甲型肝炎减毒活疫苗与麻疹减毒活疫苗联合免疫的实验研究

甲型肝炎减毒活疫苗 (甲肝疫苗 )与死疫苗如乙型肝炎(乙肝 )疫苗、免疫球蛋白联合免疫的研究已有报道[1] ,但与麻疹减毒活疫苗 (麻疹疫苗 )的联合免疫尚未见报道 ,为此 ,对甲肝疫苗与麻疹疫苗联合免疫的血清学效果进行了观察 ,报告如下。1.材料与方法 :(1)接种对象及分组 :从石家庄市郊区筛选ＨＡＶ抗体 (抗 ＨＡＶ)阴性的 5～ 10岁健康儿童 16 0人 ,分别接种杭州及昆明产甲肝疫苗 ,接种杭州苗 80人 ,其中 2 0人同时接种麻疹疫苗 ;接种昆明苗 80人 ,其中 30人同时接种麻疹疫苗。接种后 1年对所有接种者又加强了 1针甲肝疫苗 ,初免后 1年半…     

甲肝减毒活疫苗与麻疹减毒活疫苗联合免疫的实验研究

目的观察甲肝减毒活疫苗与麻疹减毒活疫苗联合免疫对甲肝疫苗免疫学效果的影响。方法对筛选出的甲肝易感者分两组,分别接种国内A、B两厂家甲肝疫苗,一部分接种者同时在对侧上臂接种了麻疹疫苗,一年时所有观察对象均又加强了一剂甲肝疫苗,于每次疫苗接种后24、48、72h观察局部及全身反应。一年半时检测接种对象血清标本中的抗-HAV。结果甲肝及麻疹疫苗接种后未见明显副反应。B厂家苗联合免疫组抗-HAV几何平均滴度(GMT)高于单纯甲肝疫苗接种组,A厂家苗组未见显著差异。结论甲肝疫苗与麻疹疫苗联合免疫安全性好,接种后不会降低甲肝疫苗免疫学效果。     

BRDⅡ株风疹疫苗免疫应答研究

本文对安徽省４２６名健康人群血清检测结果分析表明：风疹ＨＩ抗体平均阳性率为５９．１５％；育龄期妇女易感率为１０．７７％。对３６１名健康人群ＢＲＤⅡ株风疹减毒活疫苗免疫应答研究结果分析表明：各年龄组对风疹疫苗均有较好的免疫应答反应；免前阳性人群接种风疹疫苗仍可获得良好的免疫应答反应。显示我国选育的ＢＲＤⅡ株风疹减毒活疫苗具有良好的免疫原性。推荐我省风疹免疫策略：１）在全省建立风疹的监测；将风疹疫苗的接种纳入ＥＰＩ管理规程。２）实行１岁儿童完成初种及对婚前育龄期妇女给予一针风疹疫苗的接种的方案。３）在条件许可的情况下，对全省农村地区１４岁以下的儿童进行一针普种。     

国产冻干水痘减毒活疫苗的接种反应及免疫效果观察

目的分析国产冻干水痘减毒活疫苗的接种反应,探讨其免疫效果。方法将2008-2010年间来我院接种水痘疫苗的728例儿童随机分为观察组和对照组,每组各364例,观察组儿童接种国产冻干水痘减毒活疫苗,对照组儿童接种麻疹腮腺炎减毒活疫苗,比较两组研究对象的接种反应及免疫效果。结果观察组儿童接种前后抗体阳转率为97.8%(356/364),对照组儿童接种前后抗体阳转率为95.3%(347/364),抗体阳转率组间差异无统计学意义(P>0.05)。两组儿童接免疫种后的GMT水平较接种前有显著改善,差异有统计学意义(P<0.05),观察组儿童接种后的GMT水平优于对照组,差异有统计学意义(P<0.05)。观察组儿童接种应发生率为0.330%,对照组儿童为0.302%,接种反应发生率组间差异无统计学意义(P>0.05)。结论接种国产冻干水痘减毒活疫苗免疫效果确切,且接种不良反应发生率低,是一种安全有效的接种方法,值得临床进一步推广使用。     

腮腺炎疫苗分别与甲肝、白破、风疹疫苗联合免疫的效果观察

目的;观察腮腺炎疫苗分别与甲肝、白破、风疹疫苗同时接种的临床反应和免疫效果。方法：设两种疫苗同时接种组和单苗接种组,比较其副反应和血清抗体水平。结果：各接种组临床反应都轻微,两苗同时接种组与相应的单苗接种组免前免后同种抗体阳性率或保护率和GMT,以及免后抗体阳转率,其差异均无显著意义（均P＞0．05）。结论：腮腺炎疫苗与甲肝、白破、风疹减毒活疫苗之一同时接种未发现加重反应和相互干扰免疫应答,可以同时接种。     

应用循证医学的方法和理念系统评价甲型肝炎疫苗免疫程序相关因素

目的 评价甲型肝炎(甲肝)疫苗(Hepatitis A Vaccine,HepA)免疫程序相关影响因素,为HepA免疫程序的制定提供依据.方法 用循证医学系统评价的方法,对中国甲肝的主要流行病学特征和目前应用的HepA的安全性、免疫原性、保护效果、免疫持久性等进行评价.结果 ①≥2岁病例占中国甲肝病例的98%以上,中国甲肝发病的高发人群分别为5～9岁、20～34岁.②目前中国应用的HepA分别为减毒活疫苗(HepA,Live)和灭活疫苗(HepA,Inactivated),减毒活疫苗接种1剂次抗体阳转率为79.8%～100.O%,保护率为93%～98%,免疫持久性>10年;灭活疫苗接种2剂次抗体阳转率为100%,保护率为79%～99%,免疫持久性>9年.③灭活疫苗免疫应答受胎传抗体影响较小;减毒活疫苗免疫应答受胎传抗体影响较大,但出生16个月后影响已降到很低的程度.④免疫4年后,用酶联免疫吸附试验检测甲肝抗体阴性的标本,用中和试验测定,>60%有中和作用,即有预防感染的能力.⑤减毒活疫苗和灭活疫苗的临床试验观察,有发热、皮疹等一般反应发生,大规模接种后极个别受种者有异常反应发生.结论 甲肝减毒活疫苗常规免疫的起始月龄为16～24月龄;灭活疫苗为12～24月龄.减毒活疫苗采用1剂次免疫程序,灭活疫苗采用2剂次免疫程序,均有较好的安全性、免疫原性、保护效果、免疫持久性.     

流行性乙型脑炎灭活疫苗与减毒活疫苗不同免疫策略效果研究

目的:为合理利用流行性乙型脑炎灭活疫苗和减毒活疫苗各自的优点,降低预防接种副反应的发生率,提高免疫效果。方法:初免疫2针均接种乙脑灭活疫苗,初免1年后实验组使用乙脑减毒活疫苗,对照组使用乙脑灭活疫苗。观察比较两种疫苗单一使用与联合使用的免疫效果和安全性。结果:接种乙脑减毒活疫苗24 h内副反应发生率为6.06%,未发生中重度反应;接种灭活疫苗副反应发生率为25.53%,中反应以上发生率为4.12%。加强免疫后1年中和抗体的GMT从1∶20.42降至1∶7.37。第3针免疫后,联合免疫组中和抗体阳性率为99.24%,单纯使用灭活疫苗组阳性率为95.86%,差异无显著性。结论:对儿童使用乙脑灭活疫苗进行基础免疫,用减毒活疫苗进行加强免疫有很好的免疫效果和安全性,是理想的免疫策略。     

不同剂量冻干流行性腮腺炎疫苗免疫效果观察

本文对不同剂量冻干流行性腮腺炎(简称流腮)疫苗免疫效果进行了研究,结果表明两种剂量流腮疫苗接种反应发生率均低、血清学免疫效果良好,二者无差异(P>0.05)。同时显示,流腮疫苗与流行性乙型脑炎疫苗联合免疫,流腮抗体阳性率和抗体GMT明显高于单独接种流腮疫苗组,证明流腮疫苗与流行性乙型脑炎疫苗联合免疫具有增强机体免疫应答反应的作用。     

肾综合征出血热疫苗、甲肝疫苗联合接种的免疫效果

1998年吉林白城地区发生特大洪灾,历年来该地区有甲肝及肾综合征出血热散在流行,武警吉林某部官兵长年驻守此地,其中新兵有1380人。为确保大灾之后无疫情发生,我们对灾区部队新兵进行了肾综合征出血热(HFRS)灭活疫苗联合甲肝病毒(HAV)减毒活疫苗普种。既往有关HFRS灭活疫苗及HAV减毒活疫苗单独接种的安全性及免疫效果已有报道,而对HFRS灭活疫苗及HAV减毒活疫苗,同时接种的安全性及免疫效果研究未见报道,现将我们观察两种疫苗同时接种后的反应性和HFRS灭活疫苗及HAV减毒活疫苗的免疫效果报告如下。     

乙肝疫苗与计划免疫“四苗”联合免疫的研究

为了解乙肝疫苗与计划免疫“四苗”联合免疫的免疫应答情况,我们对254各新生儿和婴儿进行了乙肝疫苗与计划免疫“四苗”联合免疫研究。结果表明,乙肝疫苗与长介苗(BCG)、脊髓灰质炎疫苗(TOPV)、百白破疫苗(DPT)、麻疹疫苗(MV)联合免疫后,结核菌素试验阳转率为78.69%;TOPVⅠ、Ⅱ、Ⅲ类抗体阳转率均在97.05～100%范围内;白喉、破伤风和百日咳抗体阳转率分别为100%、100%和77.27%;麻疹抗体阳转率为100%;抗-HBs阳转率为100%。实验组各抗体阳转率和抗体几何平均滴度亦达到满意的效果。     

两种百白破联合疫苗接种后安全性比较

为了比较全细胞百白破联合疫苗 (DTwP)与无细胞百白破联合疫苗 (DTaP)在婴幼儿群体中接种后的安全性 ,对 3～ 6个月的婴儿及 18～ 2 4个月的幼儿进行了两种疫苗接种后安全性的临床观察。结果显示 :基础免疫接种DTwP后全身反应发生率为 18 0 9% ,局部反应发生率为 18 4 8% ;接种DTaP后全身、局部反应发生率均为1 97%。加强免疫接种DTwP后全身反应发生率为 34 87% ,局部反应发生率为 2 9 89% ;接种DPaT后全身反应发生率为 4 93% ,局部反应发生率为 5 80 %。表明DTaP有更好的安全性     

Mixed allele malaria vaccines: host protection and within-host selection

Malaria parasites are frequently polymorphic at the antigenic targets of many candidate vaccines, presumably as a consequence of selection pressure from protective immune responses. Conventional wisdom is therefore that vaccines directed against a single variant could select for non-target variants, rendering the vaccine useless. Many people have argued that a solution is to develop vaccines containing the products of more than one variant of the target. However, we are unaware of any evidence that multi-allele vaccines better protect hosts against parasites or morbidity. Moreover, selection of antigen-variants is not the only evolution that could occur in response to vaccination. Increased virulence could also be favored if more aggressive strains are less well controlled by vaccine-induced immunity. Virulence and antigenic identity have been confounded in all studies so far, and so we do not know formally from any animal or human studies whether vaccine failure has been due to evasion of protective responses by variants at target epitopes, or whether vaccines are just less good at protecting against more aggressive strains. Using the rodent malaria model Plasmodium chabaudi and recombinant apical membrane antigen-1 (AMA-1), we tested whether a bi-allelic vaccine afforded greater protection from parasite infection and morbidity than did vaccination with the component alleles alone. We also tested the effect of mono- and bi-allelic vaccination on within-host selection of mixed P. chabaudi infections, and whether parasite virulence mediates pathogen titres in immunized hosts. We found that vaccination with the bi-allelic AMA-1 formulation did not afford the host greater protection from parasite infection or morbidity than did mono-allelic AMA-1 immunization. Mono-allelic immunization increased the frequency of heterologous clones in mixed clone infections. There was no evidence that any type of immunization regime favored virulence. A single AMA-1 variant is a component of candidate malaria vaccines current in human trials; our results suggest that adding extra AMA-1 alleles to these vaccines would not confer clinical benefits, but that that mono-allelic vaccines could alter AMA-1 allele frequencies in natural populations.     

The safety of post-exposure vaccination of mice infected with Mycobacterium tuberculosis

New post-exposure tuberculosis vaccination strategies are being developed to prevent disease in individuals latently infected with Mycobacterium tuberculosis. However, concerns about the potential induction of deleterious Koch-like reactions after immunization of persons with latent tuberculosis has limited progress in assessing the effectiveness of post-exposure vaccination. To evaluate the safety of immunization after M. tuberculosis infection, two mouse models were established, a drug treatment low bacterial burden model and an active disease model. Twelve different M. tuberculosis antigen preparations and vaccines (including DNA, subunit, viral vectored, and live, attenuated vaccines) were evaluated using these mouse models. In the low bacterial burden model, post-exposure vaccination did not induce significant reactivational disease and only injection of BCG evoked increases in lung inflammatory responses at 1 month after the immunizations. Additionally, although significant increases in lung inflammation were seen for animals injected with the hps65 DNA vaccine or a M. tuberculosis culture supernatant preparation, no differences in the survival periods were detected between vaccinated and non-vaccinated mice at 10 months post-immunization using the low bacterial burden model. For the active disease model, significantly more lung inflammation was observed at 1 month after administration of the hsp65 DNA vaccine but none of the antigen preparations tested increased the lung bacterial burdens at this early time point. Furthermore, vaccination of diseased mice with BCG or TB DNA vaccines did not significantly affect mortality rates compared to non-vaccinated controls at 10 months post-immunization. Overall, these data suggest that while the potential risk of inducing Koch-like reactions is low after immunization of persons with latent tuberculosis, extreme caution is still needed as post-exposure vaccines progress from pre-clinical experiments into the initial phases of clinical testing.     

Comparative analysis of the immunogenicity of SARS-CoV nucleocapsid DNA vaccine administrated with different routes in mouse model

The development of strategies to augment the immunogenicity of DNA vaccines is critical for improving their clinical utility. One such strategy involves using the different immune routes with DNA vaccines. In the present study, the immunogenicity of SARS-CoV nucleocapsid DNA vaccine, induced by using the current routine vaccination routes (intramuscularly, by electroporation, or orally using live-attenuated Salmonella typhimurium), was compared in mouse model. The comparison between the three vaccination routes indicated that immunization intramuscularly induced a moderate T cell response and antibody response. Mice administrated by electroporation induced the highest antibody response among the three immunization groups and a mid-level of cellular response. In contrast, the orally DNA vaccine evoked vigorous T cell response and a weak antibody production. These results indicated that the distinct types of immune responses were generated by the different routes of DNA immunization. In addition, our results also show that the delivery of DNA vaccines by electroporation and orally using live-attenuated Salmonella in vivo is an effective method to increase the immune responses. Further studies could be carried out using a combination strategy of both oral and electroporation immunizations to stimulate higher cellular and humoral immune responses.     

Recurrent injection site reactions to vaccines: Two clinical patterns of presentation

After administration of injectable vaccines, skin manifestations are common and they usually disappear in a few hours or days. We describe a case series of recurrent injection site reactions in 8 children undergoing vaccines of the regional immunization schedule, which required specialized evaluation and advice for subsequent vaccinations. Two clinical patterns of reactions were observed. Four children manifested recurrent wheal and erythema with pruritus at vaccine injection site for up to 7 months; the remaining children showed an itching plaque or nodule at injection site, that lasted several months after vaccination with exacerbations of pruritus and erythema. Hypersensitivity to aluminium salts was demonstrated in the second group. The flare-up manifestations, related to Meningococcal B vaccine in 5 reactions, were triggered by concurrent viral infections in two patients. Communication of risks and diagnostic testing, when appropriate, resulted important to reassure parents of children and favour adequate completion of vaccination.     

佛山市流动人口聚集地区流动儿童免疫规划疫苗接种率及影响因素调查

目的了解佛山市外来流动儿童免疫规划疫苗接种率水平及影响因素,探讨加强外来流动儿童预防接种管理办法。方法在佛山市流动人口较多的17个镇/街道中选择51个村/居委会为调查点,每个调查点选择1~7岁外来流动儿童10名,于2010年3月使用自行设计的调查问卷对外来流动儿童家长/监护人进行调查。调查内容包括外来流动儿童的基本情况和预防接种状况,家长/监护人的基本情况及其对免疫规划知识掌握情况等。全程接种率的影响因素分析采用单因素和多因素非条件logistic回归模型分析。结果共调查510名外来流动儿童,回收有效问卷503份,建卡率94.0%,持证率97.8%;外来流动儿童卡介苗、脊髓灰质炎疫苗、百白破疫苗、麻疹疫苗、乙肝疫苗和乙脑疫苗的单苗接种率分别为95.0%、88.4%、87.5%、88.2%、92.2%、85.8%,上述6种疫苗全程接种率为68.4%。多因素logistic回归分析显示,儿童年龄增大、非汉族、近2年内在佛山累计居住时间1年以内、预防接种证来源于原户籍地或佛山市外的其他地区、家长对当地接种点服务不满意是外来流动儿童六苗全程接种率低的影响因素（OR=0.79、0.37、0.41、0.60、0.37）。结论流动人口聚集地区流动儿童免疫规划疫苗接种率低于本地常住儿童,需加强综合管理措施。     

2011 - 2016年松江区预防接种不良事件监测分析

目的 分析2011 - 2016年松江区预防接种不良事件（AEFI）报告情况,为提高预防接种的安全性和做好AEFI调查处置工作提供依据。方法 通过“中国免疫规划信息管理系统”收集2011 - 2016年松江区AEFI报告数据,并进行描述性分析。结果 2011 - 2016年松江区共报告预防接种4 454 897剂次,报告AEFI涉及7 300人,其中不良反应7 284人（一般反应6 866人,异常反应418人）,偶合症16人,AEFI平均报告发生率为163.86人/10万剂次。报告的AEFI中男女性别比为1.34∶1,且多发生于0岁和1岁婴幼儿中。夏季是AEFI发生的高峰期,且67.32%的AEFI发生于接种后24 h之内。AEFI临床诊断以发热、红肿、硬结反应为主,占总报告AEFI的90.01%,过敏性皮疹排第二位且在异常反应中发生率最高。报告的AEFI中狂犬病免疫血清的AEFI报告发生率和异常反应报告发生率均为最高。经比较,3种不同脊灰疫苗、减活乙脑和灭活乙脑疫苗、3种含百白破成分的疫苗AEFI发生率均有统计学差异（χ2 = 2.456,P＜0.01;χ2 = 41.872,P＜0.01;χ2 = 9.794,P＜0.01）。结论 松江区AEFI的监测敏感有效。现行的预防接种疫苗安全可靠,预防接种服务规范。一个品质安全的预防性生物制品加之专业技术人员专业素养和工作规范的落实执行,将可以持续保持预防接种的安全和有效。     

两种流行性乙型脑炎疫苗基础免疫的血清抗体观察

为考察流行性乙型脑炎 (乙脑 )减毒活疫苗和灭活疫苗的免疫效果和安全性 ,在新沂市和邳州市分别对 14 1名和 99名无乙脑疫苗接种史的 12～ 2 4月龄儿童 ,分别用乙脑减毒活疫苗和灭活疫苗进行基础免疫 ,在免疫前和免疫后 1个月采血用反向被动凝集抑制试验检测血清抗体。结果 :14 1名经减毒活疫苗免疫的儿童 ,抗体阳性率由免疫前的 2 2 70 %上升至免疫后的 87 2 3 % ,GMT由 1∶12 60上升为 1∶46 13 ;99名用灭活疫苗初免 2针的儿童 ,抗体阳性率由 13 13 %上升至 67 68% ,GMT由 1∶11 83上升至 1∶2 2 5 3。对免疫前抗体阴性的儿童 ,分别注射乙脑减毒活疫苗和灭活疫苗后 ,抗体阳转率分别为 83 49%和 62 79%。两种疫苗的安全性均好 ,接种后仅 17人 ( 0 0 7% )有轻度发热 ,11人 ( 0 0 4% )出现局部红肿。而减毒活疫苗出现反应的人数又少于灭活疫苗。本次观察表明 ,乙脑减毒活疫苗的免疫效果明显高于灭活疫苗 ,安全性好 ,接种次数少 ,适宜于推广使用。     

常州市2005-2010年疑似预防接种异常反应监测分析

目的分析2005-2010年常州市疑似预防接种异常反应（AEFI）的发生特征,评价AEFI监测系统运转情况和疫苗的安全性。方法通过中国免疫规划监测信息管理系统收集AEFl个案数据,采用描述性方法对相关指标进行流行病学分析。结果全市累计报告AEFl个案1997例,涉及疫苗32种,其中报告最多的是无细胞百白破（DPT）疫苗（24．79％）。各年报告发生率在预期发生率范围之内。接种第一剂疫苗后发生的AEFI占57．84％。反应发生在接种后0-1d的占89．23％。一般反应最多占81．62％;其次为异常反应占15．77％。临床诊断发热／红肿／硬结最多,占74．06％;其次为过敏性皮疹占13．52％。结论常州市AEFI监测敏感性虽逐年提高但仍然较低,全市监测系统运转正常,社会上所使用的疫苗安全性和预防接种服务质量良好。要加强对临床医生的相关知识培训,政府应进一步完善AEFI补偿机制。     

佛山市罗村街道0～6岁儿童预防接种需求与行为调查及相关因素分析

目的了解儿童预防接种需求与行为现状并分析其影响因素,为科学制定卫生政策,调整儿童计划免疫内容及优化服务流程提供依据。方法采用分层随机抽样的方式对佛山市罗村街道0～6岁儿童预防接种需求与行为进行调查,调查内容包括个人基本情况、预防接种情况、儿童家长对二类疫苗的需求状况、儿童家长预防接种相关知识知晓情况等。结果儿童单苗接种率为92．7％～99．7％,“六苗”全程接种率为90．1％;34．5％的家长表示能接受二类疫苗（计划外收费疫苗）,有200名儿童家长（27．9％）会选择价格较贵的进口疫苗;716名家长中对预防接种知识6个条目均回答正确的人数为0,答对〉4个条目的家长有431人（60．2％）;多因素logistic回归分析显示,影响儿童家长预防接种知识知晓率的主要因素有年龄、在该地居住时间、家庭收支情况。结论儿童基础免疫接种率较高,均保持在90％以上,二类疫苗“接种贵”现象逐渐成为亟待解决问题,应加大预防免疫知识的宣传力度,提高儿童家长预防接种相关知识知晓率。