甲型肝炎减毒活疫苗与灭活疫苗免疫效果的比较

目的 观察甲型肝炎（甲肝）减毒活疫苗Ｈ２株与ＬＡ－１株的不同剂量、不同免疫程序的免疫原性及抗体动脉变化。方法 在河北、广西两地５选择３１８名经甲肝抗体检测为阴性的易感儿童,按不同剂量程序及不同甲肝疫苗,分为６组,并在首剂接种后１、６、７、１２、１３月份分别采集血清标本,检测甲肝总抗体。结果 各组抗体水平均于再免疫后１个月达高峰,以后开始下降,再免半年后抗体水平仍明显高于初免抗体水平;灭活于再免疫后     

甲型肝炎灭活疫苗不同免疫方案对恒河猴免疫效果观察

目的 确定甲型肝炎灭活疫苗免疫恒河猴最佳免疫方案。方法 根据３个免疫方案（方案１：０周免疫;方案２：０周初次免疫、４周加强免疫;方案３：０周初次免疫、２４周加强免疫）,将１７只抗－ＨＡＶ阴性的恒河猴随机分成４组;第１组;免疫方案１;第２组：免疫方案２;第３组：免疫方案３。１～３组各５只,空白对照组２只。用同等剂量（１２８０ＥＬ．Ｕ／ｍｌ）的甲型肝炎灭活疫苗于上臂三角肌内分别免疫两组恒河猴,检测恒河     

Safety and effectiveness of the new inactivated hepatitis A virus vaccine.

PURPOSE: To examine the evidence concerning the safety and effectiveness of the inactivated hepatitis A virus vaccine recently licensed for use in Canada. DATA SOURCES: The main source of information were papers presented at the International Symposium on Active Immunization against Hepatitis A, held in Vienna, Austria, Jan. 27-29, 1992. The bibliographies of these papers were searched for additional references. Recent articles describing the new vaccine and the epidemiologic aspects of infection with hepatitis A virus (HAV) were also reviewed. STUDY SELECTION: Peer-reviewed reports of trials approved by a government regulatory agency on the safety, immunogenic properties and efficacy of the vaccine. DATA EXTRACTION: The authors assembled key reports on adverse reactions, protection from disease and serologic assessment of immune response in vaccine recipients; data from these reports were tabulated and analysed. RESULTS OF DATA SYNTHESIS: The new vaccine contains the HM175 strain of HAV, which is adapted to grow in tissue culture. The virus is purified, inactivated with the use of formaldehyde and adsorbed onto aluminum hydroxide. The recommended dose for adults is 720 enzyme-linked immunosorbent assay (ELISA) units in a 1.0-mL dose and for children 360 ELISA units in a 0.5-mL dose, injected intramuscularly. The usual schedule is three serial doses, the second given 1 month and the third 6 to 12 months after the initial dose. Reported side effects are infrequent and minor. In healthy persons who have received two doses, the seroconversion rate is almost 100%. Protective efficacy after two doses is estimated to be 94%. However, the persistence of protective antibodies has been studied only over the short term (3 years). CONCLUSIONS: The new HAV vaccine is safe, effective and best suited to pre-exposure prophylaxis in people with an increased risk of infection for an extended period, such as travellers to areas where the disease is endemic. Further studies are needed to determine whether infants respond well to the vaccine and whether the vaccine protects recipients from subclinical infection and associated fecal shedding of HAV. Controlled trials to determine the duration of protection beyond 3 years and the effects of more rapid dosage schedules are also needed.     

Increasing cervical screening in women of more than 40 years of age: an intervention in general practice

An intervention that was aimed at increasing cervical screening in women of more than 40 years of age was undertaken, with general practitioners as the primary point of contact. The intervention consisted of the practice receptionist giving female patients pamphlets about Papanicolaou smear-tests and the general practitioner offering a Papanicolaou smear-test. Nineteen general practitioners and their female patients (n = 466) of more than 40 years of age who presented for consultation over a 10-day period were involved in this study. Each woman in the study was asked when she had last undergone a Papanicolaou smear-test. All women who were found to be "at risk", that is, who had not undergone a Papanicolaou smear-test in the previous two years (57% of those women who were asked) were offered cervical screening. Over-all about 50% of the women who were found to be "at risk" underwent a Papanicolaou smear-test at the general practitioner initiated request, either at the same consultation (26% of those "at risk") or on their return at a later date (23% of those "at risk"). Therefore, the intervention appears to have been effective in encouraging a relatively high-risk group of patients to undergo Papanicolaou smear-tests. However, the strategy was differentially effective depending on age: more women of less than 65 years of age underwent a Papanicolaou smear-test than did women of more than 65 years of age. The feasibility of using the intervention in everyday general practice depends on the willingness of medical practitioners to ask female patients to undergo a Papanicolaou smear-test, the ability to take a Papanicolaou smear during the consultation or soon after, and the acceptance of the invitation by women as based on an understanding of the need.     

Intussusception in children 2 years of age or older.

The hospital records of 111 children aged 2 to 15 years who were treated for intussusception between mid-1974 and mid-1984 were reviewed. Severe intermittent abdominal pain was the most consistent, and frequently the only, clinical feature. Hydrostatic reduction was almost as successful as in children under 2 years of age, and its success was independent of the duration of symptoms. Most cases were idiopathic, but lead points were common in children 6 years of age or older. There was an unexpectedly high recurrence rate, 20%. In all three children with lymphoma the signs and symptoms were clearly atypical and were suggestive of pre-existing disease. In the absence of suspicious clinical or radiologic findings, laparotomy to rule out lymphoma is not warranted.     

海南省甲肝疫苗安全性及有效性评价

目的 了解海南省甲型病毒性肝炎(甲肝)的发病动态及流行特征,评价2008年甲肝疫苗纳入免疫规划后,在海南省使用的甲肝疫苗预防接种的安全性和有效性,为预防接种实施和控制提供策略依据。方法 收集2005年以来不同时期海南省甲肝疫情、人口统计和接种资料及2010—2014年甲肝疫苗接种后疑似预防接种异常反应(adverse events following immunization; AEFI)监测资料,从甲肝发病率、疫苗保护率、异常反应发生率、临床类型等流行病学指标评价其有效性和安全性。结果 海南省2005—2014年甲肝发病率为1.04/10万~11.35/10万,年均发病率为4.20/10万;2005—2007年甲肝疫苗未纳入扩大免疫规划(Expanded Programme on Immunization,EPI)时期,共报告甲肝2 173例,总报告发病率8.69/10万;2008—2010年甲肝减毒活疫苗分地区纳入EPI过渡时期,共报告甲肝893例,总报告发病率为3.38/10万;2011—2014年甲肝减毒活疫苗完全纳入EPI期,共报告甲肝538例,总报告发病率为1.48/10万;2010—2014年甲肝疫苗年均接种率为99.67%,年均保护率为99.97%;2008—2014年海南省5岁以下儿童甲肝发病率与甲肝疫苗接种率呈高度负相关(r=–0.862)。接种甲肝疫苗后报告AEFI病例179例,其中减毒活疫苗169例,总发生率为2.65/万;灭活疫苗10例,总发生率为1.52/万;两者以一般反应(发热/红肿/硬结),绝大多数反应均为一过性;异常反应主要表现为过敏性皮疹,严重异常反应如过敏性休克和过敏性紫癜发生率等发生率均为0.03/万~0.06/万。结论 海南省将甲肝减毒活疫苗纳入儿童计划免疫推广应用效果显著,两种工艺甲肝疫苗安全性均较高,可继续推广应用。     

Immunogenicity and safety of a new inactivated hepatitis A vaccine in young adults: a comparative study

目的：评价一种国产甲型炎灭活疫苗对我国成年人的免疫原性、安全性和适宜剂量。方法：104名甲肝抗体阴性、乙肝表面抗原阴性、血清谷丙转氨酶正常的成年志愿被随机分为三组：一组接种1000u的国产灭活疫苗,一组接种500u的国产灭活疫苗,另一组接种1440ELISAu的贺福立适甲肝灭活疫苗。所有三组均在初免后6个月时加强免疫一次。对三组间的局部和全身反应、血清甲且抗体阳转率以及抗体几何平均滴度（GMT）进行比较。结果：虽然贺福立适组在初免后局部反应销多,在初免和加强免疫后,三个组的局部和全身反应发生率基本相似。末观察到严重的局部和全身反应。初免后一个月时,1000u组的甲且抗体阳性率为87.5％,高于贺福立适组50.0％的抗体阳转率（P=0.001）;6个月时,1000u组的抗体阳转率为96.9％,高于500u组的65.0％（P=0.0029）和贺福立适组的68.8％（P=0.007）;7个月（加强免疫后一个月）时,所有接种对象全部阳转。三组在初免后一个月时,抗体GMT为264mIU/ml,高于贺福立适组的135mIU/l,（P=0.0013）;7个月时为2747mIU/ml,既高于贺福立适组的1316mIU/ml（P=0.01）,也高于500u组的167mIU/ml(P=0.0224)。结论：国产甲肝灭活疫苗免疫原性良好并且是安全性的,成人每次接种1000u,按0,6月程序接种可以提供很好的保护作用。     

甲型肝炎灭活疫苗和冻干减毒活疫苗接种后1年的免疫原性研究

目的评价甲型肝炎灭活疫苗和冻干减毒活疫苗接种1剂1年后的免疫原性。方法采用单一中心随机双盲试验设计,对18月龄~4岁健康幼儿受试者随机接种1剂设盲的甲肝灭活疫苗或甲肝减毒活疫苗。接种前及接种后12个月,采用微粒子酶免法（MEIA）定量检测受试者甲型肝炎抗体（抗-HAV）。结果免疫后1年,甲肝灭活疫苗组和甲肝减毒疫苗组分别有124人和135人完成试验,抗-HAV阳转率分别为95.2%和91.1%,抗-HAV的几何平均浓度（GMC）分别为101.7 IU/L和65.5 IU/L,甲肝灭活疫苗免疫的抗体水平明显高于甲肝减毒活疫苗（P〈0.001）。结论接种1剂甲肝灭活疫苗或甲肝减毒活疫苗后12个月,均可产生良好的免疫效应,甲肝灭活疫苗免疫的抗体水平明显高于甲肝减毒活疫苗。     

聊城市乙肝疫苗免疫效果评价研究

目的评价聊城市开展阻断乙肝行动乙肝疫苗接种后的免疫效果。方法抽取本市3个县1 500人,对其中HBsAg、抗-HBs检测均为阴性的给予乙肝疫苗注射,于完成全程免疫后1个月进行抗原抗体检测。利用SPSS16.0统计软件进行统计分析。结果 HBsAg、抗-HBs检测均为阴性的为849人,不同地区、不同年龄组人群间乙肝疫苗免疫成功率差异有统计学意义。结论乙肝疫苗接种工作应进一步加强,对无应答者给予加强复种,并在健康人群中大力开展乙肝疫苗接种的相关健康教育工作。     

Direct costs of coronary artery bypass grafting in patients aged 65 years or more and those under age 65

BACKGROUND: Over the past 20 years, there have been marked increases in rates of coronary artery bypass grafting (CABG) among older people in Canada. The objectives of this study were to accurately estimate the direct medical costs of CABG in older patients (age 65 years or more) and to compare CABG costs for this age group with those for patients less than 65 years of age. METHODS: Direct medical costs were estimated from a sample of 205 older and 202 younger patients with triple-vessel or left main coronary artery disease who underwent isolated CABG at The Toronto Hospital, a tertiary care university-affiliated hospital, between Apr. 1, 1991, and Mar. 31, 1992. Costs are expressed in 1992 Canadian dollars from a third-party payer perspective. RESULTS: The mean costs of CABG in older and younger patients respectively were $16,500 and $15,600 for elective, uncomplicated cases, $23,200 and $19,200 for nonelective, uncomplicated cases, $29,200 and $20,300 for elective, complicated cases, and $33,600 and $23,700 for nonelective, complicated cases. Age remained a significant determinant of costs after adjustment for severity of heart disease and for comorbidity. Between 59% and 91% of the cost difference between older and younger patients was accounted for by higher intensive care unit and ward costs. INTERPRETATION: CABG was more costly in older people, especially in complicated cases, even after an attempt to adjust for severity of disease and comorbidity. Future studies should attempt to identify modifiable factors that contribute to longer intensive care and ward stays for older patients.     

60岁以上尿毒症患者肾移植的临床观察

目的：探讨高龄尿毒症患者尸体肾移植手术的适应证、免疫抑制剂的应用和T细胞亚群、ICAM—1对急性排斥的监测治疗及并发症的防治。方法：对37例60～71岁尿毒症患者进行尸体肾移植手术，术后进行各项指标监测。结果：1年人／肾存活率为83．8％／75．7％；3年为78．6％／67．9％，5年为72．2％／55．6％。急性排斥发生率为24．3％。结论：合理应用免疫抑制剂及监测和治疗急性排斥反应，降低术后并发症是提高高龄患者肾移植存活率的重要因素。     

无锡某社区14岁以下儿童乙肝疫苗接种及乙肝病毒感染情况调查分析

目的了解儿童乙肝疫苗接种及乙肝病毒（HBV）感染情况,为制定或调整乙肝疫苗接种策略提供依据。方法随机选取无锡市某社区534名1-14岁常住儿童作为调查对象,对其进行乙肝疫苗接种情况问卷调查,并通过酶联免疫吸附法（ELISA）检测血清中乙肝病毒表面抗原（HBsAg）、乙肝病毒表面抗体（抗-HBs）和乙肝病毒核心抗体（抗-HBc）三项指标。结果该社区1-14岁儿童乙肝疫苗接种率和首针及时接种率分别为97.75%和91.57%,6岁以下两组儿童乙肝疫苗接种率和首针及时接种率差异无统计学意义（P〉0.05）,7-14岁儿童乙肝疫苗接种率和首针及时接种率均低于1-6岁儿童（P〈0.01）;HBV感染率随年龄增长呈递增趋势,1-6岁儿童HBV感染率低于7-14岁儿童（P〈0.05）。结论近年来无锡市儿童乙型肝炎防治效果显著,加强儿童乙肝疫苗接种工作,特别是提高疫苗接种率对于防治HBV感染意义重大。     

甲型肝炎减毒活疫苗H2株免疫后3的血清学效果研究

目的研究规范化H2株甲型肝炎(简称甲肝)减毒活疫苗免疫学效果和抗感染能力.方法从3042名6～13岁儿童中筛选出甲肝病毒易感者1117名,将他们随机分为疫苗组和对照组.疫苗组在接种后6、36个月随机采样抽血检测血清甲肝抗体(抗-HAV).结果免疫后6个月抗体转阳率达92.8%,几何平均滴度(GMT)为14.68.免疫后36个月抗体阳性率为92.3%,GMT为12.75.免疫后36个月疫苗组感染率为16.4%,对照组感染率为13.1%,两组差异无显著性(x2=2.44,P》0.05).结论本疫苗具有良好的免疫原性.疫苗抗体可能只有抗发病能力,而无抗感染能力.     

Seroepidemiology of hepatitis E virus infection in Mexican subjects 1 to 29 years of age.

BACKGROUND: Hepatitis E virus (HEV) infection causes an acute, self-limited hepatitis associated with high mortality in pregnant women. Community-based surveys are scarce and information on HEV infection in populations is needed. The aim of this work was to study seroprevalence to HEV in young adults and children in Mexico, using a community-based survey. METHODS: Serum samples from 3,549 individuals were studied; the population included subjects from 1 to 29 years old from all regions of the country representing all socioeconomic levels. IgG anti-HEV was determined by ELISA. RESULTS: Anti-HEV antibodies were found in 374 (10.5%) individuals. Seroprevalence increased with age from 1.1% in children younger than 5 years to 14.2% in persons 26 to 29 years of age (p = 0.006). Risk factors for infection included living in rural communities and a low educational level. Seroprevalence was not associated with the level of regional development. CONCLUSIONS: HEV infection is endemic in Mexico. Age, type of community, and educational level were identified as risk factors for infection.     

Impaired serum antibody response to inactivated influenza A and B vaccine in cancer patients.

The serum antibody response to vaccination with bivalent inactivated influenza vaccine containing A/Port Chalmers/1/73 (H3N2) and B/Hong Kong/5/72 antigens was assessed in 44 patients with cancer and in 27 healthy control subjects. A fourfold or greater increase in antibody titre after vaccination occurred in 16 of the 44 cancer patients and 25 of the 27 controls for the A antigen, and in 14 of the 44 cancer patients and 20 of the 27 controls for the B antigen. Patients with lymphoma, who tended to have hypogammaglobulinemia, responded less well than did patients with solid tumours. Among the latter the failure to show a fourfold or greater increase in antibody titre correlated with a poorer 18-month survival.