Efficacy,immunogenicity, and safety of available vaccines in children on biologics: A systematic review and meta-analysis

Vaccinations are essential for preventing infectious diseases in children with chronic diseases as they have increased risk of infection from frequent use of biologics. Response to immunizations in this group is not well known.ObjectiveA systematic review was performed to evaluate three primary outcomes: efficacy; immunogenicity; and safety of vaccines in children with chronic conditions treated with biologics.MethodsThe protocol for our systematic review and meta-analysis was registered and published with PROSPERO. We searched electronic bibliographic databases for studies published from 2009 to 2019, focusing on vaccinations in children with chronic conditions treated with biologics.ResultsWe retrieved 532 records. Thirty-one full-text articles were selected, and 14 were included in the meta-analysis. No significant publication bias was found. Efficacy: limited data are available regarding the efficacy of vaccination, as most studies have focused on immunogenicity as surrogate outcome for efficacy. Immunogenicity: patients receiving anti-TNF-alpha therapy had a statistically significant risk of poor seroconversion (p = 0.028) and seroprotection by the serotype B influenza vaccine [inflammatory bowel disease (IBD) p = 0.013; juvenile idiopathic arthritis (JIA) p = 0.004]. We found adequate responses with H1N1 and H3N2 serotypes. Few studies existed for pneumococcal, hepatitis A virus, hepatitis B virus, varicella-zoster virus, Measles Mumps Rubella virus, and multiple vaccine administration. Safety: vaccine administration was not associated with serious side effects, but JIA patients on anti-TNF alpha therapy had a statistically significant risk of presenting with myalgia or arthralgia postinfluenza vaccine (p = 0.014).ConclusionsMore evidence concerning efficacy, immunogenicity, and safety of vaccinations is needed to guide physicians in the vaccine decision process for this pediatric population.     

Cross-neutralization between vaccine and circulating wild-type mumps viruses in Korea

Mumps is a contagious disease caused by the mumps virus. It can be prevented using mumps vaccines, administered as a measles-mumps-rubella (MMR) vaccine. For first and second dose immunization, children aged 12–15 months and 4–6 years have been administered this vaccine since 1997 in Korea. Nevertheless, mumps outbreaks still occur in vaccinated populations worldwide. Hence, immunity against these diseases may be attenuated, or there are antigenic differences between currently available vaccine strains and circulating wild-type viruses. After the introduction of national immunization programs in Korea, mumps cases became sporadic. Viral genotypes F, H, and I have emerged since 1998 whereas the vaccine strains belong to genotype A. Here, we compared the amino acid sequences of the haemagglutinin-neuraminidase (HN) gene from wild-type viruses and the mumps vaccine and measured the cross-neutralization titers between them. We selected the F, H, and I wild-type mumps strains circulating in Korea from 1998 to 2016 and analyzed changes in the amino acid sequence of the protein encoded by the HN gene. We measured mumps virus-specific IgG and rapid focus reduction neutralization test (FRNT) titers in Korean isolates and sera obtained from 50 children aged 1–2 years who had been administered a single dose of MMR vaccine. Analysis of the HN protein sequences disclosed no changes in the glycosylation sites but did reveal 4–5 differences between the Korean isolates and the genotype A vaccine strain in terms of the neutralizing epitope sites on their HN proteins. Post-vaccination FRNT titers were significantly lower against genotypes F, H, and I than they were against genotype A. This finding highlights the possibility of a recurrence of mumps outbreaks in vaccinated populations depending on the degree of genetic conservation of the HN gene. Further research into this issue is needed to prevent the resurgence of mumps.     

Humoral immunity to mumps in a highly vaccinated population in Taiwan

BackgroundA resurgence of mumps was noted recently and outbreaks were increasingly reported in populations with high vaccine coverage. We aimed to evaluate the seroprevalence to mumps in Taiwan, where a two-dose childhood mumps-containing vaccine program, with a high coverage rate, had been implemented for >20 years.MethodsThe anti-mumps IgG was determined in 3552 participants of all ages in Taiwan. The age-specific seropositivity rates were calculated and the sociodemographic variables associated with the seronegative sera were analyzed with a logistic regression method.ResultsThe overall seroprevalence to mumps was 71%, with a higher rate in adults ≥19 years old than in the pediatric population <19 years old (80.4% versus 62.0%, P < 0.0001). In participants aged 2–20 years, who had been given at least one mumps-containing vaccine, the seropositivity fluctuated across different age subgroups and the lowest rate (36.8%) occurred in the 17–18 years age group. The multivariate analysis identified age within 17–18 years (adjusted odds ratio [aOR] 8.598, 95% confidence interval [CI] 2.990–24.722, P < 0.0001), within 19–20 years (aOR 5.076, 95% CI 1.702–15.133, P = 0.0080), and being a resident of the suburban area of northern Taiwan (aOR 1.089, 95% CI 0.823–1.414, P = 0.0008) as independent factors associated with an increased risk of seronegative sera.ConclusionThe seropositivity to mumps was unexpectedly low in highly vaccinated generations, and with a significant geographical discrepancy in Taiwan, which may have been responsible for the sustained reports of mumps cases in Taiwan.     

Sera from different age cohorts in Belgium show limited cross-neutralization between the mumps vaccine and outbreak strains

ObjectivesMumps used to affect children between 2 and 15 years old. The mumps–measles–rubella (MMR) vaccine is available, with vaccine coverage rate of about 85% after two vaccine doses. Recently new mumps outbreaks have emerged in highly vaccinated populations; the causes for these new outbreaks are yet unknown. We tested if a difference in seroneutralizing capacity against the vaccine and wild-type viruses existed and if waning immunity could be detected.MethodsIn this study, 570 serum samples (age group 2–3 years (n = 96), 8–9 years (n = 95), 13–14 years (n = 94), 18–20 years (n = 96), 24–26 years (n = 92) and 50 + years (n = 97)) in Belgium were tested in the rapid fluorescent foci inhibition test for their neutralizing capacity against the vaccine and wild-type viruses.ResultsNeutralizing antibodies against the vaccine strain were present in 84% (81/97) of the 2–3-year, 74% (70/95) of the 8–9-year, 81% (76/94) of the 13–14-year, 76% (73/96) of the 18–20-year, 67% (62/92) of the 24–26-year and 77% (75/97) of the 50+-year age group serum samples. For all age groups, only about half of these serum samples were also positive for the wild-type virus. The geometric mean titres for the vaccine and wild-type virus for all younger age groups, except for 24–26 years, were significantly different, demonstrating poor in vitro cross-neutralization.ConclusionsA possible contribution of antigenic differences between the genotype A and G mumps virus as well as other immune factors, in addition to lower-than-optimal vaccination coverage and waning immunity, could explain the poor in vitro cross-neutralization and should be further studied.     

深圳市某两所小学流行性腮腺炎突发疫情的流行病学分析

目的：通过对深圳市某两所小学发生的流行性腮腺炎突发疫情的流行病学特点及差异性进行分析,为制定科学、高效的防控策略提供科学依据。方法2013年5～7月深圳市大鹏新区某两所小学爆发流行性腮腺炎,以学校为整体研究对象,分别标记为学校A（24个班,学生1210例）和学校B（27个班,学生1274例）,对比两所小学的疫情流行病学差异性。结果分析发现,学校A流行性腮腺炎发病率为4.30%,发病班级所占比54.17%,均较学校B1.73%和29.63%高,对比差异有统计学意义（P＜0.05）;分析显示学校A学生出现疫病平均年龄为（11.2±1.1）岁,较学校B（9.34±1.0）岁,对比差异明显（P＜0.05）;且两组疫病患儿在接种疫苗率对比上差异无统计学意义（P＞0.05）;但疫情发生时,学校B疫苗紧急接种率明显高于学校A,对比差异有统计学意义（P＜0.05）。结论小学作为流行性腮腺炎爆发的主要场所之一,疫病爆发高峰季节前,针对易感染人群给予相应的疫苗接种等预防控制措施,同时加强流行性腮腺炎的监测,对于降低感染人群数量,减轻、遏制疫情有着积极的意义,值得相关防控部门重视。     

头孢克肟引起的过敏性腮腺炎误诊为流行性腮腺炎一例并文献复习

过敏性腮腺炎是一种少见的过敏性疾病,在国内外鲜见报道,其疾病特征和临床表现主要为患者在接触过敏源后有类似上呼吸道感染的过敏性鼻炎症状,继而出现耳垂下肿胀疼痛,部分为单侧肿胀,发生肿胀时间普遍较短,几小时内迅速肿大,部分可在24h以后缓慢肿大[1]。     

Mumps Hoshino and Torii vaccine strains were distinguished from circulating wild strains

Aseptic meningitis and acute parotitis have been observed after mumps vaccination. Mumps outbreaks have been reported in Japan because of low vaccine coverage, and molecular differentiation is required to determine whether these cases are vaccine associated. RT-nested PCR was performed in the small hydrophobic gene region, and viruses were differentiated by restriction fragment length polymorphism assay. A total of 584 nucleotides were amplified. The PCR product of the Hoshino strain was cut into two fragments (313 and 271 nucleotides) by MfeI; that of the Torii strain was digested with EcoT22I, resulting in 332- and 252-nucleotide fragments. Both strains were genotype B and had an XbaI site, resulting in two fragments: 299 and 285 nucleotides. Current circulating wild types were cut only by XbaI or MfeI. However, the MfeI site of the wild types was different from that of the Hoshino strain, resulting in 451- and 133-nucleotide fragments. Using three restriction enzymes, two mumps vaccine strains were distinguished from wild types, and this separation was applied to the identification of vaccine-related adverse events.     

优质护理对小儿流行性腮腺炎治疗的作用

目的探究优质护理对小儿流行性腮腺炎治疗的作用。方法在2010年6月~2013年6月我院收治了100例流行性腮腺炎患儿,并通过抽签法将100例患儿分为研究组和参照组,每组各50例患儿,其中对研究组患儿在进行常规护理的同时进行优质护理,对参照组患儿进行常规护理,对两组患儿的恢复情况进行分析。结果对研究组和参照组的患儿进行不同的护理,可以看出研究组的患儿病情的恢复情况比参照组患儿的情况要明显,因此(P0.05)具有统计学意义。结论优质的护理对于小儿流行性腮腺炎治疗起到了积极的作用,不仅有效的治愈了患儿的疾病,也使得家长更加安心,值得临床推广。     

2010年河南省麻疹减毒活疫苗强化免疫疑似预防接种异常反应监测分析

目的分析2010年河南省开展麻疹减毒活疫苗(Measles Attenuated Live Vaccine,MV)强化免疫活动(SupplementaryImmunization Activity,SIA)后,疑似预防接种异常反应(Adverse Events Following Immunization,AEFI)的发生特征,探讨MV SIA的安全性。方法采用描述性方法对相关指标进行流行病学分析。结果 2010年河南省MV SIA活动共报告AEFI 872例,发生率4.31/10万剂;男性多于女性。>80%的AEFI出现在接种后<2 d;临床损害以红肿、发热和过敏性皮疹等为主;绝大多数病例预后良好。结论 MV SIA的AEFI监测敏感性高,疫苗安全性良好,接种对象在接种MV后<2 d是监测的重点。