中学生接种甲型H1N1流感疫苗保护效果的评价

目的 了解中学生接种甲型H1NI流感疫苗的保护效果.方法 采用非随机对照临床试验方法,选择8所中学14 883名学生,分甲型H1N1流感疫苗接种组6334人,对照组(未接种)8549人,随访观察一个流行周期(6个月),比较两组流感样病例、甲型H1N1流感病例、季节性流感病例的发生率.结果 所有研究对象累计观察7441.75人年.接种组流感样病例发病密度为21.47/1000人年,低于对照组(22.69/1000人年),差异无统计学意义(P>0.05);接种组甲型H1N1流感发病密度为0,低于对照组1.64/1000人年,两者率差为-1.64/1000人年(95%CI:-3.04～-0.23),差异有统计学意义(P=0.010);接种组流感病毒核酸阳性病例发病密度为6.63/1000人年,低于对照组(7.02/1000人年),差异无统计学意义(P>0.05);接种组乙型流感发病密度为6.63/1000人年,高于对照组(5.38/1000人年),差异无统计学意义(P>0.05).结论 学生大规模接种甲型H1N1流感疫苗能有效预防甲型H1N1流感,其保护效果良好,但对于其他季节性流感可能无交叉保护作用.

Abstract：

Objective To evaluate the epidemiological effects of vaccine immunization program related to A(H1N1)influenza in the middle school students.Methods Non-randomized clinical trial was designed to assess the A(H1N1)influenza vaccine on its efficacy.14883 students from 8 middle schools in Zhejiang province were recruited and classified into vaccinated or control groups,based on the status of immunization with A(H1N1)influenza vaccine.All subjects were followed up through one epidemic period(6 months)and the incidence rates of influenza-like illnesses,A(H1N1)influenza,and seasonal influenza in these two groups were compared to evaluate the efficacy of the vaccine.Results There were 6334 subjects in the vaccinated group and 8549 in the control group.7441.75 person-years were followed from these two groups.The incidence rate of A (H1N1)influenza in vaccinated group was 1.64‰ per person-year,lower than that of the control group.The rate difference(RD)was-1.64‰ per person-year(95% confidence interval value from-3.04‰ to-0.23‰ per person-year),and the difference was significant(P=0.010).The incidence rate of influenza-like illnesses in vaccinated group was 21.47‰ per person-year,lower than that of the control group(22.69‰ per person-year)and the diffefence was not significant(P>0.05).The incidence rate of B influenza in vaccinated group was 6.63‰ per person-year,higher than that of control group(7.02‰ per person-year)but the difference was not significant(P>0.05).Conclusion This vaccine demonstrated a good epidemiological effect against the A(H1N1)influenza virus infection,observed through a student-immunization program.The cross-protection effect against the influenza-like illnesses and other seasonal influenzas was not noticed in this study.     

甲型H1N1流感疫苗预防接种效果观察

目的探讨接种甲型H1N1流感疫苗的有效性和安全性。方法选择120例18～60岁在我院接种甲型H1N1流感疫苗人员为接种组,同时按照年龄、性别、疾病匹配的情况选取未接种甲型H1N1流感疫苗者110例为对照组。调查分析甲型H1N1流感疫苗接种后90d内两组甲型H1N1流感发病率和其他流感样疾病发生情况。同时观察接种甲型H1N1流感疫苗后48h内不良反应发生情况。结果接种组甲型H1N1流感发病率和就诊率为0%,对照组甲型H1N1流感发病率和就诊率为7.3%,两组比较有显著统计学差异（P〈0.01）;接种组90d内甲型H1N1流感的保护率为100%,减少就诊率100%。接种组其他流感样疾病发生率（15.0%）和就诊率（8.3%）均明显低于对照组（22.7%和16.3%）,有统计学差异（P〈0.05）;接种组90d内其他流感样疾病的保护率为33.9%,减少就诊率49.4%;接种组共出现不良反应8例,总体不良反应率6.7%,给予适当的处理,症状很快消失。结论接种甲型H1N1流感疫苗是有效和安全的。     

2009年华容县健康人群甲型H1N1流感疫苗免疫效果分析

目的了解健康人群接种甲型H1N1流感疫苗后的免疫效果及抗体水平。方法观察接种甲型H1N1流感疫苗人群中不良反应的发生情况;按照不同的年龄组随机抽取350人,采用描叙性流行病学方法,对疫苗的安全性和有效性进行评价;微量血凝抑制试验检测接种者甲型H1N1流感病毒抗体,SPSS16.0统计学软件对接种30 d后甲型H1N1流感与普通流感的发病率、就诊率及HI抗体阳转率进行比较。结果接种组接种甲型H1N1流感疫苗30 d后甲型H1N1流感与普通流感的发病率与就诊率均低于对照组,差异有统计学意义（P〈0.05）;接种甲型H1N1流感疫苗人群中共出现不良反应1 891例,总不良反应率为4.35%;接种组总体HI抗体阳转率显著高于对照组（χ2=4.27,P〈0.05）,达到欧盟药品评价委员会的标准,各年龄组间HI抗体阳转率差异无统计学意义。结论国产甲型H1N1流感疫苗具有较高的安全性与较好的免疫原性,适合在健康人群中普遍接种。     

无锡市甲型H1N1流感及季节性流感疫苗接种效果分析

目的调查流感样病例(ILI)和无锡市一般人群中甲型H1N1流感疫苗及季节性流感疫苗的接种情况,评估疫苗接种后对人群的保护效果。方法以无锡市2家哨点医院为基础,采集流感样病例病毒核酸检测阳性的病例作为病例组,共1 529人,同时按照"病例"的电话信息,随机产生电话号码选择、年龄匹配的一般人群作为对照组,共380人。结果病例组甲型H1N1流感疫苗接种率为6.1%(94/1 529),对照组甲型H1N1流感疫苗接种率为12.1%(46/380),两组比较,差异有统计学意义(P0.01);甲型H1N1流感病例中接种甲型H1N1流感疫苗的比例为12.5%(3/24),门诊检测阴性的ILI病例接种甲型H1N1流感疫苗的比例为6.1%(78/1 273),"接种甲型H1N1流感疫苗"因素的OR值为0.457(P=0.201);以电话调查一般人群(330例)作为对照组,接种甲型H1N1流感疫苗的比例为13.3%(44/330),OR值为1.077(P=0.908)。结论该次调查说明接种甲型H1N1流感疫苗对预防流感样病例有一定效果,但由于样本量较少,24种方法病例对照分析均未得出差异有统计学意义。     

接种甲型H1N1流感疫苗后副反应分析

目的分析人群接种甲型H1N1流感病毒裂解疫苗(甲流疫苗)后副反应生情况,了解其安全性。方法对接种甲流疫苗后人群进行常规副反应监测,并对出现疑似预防接种异常反应者进行个案调查,利用EXCEL2003及描述性方法对数据进行整理分析。结果全市共接种368538人,报告副反应63例,报告发生率为17.09/10万,其中比例高的前3位是高热21例(33.33%)、群发性癔症16例(25.40%)、神经系统过敏反应7例(11.11%),发生率分别为5.7/10万、4.34/10万、1.90/10万;职业发生率前3位是医务人员(37.69/10万)、工人(36.68/10万)、农民(36.18/10万);男女性别比为2.15∶1(43/20),平均年龄19.81岁,平均发生时间6.3hr。结论甲流疫苗副反应发生率低,以发热和疫苗过敏性反应为主。     

甲型H1N1流感疫苗最新研究

关于甲型H1N1流感,国内研究机构接连发表2篇重要研究成果,为预防治疗甲H1N1流感,深入了解H1N1流感作用机制,从根源上遏制这种病毒再次侵害,提供重要依据。第一篇文章发表于2009年10月27日出版的《英国医生杂志》上。     

接种甲型H1N1流感疫苗后患甲型H1N1流感分析

目的 分析接种甲型H1N1流感疫苗后发生甲型H1N1流感感染的病例,探讨发病原因,为进一步提高疫苗预防效果提供参考依据.方法 对接种甲型H1N1流感疫苗后发生甲型H1N1流感感染148例,进行回顾性调查分析.结果 接种甲型H1N1流感疫苗11176例.发生甲型H1N1感染148例,感染率1.32%,其中1～14 d感染81例,感染率0.72%,＞15 d感染67例,感染率0.60%.结论 甲型H1N1流感病毒裂解疫苗是一种安全高效的疫苗,不足之处尚待进一步探讨、完善.     

怀柔区接种甲型H1N1流感疫苗分析

本文对2009年度在怀柔城区的3家预防接种保健科，进行甲型H1N1流感疫苗预防接种的实例分析，与世界卫生组织发布的全球甲型H1N1流感疫苗接种安全性评估结论基本一致，证明我国使用的疫苗安全稳定。     

初中生甲型H1N1流感疫苗接种效果分析及抗体水平监测

目的了解初中生接种甲型H1N1流感疫苗的流行病学效果及抗体水平。方法采用非随机对照临床试验方法,选择9 123名初中生,分甲型H1N1流感疫苗接种组(3 726人)和对照组(5 397人),随访观察一个流行周期(6个月),比较两组流感样病例、甲型H1N1流感病例、季节性流感病例的发生率及接种前后阳性率和阳转率。结果接种组与对照组除甲型H1N1流感发病密度(接种组:0/1 000人年,对照组:2.22/1 000人年)差异有统计学意义外(P=0.0121),其他流感相关疾病(流感样病例、乙型流感、流感病毒核酸阳性)发病密度差异无统计学意义(P>0.05);不管是接种组还是对照组,不同住宿情况(住校和走读)流感样病例发生差异均有统计学意义,接种组中,季节性流感接种对乙型流感和流感病毒核酸阳性差异均有统计学意义;对照组中,流感症状史对甲型H1N1、乙型流感和流感病毒核酸阳性差异均有统计学意义;疫苗接种前与接种后1个月比较,流感抗体几何平均滴度(GMT)与阳性率都增高(P<0.05)。结论初中生大规模接种甲型H1N1流感疫苗能有效预防甲型H1N1流感,其免疫及保护效果良好,住校生较走读生更易发生流感样病例,疫苗接种可能不存在交叉保护作用。     

中山市某大学学生接种甲型H1N1流感疫苗安全性及免疫效果评价

目的分析中山市当前接种的甲型H1N1流感疫苗的安全性及免疫效果,为甲型H1N1流感疫苗的科学使用提供依据。方法采用多阶段随机抽样方法抽取一定数量对象作为接种组和对照组,运用流行病学实验研究的方法,观察接种组疑似预防接种异常反应发生情况,监测抗体阳转率,比较接种组和对照组甲型H1N1流感的发病率,并计算效果指数和疫苗保护率。结果本研究接种组和对照组均为464人,接种组接种甲型H1N1流感疫苗后均未出现疑似预防接种异常反应。在接种组抽取100名接种对象进行抗体检测,出现抗体阳转61例,抗体阳转率为61.00%。接种组与对照组的甲型H1N1流感发病率分别为4.74%(22/464)、10.34%(48/464),差异有统计学意义(P<0.01)。疫苗的效果指数为2.18、保护率为54.16%。结论中山市当前接种的甲型H1N1流感疫苗具有良好的安全性,但免疫效果偏低,是否有进一步提高的空间,有待进一步研究。     

甲型H1N1流感疫苗大规模人群应急接种分析

目的 控制甲型H1N1流感疫情的传播,为规范有序地应急接种提供依据.方法 按照分步实施、保证重点、知情同意、自愿接种的原则,分4个批次对浙江省象山县重点人群进行应急接种.结果 从2009年11月1日-2010年4月30日,共接种40 734人,接种率达49.83%,其中学生接种26 595人,接种率为64.34%,占总接种人数的65.29%;累计报告预防接种疑似异常反应(AEFI)15例,AEFI报告发生率为34.93/10万.结论 应用甲型H1N1流感疫苗(简称甲流疫苗)对易感人群进行应急接种是防控甲流疫情的有效手段,人群大规模甲流疫苗接种安全可行.     

湖北省2009年甲型H1N1流感流行病学特征分析

目的分析湖北省2009年甲型H1N1流感的流行病学特征,为防治提供科学依据。方法应用甲型H1N1流感信息管理系统和疫情监测信息管理系统收集湖北省各市(州)报告的甲型H1N1流感病例相关信息,采用Excel软件建立病例信息库,并进行统计学分析。结果 2009年全省共报告甲型H1N1确诊病例5527例,其中重症病例63例,死亡6例。疫情在全省17个市、州均有分布;9～12月报告病例数占总报告数的99.57%;主要发病年龄组为10岁～与15岁～年龄组;86%的病例为在校学生。结论通过采取科学防控措施,加强疫情监测,积极救治病人及对易感人群的保护,湖北省2009年甲型H1N1流感疫情得到有效控制,其危害也降到最低程度,保障了社会经济生活的正常秩序。     

广州市甲型H1N1流感流行初期疫情特点分析

目的总结广州市甲型H1N1流感流行特点,为预防控制提供参考。方法从三间分布、本地病例与输入性病例特点、感染场所、暴发疫情特点、临床表现、流行病学史、发现方式等特征分析广州市2009年5~7月网络直报的173例实验室确诊病例。结果本地病例97例(56.1%),输入性病例76例(43.9%)。男性104例(60.1%),女性69例(39.9%)。年龄为6个月至71岁,中位数为18.4岁。本地病例感染场所主要为学校,占64.9%。输入性病例中60.5%为散发病例,而本地病例中23.7%为散发病例,以聚集性为主,两类病例流行形式差异有统计学意义(χ2=24.9,P0.001)。临床表现以发热(≥37.5℃)(94.6%)、咳嗽(63.1%),咽痛(40.3%)为主。8.7%病例出现消化道症状。47.0%的病例与有明确类症状病人接触史。输入性病例发病至确诊时间比本地病例要短(t=2.791,P=0.006),发病至首次就诊时间间隔也比本地病例短(t=2.059,P=0.041)。输入性病例主要为出入境检验检疫发现(72.4%),本地病例主要为自行就诊发现(46.4%)。结论广州市仍处于甲型H1N1流感流行初期。部分甲型H1N1流感病例有消化道症状,提示消化道传播的可能性需要关注。     

Relationship between intention of novel influenza A (H1N1) vaccination and vaccination coverage rate

We carried out this study to describe the difference between intention to receive vaccine against influenza A (H1N1) before the vaccination campaign and actual vaccine coverage rate after vaccination campaign; and to find out the factors affecting the acceptability. We analyzed data on intention to receive vaccine against influenza A (H1N1) and actual vaccination coverage rate from IR (immunization registry). In a survey of pre-vaccination, the sample size was 1042 and the survey results were weighted with gender and age distribution for sample distribution to be similar to population distribution. Although the intention to receive vaccine against influenza A (H1N1) was high, the actual vaccination coverage was lower than their intention. The factors affecting their intention were the degree of fear for novel influenza A (H1N1), the possibility to be infected with the virus, priority for production of novel influenza vaccine between timing and safety, and belief for effectiveness of novel influenza vaccine. Besides 2009 influenza A (H1N1) vaccination experience developing to resolve the effecting factors on intentions to receive vaccine, which would be the effective way to prepare for anther pandemic in the future.     

Responses after one dose of a monovalent influenza A (H1N1) 2009 inactivated vaccine in Chinese population—A practical observation

Background

The globally large-scale immunization was the most important method of controlling the 2009 pandemic influenza.

Methods

We conducted an observational clinical trial, including 148 adults aged 18-60 years to evaluate the safety and immunogenicity of a licensed 2009 H1N1 influenza vaccine. All subjects received a single 15-μg dose of a monovalent, unadjuvanted inactivated vaccine. Antibody titers were measured by means of hemagglutinin-inhibition assays and neutralization assays based on Real-Time Cell Analyzer (RTCA) instruments at baseline, 7 days and 21 days after vaccination.

Results

Local and systemic reactions were respectively reported by 19.1% and 22.1% of subjects. All adverse events were mild to moderate in intensity, without any deaths or serious events. By day 21 after vaccination, hemagglutinin-inhibition antibody titers of 1:40 or more were achieved in 101 of 123 (82.1%) subjects and the geometric mean titers (GMTs) increased to 1:95.27. For neutralization assays, all subjects could provide the protection against wide influenza virus, with the GMT of 1:525.44. Moreover, the rates of seroconversion, as measured using hemagglutinin-inhibition assays and neutralization assays, were 73.98% and 91.87% of subjects, respectively.

Conclusions

A single 15-μg dose of a monovalent, unadjuvanted inactivated 2009 H1N1 influenza vaccine was well tolerated, and induced a protective immune response in the majority of subjects aged 18-60 years (clinical trials gov number, NCT01055990).     

人口流动强度与甲型H1N1流感和人感染H7N9禽流感流行的相关性研究

目的 探讨人口流动强度与甲型H1N1流感（简称H1N1）和人感染H7N9禽流感（简称H7N9）的流行关系的模式。方法 利用2009年H1N1监测数据和2013年至2017年2月的H7N9监测数据,采用秩相关、主成分分析、Getis-Ord Gi*热点分析和对应分析探讨人口流动强度与上述两种传染病流行的相关关系。结果 人口流动强度与H1N1和H7N9的发病数均呈正相关。家禽出栏量与H7N9的发病数和人口流动强度也呈正相关。人口流动强度分别与H1N1（〖XC小五号.EPS;P〗=43.40,P<0.0001）和H7N9（〖XC小五号.EPS;P〗=51.82,P=0.0010）的热区位于对应分析图的相同区域,且均存在相同级别的热区聚集在一起,提示人口流动强度与这两种疾病均存在一定的对应关系;家禽出栏量和H7N9的热区位于对应分析图的相同区域,且热区级别大致一一对应,即存在相对严格的对应关系（〖XC小五号.EPS;P〗=36.47,P=0.0140）。人口流动强度与家禽出栏量也存在一定的对应关系,两者的热区位于对应分析图的同一区域（〖XC小五号.EPS;P〗=32.26,P=0.0410）。结论 人口流动强度与H1N1的暴发流行有相关关系,而人口流动强度与H7N9的流行关系是一种典型的“人-物流”的动物源性的传染病模式。     

宁波地区轻重症甲型H1N1流感的流行病学和临床对比分析

目的对比分析宁波地区轻、重症甲型H1N1流感的流行病学和临床特征。方法回顾分析宁波市传染病院2009年7月1日至2009年12月31日收治的204例患者的临床资料,其中轻症52例,重症152例。结果两组患者均以本地户籍者居多,均无明确接触史。成人患者以青年人群为主,但重症者多见于小儿、老年、伴有肥胖和相关代谢综合征、孕妇或剖宫产术后人群。职业分布均以中青年职员和学生为主。发热、咳嗽、咳痰为其突出及特征表现,两组高热(≥39℃)患者的构成比及发热持续时间比较差异有统计学意义;重症患儿的平均最高体温、流涕及消化道症状、咽部充血及扁桃体肿大均高于重症成人患者。轻症患者无并发症;重症患者并发不同程度肺炎或支气管肺炎,小儿以支气管肺炎为主,成人以肺炎为主。两组患者肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、肝功能及白细胞(WBC)升高异常率比较差异均有统计学意义。重症患者平均住院时间较长。结论重症病例仍以发热及呼吸道改变为主,并发症以支气管肺炎、肺炎、心肌及肝功能损害为主,成人及小儿临床表现不一致。     

Reduced immune response to influenza A (H1N1) 2009 monovalent vaccine in HIV-infected Japanese subjects

We evaluated the immunogenicity and safety of the influenza A (H1N1) 2009 monovalent vaccine in HIV-infected Japanese subjects. A total of 182 HIV-infected and 42 HIV-uninfected subjects were enrolled, and antibody (ab) titers were measured by hemagglutination-inhibition assay at baseline and 32.3 ± 10.4 and 29.7 ± 3.3 days after vaccination, respectively. In the HIV-infected cohort, ab titers ≥1:40 at baseline and post-vaccination were 12.6% and 49.5%, respectively. The seroconversion rate, defined as either an ab titer ≤1:10 before and ≥1:40 after or ≥1:10 before and ≥4-fold increase in ab titer, was only 38.5% in the HIV-infected cohort, whereas the rate was 85.7% in the HIV-uninfected cohort. Multivariate logistic regression analysis showed that the CD4 cell count was the only significant predictor of a positive vaccine response. There were no serious adverse events in any of the subjects receiving the vaccine. Additional study is warranted to identify a more effective method of vaccinating HIV-infected Japanese subjects.