82(10.61～26.66),b(95%CI)值分别为0.99(0.86～1.12)、1.87(1.76～1.97)和3.30(3.15～3.44)。T2时HBsAg阳转者9例,HBsAg阳转率为0.22%。结论成人HepB初免正常应答和高应答者初免后9年抗-HBs阳性率和GMC均下降,但多数人抗-HBs阳性率仍维持在保护水平;抗体持久性主要与初免疫苗类型和T1时抗-HBs的GMC有关。     

北京市海淀区128例新生儿10μg重组乙肝疫苗初免后5年免疫效果观察

目的评价北京市海淀区128例新生儿全程接种10μg重组乙型肝炎(乙肝)疫苗(HepB)后5年免疫效果。方法选取按照北京市免疫程序0、1和6月龄完成3剂10μg重组HepB、并于7~12月龄完成初免效果调查的儿童128人,于初免后5 a采集静脉血标本5 ml,检测乙肝表面抗体(抗-HBs)、乙肝表面抗原(HBsAg)和乙肝核心抗体(抗-HBc)。采用χ2和t检验对不同特征儿童抗-HBs阳性率和常用对数转换后的平均几何浓度(GMCs)进行比较,初免后5 a抗-HBs阳性率影响因素分析采用非条件多因素logistic回归模型。结果新生儿完成10μg重组HepB初免后5 a,无HBsAg阳性出现,抗-HBc阳性率为0.78%。抗-HBs阳性率为75.00%,抗-HBs GMCs为27.16 m U/ml,低于HepB初免后抗-HBs阳性率(100%)和GMCs(1 628.17 m U/ml),差异有统计学意义(χ_(配对)~2=30.031,P<0.01;t_(配对)=36.077,P<0.01)。多因素logistic回归模型分析显示,HepB初免后5 a抗-HBs阳性率与初免后抗-HBs高应答有关(OR=9.210,95%CI:3.539~23.972;P<0.01)。结论新生儿10μg重组HepB初免后5 a免疫效果较好,虽然抗-HBs阳性率和抗-HBs GMCs随时间下降,但仍然维持在较高的水平。     

乙肝疫苗初免失败婴儿再免疫方法研究

目的探索乙肝疫苗初次全程免疫失败婴儿的再免疫方法.方法对乙肝疫苗全程免疫后乙肝病毒表面抗体(抗-HBs)和乙肝病毒表面抗原(HBsAg)均阴性的144名婴儿,随机分成5组,1组为对照组,其余4组分别采用不同的再免疫方法,观察再免成功率.结果抗-HBs总阳转率为93.79%,抗-HBs几何平均滴度(GMT)为546.97mIU/ml,各组抗-HBs阳转率分别为87.88%、90.91%、100%、96.88%;各组GMT分别为475.34mIU/ml、658.65mIU/ml、625.18mIU/ml、455.90mIU/ml.结论乙肝疫苗初免失败婴儿,再免成功率达93.79%.     

小月龄婴儿母传麻疹抗体水平动态变化的纵向研究

目的 研究小月龄婴儿母传麻疹抗体水平的动态变化,探讨减少其感染麻疹病毒的免疫策略。方法 采集2013年7月至2014年4月在广州市某妇幼保健院分娩的母亲及其新生儿出生时(0)、3、5和7月龄血清,采用ELISA检测麻疹IgG抗体,分析母传麻疹抗体水平。结果 共纳入689名母亲及691名新生儿(其中双胞胎2对)。母亲血清麻疹抗体浓度和抗体阳性率分别为513.8 mIU/ml和81.6%,新生儿分别为732.8 mIU/ml和87.3%。新生儿血清麻疹抗体水平与其母亲的血清麻疹抗体水平呈正相关(r=0.9175,P<0.001)。婴儿自出生后体内的麻疹抗体水平在3月龄时迅速下降,至7月龄时基本转为阴性。低、中抗体水平组婴儿在3月龄时抗体水平均已转为阴性,而高抗体水平组的婴儿在5月龄时抗体水平仍为阳性。结论 不同免疫状态母亲的婴儿其母传麻疹抗体水平在8月龄前已基本无法保护婴儿免于感染麻疹,建议适当调整婴儿麻疹疫苗初免月龄,并提高育龄期妇女麻疹抗体水平,以减少小月龄婴儿麻疹发病。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.