新生儿BCG接种工作的评价

新生儿卡介苗接种在预防儿童结核病特别是儿童结脑和粟粒型结核方面起着重要的作用,因此,系统评价和科学总结在指导卡介苗接种工作中有着非常重要的意义。为不断完善我市新生儿卡介苗接种工作,特对我市12年来新生儿卡介苗接种工作评价如下。     

5岁以下儿童接种b型流感嗜血杆菌疫苗流行病学效果的Meta分析

目的对5岁以下儿童接种b型流感嗜血杆菌疫苗(Hib)的流行病学保护效果进行Meta分析。方法检索美国国家医学图书馆数据库(NCBI)、Cochrane协作网图书馆数据库、中国生物医学文献数据库、中国期刊全文数据库和万方全文数据库,采用Rev Man 5.3软件对纳入的有关5岁以下儿童接种Hib的流行病学保护效果的文献进行Meta分析。结果共纳入9篇文献,其中7篇为随机对照试验,2篇为半随机对照试验。接种1、2和3剂次Hib后产生的疫苗保护率分别为65%(95%CI:23%~84%)、79%(95%CI:54%~90%)和85%(95%CI:77%~90%)。结论 Hib具有良好的保护效果,2剂次和3剂次Hib基础免疫程序在5岁以下儿童中的保护效果相似。     

卡介苗预防儿童结核性脑膜炎效果病例对照研究

目的:讨论卡介苗保护儿童结核性脑膜炎(结脑)的效果,探讨儿童现行卡介苗(BCG)免疫策略。方法:严格采用病例对照研究方法,对入选结脑病例和对照进行调查,以Epi Info流行病学软件建立数据库,进行相应分析,据此测算疫苗效力(VE)。结果:入选42例病例及126例对照。接种BCG(χ2=25.487 3,P=0.000 0)与儿童结脑发病有统计学关联,BCG的VE=89.42%,95%可信区间(CI)为(69%,97%)。结论:接种BCG是儿童结脑保护因素,保护率89.24%。建议继续推行卡介苗免疫策略,以保护儿童免受结脑等重症结核的侵袭。     

流行性乙型脑炎减毒活疫苗加强免疫的Meta分析

目的 系统评价乙脑减毒活疫苗加强免疫效果并探讨其必要性。方法 计算机检索中国知网、万方数据知识服务平台、Cochrane Database 、PubMed、Web of Science数据库,收集乙脑减毒活疫苗加强免疫的研究,检索时限均为从建库至2015年3月。由2名研究者按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量,使用Stata 12.0 软件进行统计计算。结果 总共纳入9篇文献。Meta分析结果显示:基础免疫后一个月合并阳性率为79%（95% CI:69%～90%）,基础免疫一年后,接种者的抗体水平下降（合并阳性率51%,95% CI:17%～86%）,加强免疫后抗体水平明显升高（合并阳性率98%,95% CI:97%～99%）。结论 乙脑减毒活疫苗加强免疫能提高人群乙脑抗体阳性率和抗体平均几何滴度,有利于达到对人群长期保护的目的。     

新型冠状病毒疫苗对新型冠状病毒德尔塔变异株预防效果的Meta分析

目的 运用循证医学Meta分析方法,探究和评价新型冠状病毒疫苗对新型冠状病毒德尔塔变异株的预防效果,为新冠肺炎的防控提供循证支持。方法 以新型冠状病毒德尔塔毒株、疫苗及其同义词、近义词作为检索词,系统检索中国知网、万方数据库、维普数据库、中国生物医学文献服务系统、PubMed、考科蓝图书馆、Web of Science、BioRxiv、MedRxiv和Europe PMC关于新型冠状病毒疫苗保护效果(Vaccine Effectiveness,VE)的文献,使用纽卡斯尔-渥太华风险评分量表对纳入的队列研究和病例对照研究文献进行质量评价,对纳入的随机对照试验则使用Jadad评分进行质量评价,运用Stata 12.0进行异质性检验、总效应值和发表性偏倚估计。结果 共纳入文献14篇,其中病例对照研究文献5篇,队列研究文献8篇,随机对照实验1篇。Meta分析显示,接种一剂新冠疫苗的合并VE(95%CI)为34.57%(95%CI:21.70%～47.44%),接种两剂新型冠状病毒疫苗的合并VE(95%CI)为70.56%(95%CI: 64.29%～76.82%)。漏斗图分析表明存在发表偏倚风险。结论 接种新型冠状病毒疫苗对预防新型冠状病毒德尔塔变异株有保护作用,且2剂疫苗保护作用明显比1剂疫苗强。后续仍需要收集更多的疫苗保护率研究,提供发表性偏倚风险小的证据。     

接种卡介苗后预防接种异常反应研究进展

卡介苗(Bacille Calmette-Guerin Vaccine,BCG)是唯一被批准用于结核病预防的疫苗,在结核性脑膜炎及粟粒性结核的预防和控制方面有着良好的效果,但接种卡介苗后出现异常反应的比例高于其他疫苗,考虑这主要与卡介苗的固有特性有关。本文结合近些年来关于卡介苗相关研究文献,对卡介苗基础知识、接种操作要点、预防接种异常反应(AEFI)分类及监测、AEFI发生情况、医疗救治措施及处理措施和新型疫苗的研究进展等进行综述,为今后针对减少接种卡介苗导致AEFI发生的研究提供参考。     

在校学生结核感染情况调查和卡介苗接种效果评价

目的：了解大、中专生在校期间结核自然感染和对结核病的免疫力水平及卡介苗接种效果。方法：在新生入学时结核菌素试验（简称结试）的基础上，对结试阴性的学生，再查结试，对结试阴性者接种卡介苗，于接种后第十二周查结试以评价接种效果。结果：检查1322人，阳性240人，阳性率18.15%;阴性1082人，其中接种卡介苗975w ,接种率90.11%。于接种后第十二周查结试，阳转率92.72%。结论：本次调查结核年感染率较高^[1]，卡介苗接种效果较好。加强结核病的监查、进行卡介苗接种及开展结核病防治的健康教育是控制结核病的简捷、有效、经济的办法。     

我国甲型H1N1流感疫苗免疫效果评估系统综述*

目的 通过对甲型H1N1流感疫苗免疫学效果和保护效果的系统回顾,为完善甲型流感免疫策略提供依据。方法 采用系统评价方法,“甲型H1N1流感疫苗”或“甲型流感疫苗”“评估”或“效果”或“效果评估”为检索词,全面检索中国知识资源总库期刊全文数据库（2009~2014年6月）和万方学术期刊数据库（2009~2014年6月）,对纳入文献进行系统分析。结果 符合纳入标准的文献12篇,免疫学效果和保护效果系统评价显示：抗体阳转率为61％~100％,GMT为1:200~1:736.23,甲流发病率<8.5%,疫苗的保护率为 45.15%~100%。结论 甲流疫苗具有较好的免疫保护作用。     

卡介苗疑似预防接种异常反应监测分析

卡介苗(BCG)对预防和控制儿童结核性脑膜炎、粟粒性结核有较好的效果。BCG与1921年首次用于免疫人群,1974年世界卫生组织(WHO)将其纳入扩大免疫规划,我国自1978年将BCG纳入儿童计划免疫。目前,我国结核病缺乏早期诊断和有效的治疗系统;而BCG接种方便,且我市自2009年实施免费接种,所以,新生儿出生后24小时内接种BCG普遍被人们     

新型冠状病毒疫苗接种策略经济学评价研究进展

目的:了解国内外新型冠状病毒疫苗（新冠疫苗）接种策略相关的经济学评价研究进展,为开展基于中国真实世界证据疫苗接种策略经济学评价提供参考。方法:对中英文数据库2020年1月至2021年12月的文献进行检索,纳入新冠疫苗接种策略经济学评价研究,并对相关文献进行叙述性整合。结果:共纳入16篇英文文献（含3篇综述）,发现无论品...     

Evaluation of the effectiveness of BCG vaccination using the case-control method in Buenos Aires, Argentina

A retrospective case-control study was conducted in Argentina to determine the protection conferred by BCG vaccination against tuberculosis in children under six years of age, in an area where coverage is about 55%. A total of 175 tuberculosis patients were included. Five controls selected from patients treated at the same hospital as those under study for reasons other than tuberculosis were matched to each case on the basis of age, socioeconomic origin, nutritional status and place of residence. Information on BCG vaccination status was collected by an independent examiner. Tuberculosis localizations were as follows: 152 pulmonary, pleural and/or miliary; 18 meningitis; 2 lymphadenitis; 2 osteoarticular; and 1 otic. The diagnosis was based on bacteriological and histopathological tests, computerized tomography, radiology, clinical examination, endoscopy, and proved source of infection. The protective effect of BCG among those who were vaccinated was 73.0% with 95% confidence limits of 82% and 62%. According to these results BCG vaccination given early in life is very effective in preventing tuberculosis.     

脊柱结核有限性病灶清除术的临床研究

目的：研究采用有限结核病灶清除术治疗脊柱稳定性未完全破坏、无神经损害脊柱结核的效果。方法：2007年1月-2012年2月手术治疗脊柱稳定性尚未完全破坏、无神经损害脊柱结核患者86例,根据住院顺序随机分成两组：彻底病灶清除固定组44例,给予病灶彻底清除术＋内固定术,有限清除组42例,给予结核病灶有限清除术。随访3个月-3年,比较两组患者术后效果、费用等情况。结果：全部患者手术切口都为一期愈合。两组术后效果比较差异无统计学意义（P〉0．05）。与彻底病灶清除固定组比较,有限清除组手术时间显著缩短“）〈0．05）,出血量显著减少（P〈0．05）,脊柱畸形矫正度数小0）〈0．01）,治疗费用少（P〈0．01）。结论：有限脊柱结核病灶清除术治疗无明显失稳及神经损害脊柱结核经济而有效。     

东莞市厚街镇2008——2012年肺结核病流行特征分析

目的了解东莞市厚街镇肺结核病流行现状,评价该地区目前肺结核病防控措施的效果,为今后制订结核病预防控制策略提供科学依据。方法运用描述性流行病学方法。对2008～2012年厚街镇肺结核病疫情资料进行分析。结果2008—2012年共报告肺结核病患者3394例,以2011年报告发病率最高（166．04／10万）,其次为2008年（165．61／10万）,2012年最低（146．93／10万）;流动人口报告发病率显著高于常住人口,差异有统计学意义（χ2=-302．86,P〈0．001）;报告病例分类以茵阴比例最高,占49．50％,其次为未痰检,占36．30％,涂阳占13．99％;发病的男女性别比为2．07：1;报告病例的年龄主要集中在20—44岁,14岁以下儿童发病极少;职业分布以工人发病比例最高,占66．08％;季节分布以夏季发病例数最多。结论厚街镇流动人口的肺结核病疫情不容乐观．应着重加强这部分人群的肺结核病防治管理工作及归口管理工作,同时,继续加强儿童计划免疫和新生儿卡介苗预防接种工作．使结核病的防控工作取得更大成效。     

The geographic location (latitude) of studies evaluating protective effect of BCG vaccine and it's efficacy/effectiveness against tuberculosis

OBJECTIVE: To study association between the geographic location (latitude) of studies evaluating protective effect of BCG vaccine and it's efficacy / effectiveness against tuberculosis. METHODS: A comprehensive literature search was carried out to identify relevant studies. Data extraction from these studies included place of study (geographic latitude), study design and reported point estimate of protective effect of BCG vaccine against tuberculosis. Information on latitude was obtained from Oxford School Atlas for World Geography. A spearman rank correlation coefficient was estimated to study the association between the latitude of studies and protective effect of BCG vaccine. RESULTS: The Spearman's rank correlation coefficient was significant for all studies grouped together & trials and marginally non-significant for other observational studies. However it was not statistically significant for case-control studies and cohort studies. Overall rho (for 80 studies) between latitude and protective effect of BCG was calculated to be 0.3853 (p = 0.0004). The results thus demonstrated that, in general BCG appeared to provide greater protection at higher latitudes. Thus a correlation coefficient of 0.3853 between latitude and protective effect would indicate that (0.3853)(2) or 15% of the variance in protective effect was accounted for by latitude. CONCLUSION: The study recognized an association between geographic locations of studies and reported protective effects of BCG vaccine against tuberculosis.     

卡介苗预防结核病的效果与策略

迄今为止,全球大约有超过30亿人口接种卡介苗。卡介苗最多能预防80%的结核病,主要预防粟粒性结核病和结核性脑膜炎,且有效性长达15年;然而,它的保护作用依地理变化而异,这可能与频繁暴露于结核病、卡介苗菌毒株的基因变异、人群遗传差异、非结核分枝杆菌的干扰、受寄生虫感染的干扰等有关。卡介苗是世界上使用最广泛、最安全的疫苗之一;但如果给有免疫缺陷的婴儿接种卡介苗,会引起播散性或致命性感染。世界卫生组织推荐在高结核流行区的国家,所有新出生儿童都应接种卡介苗。     

接种卡介苗对毛细支气管炎日后发展成支气管哮喘的临床研究

目的 观察按计划接种卡介苗对毛细支气管炎患儿日后发展成支气管哮喘的影响.方法 采用回顾性研究和临床随访的方法,选择1995年1月至2002年12月确诊为毛细支气管炎的280例患儿,按计划接种卡介苗者135例（卡介苗接种组）,未按计划接种卡介苗者145例（非卡介苗接种组）,随访3～ 10年,比较两组支气管哮喘发生情况.结果 卡介苗接种组支气管哮喘发生率为17.04％（23/135）,明显低于非卡介苗接种组的40.69％（59/145）,差异有统计学意义（P＜0.01）.结论 婴幼儿毛细支气管炎易发展为儿童支气管哮喘,及时接种卡介苗对其日后支气管哮喘的发生呈现保护作用.     

Scar size and effectiveness of Bacillus Calmette Guerin (BCG) vaccination in the prevention of tuberculosis and leprosy: a case-control study

BACKGROUND: The study was undertaken to estimate the effectiveness of BCG vaccination in relation to scar size in the prevention of tuberculosis and leprosy. METHODS: The present study was designed as hospital-based pair-matched case-control study and was carried out at Government Medical College Hospital, Nagpur, Maharashtra, India. It included 877 cases of tuberculosis and 292 cases of leprosy (diagnosed by WHO criteria), born onwards 1962. Each case was pair-matched with one control for age, sex and socio-economic status. BCG vaccination status was assessed by examination for the presence of BCG scar, immunisation records if available and information from subjects/parents of children. Subjects uncertain about BCG vaccination were not included. The diameter of the BCG scar was measured both across and along the arm in millimeters using a plastic ruler. The average was then calculated. RESULTS: A significant protective association between BCG vaccination and tuberculosis (OR=0.38, 95% CI 0.31-0.47) and leprosy (OR = 0.38, 95% CI 0.26-0.55) was observed. The overall vaccine effectiveness (VE) was 62% (95% CI 53-69) against tuberculosis and 62% (95% CI 45- against leprosy. Vaccine effectiveness against tuberculosis and leprosy was non-significantly greater in the group who had BCG scar size < or =5 mm as compared to subjects who had BCG scar size > 5 mm. Thus there was no clear association between BCG scar size and its effectiveness. CONCLUSION: The current study did not identify any significant association between BCG scar size and its effectiveness against tuberculosis or leprosy.     

结核杆菌重组Rv3425蛋白的结核病血清学诊断价值的评价

[目的]评价结核分支杆菌重组Rv3425蛋白在结核病血清学诊断中的价值。[方法]以重组Rv3425作为抗原，采用酶联免疫吸附试验（ELISA）检测151份确诊结核病人、143份健康人、38份卡介苗接种阳转者和42份非结核病人血清中的抗结核抗体水平，并与结核菌素纯蛋白衍生物（PPD）、Ag85B蛋白及TB—DOT、TB-CHECK-1试剂盒的检测结果进行比较，以此来评价重组Rv3425蛋白在结核病诊断上的价值。[结果]Rv3425与PPD和Ag85B抗原一样能够诊断结核病人，但PPD不能有效区分结核病人和BCG接种者，Rv3425和Ag85B蛋白可以明确区分。[结论]虽然重组Rv3425蛋白对结核病的阳性率尚不能与试剂盒媲美，但由于其能够有效区分结核病人和BCG阳转者，在结核病诊断方面具有很大的应用价值，可以作为结核病诊断的备选抗原之一。     

The BCG controversy: a reappraisal of the protective effect against tuberculosis and leprosy

BCG (Bacillus Calmette Guerin) vaccine remains a highly controversial method of preventing tuberculosis and leprosy despite more than eighty years of use. The protective effect against tuberculosis observed in various studies ranged from -56% to 98%. Case-control studies carried out at Nagpur reported moderate effectiveness of BCG vaccination in prevention of tuberculosis. Its effectiveness was higher against extra-pulmonary tuberculosis. The summary protective effects obtained from meta-analysis of trials, cohort studies and case-control studies of BCG vaccination and tuberculosis were 51 (33-64), 76 (63-85), and 65 (57-72) percent respectively. The case-control studies carried out at Nagpur also demonstrated a significant protective association between BCG vaccination and leprosy. The summary protective effects obtained from meta-analysis of trials, cohort studies and case-control studies of BCG vaccination and leprosy were 43 (27-55), 62 (53-69), and 59 (46-68) percent respectively. The results of the current study and systematic review thus supported arguments favoring use of BCG vaccine for prevention of tuberculosis and leprosy.