中小学生乙肝疫苗强化免疫后无应答影响因素分析

研究中小学生乙肝疫苗强化免疫后无应答的发生率及其影响因素,为乙肝免疫的合理接种与补种提供依据.方法 对检测发现HBsAg和抗-HBs两项指标均为阴性的乌鲁木齐县469名中小学生进行0,1两针剂乙肝疫苗接种,采用酶联免疫法(ELISA)检测抗-HBs.根据检测结果分为抗-HBs无应答组(病例组)和应答组(对照组),并调查相关暴露因素,采用SPSS 17.0软件进行1∶2病例对照单因素和多因素条件Logistic回归分析.结果 中小学生乙肝疫苗无应答率为11.94%.单因素分析发现,与无应答相关的因素为拔牙(OR=4.932,95% CI=1.091~ 22.295)、分娩地点(OR=0.361,95%CI=0.165 ~0.790)、新生儿出生体重(OR=0.255,95%CI=0.116~0.560)、喂养方式(OR=0.423,95% CI=0.179~0.999)、新生儿24h内接种乙肝疫苗(OR=0.453,95% CI=0.209~0.980);多因素条件Logistic回归分析中,最终进入模型的因素有拔牙(OR=5.416,95%CI=1.197 ~24.506)、新生儿出生体重(OR=0.410,95%CI=0.172~0.979)、分娩地点(OR=0.445,95% CI=0.213~0.929)、新生儿24h内接种疫苗(OR=0.399,95%CI=0.184~0.863).结论 中小学生乙肝疫苗无应答与多种因素有关,拔牙是无免疫应答的危险因素,而医院分娩、母乳喂养、新生儿24h内接种乙肝疫苗则是保护因素.     

儿童对HBV基因重组疫苗加强接种的免疫应答

目的 观察乙型肝炎疫苗初免的38名儿童对乙型肝炎病毒基因重组疫苗(CHO疫苗)加强接种的免疫效果。方法 挑选母亲分娩前HBsAg均为阳性,抗-HBs阴性的学龄前儿童38名,于疫苗加强接种前及接种后3周、3个月、6个月分别采静脉血,以固相放射免疫法(SPRLA)检测血清抗-HBs及HBsAg。结果 疫苗加强接种后97.4％(37/38)儿童产生了免疫应答,接种后3周、3个月及6个月的抗-HBs水平由接种前的33.6 IU/L,分别增至824.1、407.7及193.6 IU/L,平均增高24.5、12.1和5.8倍。加强接种后3周抗-HBs水平达到高峰,3个月及6个月时抗-HBs水平比3周时分别下降50.5％和76.5％。结论 加强免疫的应答效果主要由初免的免疫应答状态所决定。儿童用10μg CHO疫苗加强接种能获得良好的免疫应答效果。     

浙江省嘉善县儿童监护人肠道病毒71型疫苗接种意愿及影响因素的调查分析

目的 了解嘉善县5岁以下儿童监护人对肠道病毒71型(EV71)疫苗的接种意愿,分析其影响因素,为制定疫苗接种和疫情防控策略提供依据.方法 在嘉善县所有接种门诊接种现场随机选取5岁以下儿童监护人进行统一问卷调查.结果 共调查854名监护人,其中488名监护人(57.14％)愿意为孩子接种EV71疫苗,366名监护人(42.86％)不愿意为孩子接种EV71疫苗;调查儿童中有54名(6.32％)曾患过手足口病.监护人文化程度越高(x2趋势=7.59,P＜0.01)、年收入越高(x2趋势=13.31,P＜0.01)越愿意为孩子接种EV71疫苗.儿童监护人性别为男性(OR=1.38,95％CI:1.04～1.85)、听说过EV71疫苗(OR=1.51,95％CI:1.15～1.99)、孩子曾患过手足口病(OR =4.66,95％CI:2.17～9.99)是愿意为孩子接种EV71疫苗的保护因素.监护人不愿意接种的主要原因为担心疫苗安全性和不良反应(45.63％)、担心疫苗保护效果(26.78％)和疫苗价格太高(17.76％).结论 嘉善县儿童监护人对EV71疫苗的接种意愿不高,今后应加强EV71疫苗和手足口病相关知识的健康教育,提高家长对疾病的认识,消除在疫苗安全性与接种效果等方面的顾虑,提高疫苗接种率.     

宜州市5岁以下儿童乙肝疫苗免疫效果及影响因素研究

目的了解宜州市5岁以下儿童乙肝疫苗免疫效果及影响因素,为提高乙肝疫苗免疫效果提供依据。方法采用横断面调查方法,采用多阶段抽样方法选取宜州市按照乙肝疫苗免疫程序全程接种乙肝疫苗3剂次的0~4岁儿童作为研究对象,开展流行病学调查并采集静脉血3~5 ml,分离血清后采用酶联免疫吸附试验(Enzyme linked immunosorbent assay,ELISA)法检测乙肝表面抗原(hepatitis B surface antigen,HBs Ag),抗乙肝表面抗体(antibody to HBs Ag,抗-HBs),抗乙肝核心抗体(antibody to HBV core antigen,抗-HBc)。结果 862名0~4岁儿童HBs Ag检测结果均为阴性,抗-HBc阳性率为59.63%(95%CI:56.32~62.85),且随着年龄增长而增高(趋势χ2=10.88,P0.05)。抗-HBs阳性率为84.11%(95%CI:81.52~86.40),且随着年龄增长而降低(趋势χ2=38.37,P0.001)。乙肝疫苗首针及时接种组抗-HBs阳性率(85.95%)高于首针不及时接种组(65.82%),差异有统计学意义(χ2=21.75,P0.001)。非条件多因素Logisitic回归模型分析结果显示,与4岁年龄组比较,1岁组(OR=21.688,95%CI:10.382~45.306)、2岁组(OR=7.501,95%CI:4.181~13.456)、3岁组(OR=2.249,95%CI:1.319~3.835)均为抗-HBs阳性的危险因素;首针及时接种(OR=2.898,95%CI:1.540~5.454)、有加强接种史(OR=12.414,95%CI:6.606~23.330)也是抗-HBs阳性的危险因素,低出生体重(OR=0.343,95%CI:0.150~0.784)则是抗-HBs阳性的保护因素。结论宜州市5岁以下儿童乙肝疫苗免疫规划已取得良好效果,由于3岁以上儿童抗-HBs水平下降较快,而且存在影响免疫效果的因素,仍需提高乙肝疫苗首针接种率和全程接种率,开展抗-HBs水平监测,及时开展加强免疫,继续巩固和提高乙肝疫苗免疫效果。     

Th1/Th2细胞相关因子对乙型肝炎疫苗免疫效果的影响研究

目的探讨Th1、Th2相关细胞因子IFN-γ,IL-4对乙型肝炎疫苗免疫效果的影响,为提高乙型肝炎疫苗免疫的成功率提供科学理论依据。方法选择年龄21~24岁接种过乙型肝炎疫苗的广西籍汉族大学生作为研究对象,根据接种乙型肝炎疫苗后产生不同免疫效果将研究对象分为抗-HBs中或强阳性组和抗-HBs阴性或弱阳性组;两组各88名,采用ELISA法分别检测两组研究对象血清中Th1/Th2细胞相关因子IFN-γ、IL-4的OD值,计算浓度值并进行比较分析。结果抗-HBs阴性或弱阳性组IFN-γ的平均表达水平为(3.88±4.57)pg/ml,显著低于抗-HBs中或强阳性组的平均表达水平(7.49±7.05)pg/ml,差异有统计学意义(P<0.01);抗-HBs阴性或弱阳性组IL-4的平均表达水平为(2.45±1.64)pg/ml,也显著低于抗-HBs中或强阳性组的平均表达水平(5.25±3.08)pg/ml,差异有统计学意义(P<0.01)。结论接种乙型肝炎疫苗后抗-HBs阴性或弱阳性者其体内Th1/Th2细胞相关因子IFN-γ和IL-4的表达水平均较产生抗-HBs中或强阳性者显著低下;提示Th1/Th2细胞相关因子IFN-γ、IL-4的表达水平可能影响机体乙型肝炎疫苗的免疫效果,似可应用IFN-γ、IL-4作为乙型肝炎疫苗佐剂以提高乙型肝炎疫苗的免疫效果。     

中小学生大规模乙型肝炎疫苗接种效果评价

目的了解中小学生大规模乙型肝炎疫苗接种效果.方法随机选取未实行乙型肝炎疫苗计划免疫管理的6～18岁中小学生1 829名,采用血清流行病学方法观测大规模酵母重组乙型肝炎疫苗接种效果.结果对HBsAg、抗-HBs和抗-HBc全阴性者,接种疫苗一年后,抗-HBs阳性率为70.55%,HBsAg和抗-HBc阳性率分别为0.56%和1.96%;该人群接种前HBVM阳性率为63.31%,接种后为85.51%,抗-HBs阳性率显著增高,且以6～12岁低年龄组人群更明显,而HBsAg和抗-HBc阳性率在接种后一年无明显变化.结论酵母重组乙型肝炎疫苗大规模接种后,在中小学生中形成了乙型肝炎高保护性、低感染状态,未实行乙型肝炎疫苗计划免疫的低年龄组人群,是大规模接种的优选对象.酵母重组乙型肝炎疫苗大规模接种的影响因素值得进一步探讨.     

国产血源性乙肝疫苗在健康儿童中全程接种后23年的效果

目的 评价国产血源性乙型肝炎疫苗（乙肝疫苗）接种23年后的免疫原性和预防感染的保护效果。方法 1986年在西安市两所乡村小学筛检了261名5～9岁学生,按照分层随机分为疫苗组（126名）和对照组（135名）。2009年进行随访,剔除自行接种者后,疫苗组和对照组分别有81名和75名。对乙型肝炎病毒表面抗体（抗-HBs）＜10 mIU/ml及乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒核心抗体（抗-HBc）和乙肝病毒(HBV) DNA阴性者复种1针5μg国产重组疫苗,复种后1个月再次采血检测抗-HBs。结果 消除早期复种和自行接种的影响后,在第23年时,疫苗组48.1％(39/81)的研究对象抗-HBs仍保持在10 mIU/ml以上,高于对照组的阳性率[34.7％(26/75)]。疫苗组中84.0％ (21/25)的抗-HBs和抗-HBc均阴性的研究对象复种后产生了较强的回忆应答,而对照组中相似的抗-HBs阳性率为7.5％ (3/40)。本次随访未发现乙肝临床病例,但疫苗组和对照组的抗-HBc阳性率分别为16.0％( 13/81)和30.7％ (23/75)(x2=4.687,P＜0.05)。结论 国产血源性乙肝疫苗在健康儿童中全程接种后23年,免疫效果仍维持良好或有免疫记忆;疫苗仍有较好的保护效果。     

儿童对乙型肝炎疫苗加强接种的免疫应答

观察了经乙型肝炎疫苗初免的38名儿童对乙型肝炎疫苗加强接种的免疫效果。疫苗加强接种后97.4%(37/38)儿童产生了免疫应答,接种后3周、3月及6月的抗-HBs水平由接种前的33.6IU/L,分别增至824.1、407.7及193.6IU/L,平均增高24.5、12.1和5.8倍,加强接种后3周抗-HBs水平达到高峰,3月及6月时抗-HBs水平比3周时分别下降50.5%和76.5%。加强免疫的应答效果主要由初免的免疫应答状态所决定。本文显示,儿童用10μg乙型肝炎疫苗加强接种能获得良好的免疫应答效果。     

成年人接种乙肝疫苗后无(弱)应答状况及其影响因素分析

目的 探讨成年人接种乙型肝炎疫苗后无(弱)应答的发生率及其影响因素.方法 采用整群随机抽样法调查1 256名接种过乙肝疫苗的工人,采用统一的方法进行问卷调查和免疫学检测.应用非条件Logistic回归对无(弱)应答的影响因素进行分析.结果 乙型肝炎疫苗无(弱)应答率为12.98%.无(弱)应答率随年龄增高逐渐上升.单因素Logistic回归分析结果表明,接种者的年龄、接种部位、吸烟、饮酒、喜欢吃鱼、输过血制品、餐具不消毒、母亲接种过疫苗、父母亲接种乙肝疫苗后有无抗体产生等因素与接种乙肝疫苗后无(弱)应答的发生有关.多因素Logistic回归分析发现,接种时年龄大(OR=1.493 6,95% CI:1.278 6～1.744 8)、接种部位(OR=1.265 5,95% CI:1.107 2～1.446 5)、吸烟(OR=1.307 6,95% CI:1.073 1～1.593 5)、餐具不消毒(OR=1.471 5,95% CI:1.010 6～2.142 6)、父亲接种后无抗体产生(OR=1.338 5,95% CI:1.113 5～1.609 1)、母亲接种后无抗体产生(OR=1.307 9,95% CI:1.125 1～1.520 3)为无(弱)应答的危险因素,喜欢吃鱼(OR=0.628 1,95% CI:0.425 6～0.926 8)为保护因素.结论 接种乙肝疫苗后无(弱)应答状况与接种因素、饮食因素、机体发育因素、遗传因素和卫生行为习惯有关.     

60 μg重组乙型肝炎疫苗(酿酒酵母)对无应答人群免疫效果观察

目的 探讨无应答人群接种60 ug重组乙型肝炎疫苗(酿酒酵母)免疫成功率和效果. 方法 选择桃江县40名17岁以上接种常规乙肝疫苗后抗体(抗-HBs)没有阳转的人群,应用深圳康泰生物制品股份有限公司生产的60 μg重组乙型肝炎疫苗(酿酒酵母),采用一针接种后1月采血,进行血清免疫学观察. 结果 接种人群均未出现局部反应和全身反应.接种一针后1个月,阳转率达97.5％,抗-HBs几何平均滴度(GMT)为50.657 mIU/ml.结论 60μg重组乙型肝炎疫苗(酿酒酵母)安全性良好,免疫成功率高,不受地域、年龄组等影响,可以在全国范围内广泛使用,对于常规免疫无应答人群使用60 μg/ml乙肝疫苗,免疫效果可能更好.     

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.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

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.