2004～2010年蒙山县接种卡介苗发生淋巴结炎的原因分析

目的 分析蒙山县2004-2010年接种卡介苗发生淋巴结炎的原因,为减少卡介苗淋巴结炎的发生提供依据.方法 收集蒙山县接种卡介苗发生淋巴结炎资料进行流行病学方法分析.结果 对接种人员进行免疫规划技术培训前卡介苗淋巴结炎发生率为1.01%o,培训后专人接种前卡介苗淋巴结炎发生率为0.70%o,而专人接种卡介苗后,发生率为0.15%o.结论 通过对接种人员进行免疫规划技术培训和由专人负责卡介苗接种后,可以有效降低卡介苗淋巴结炎的发生率.     

2004～2010年蒙山县接种卡介苗发生淋巴结炎的原因分析

目的 分析蒙山县2004-2010年接种卡介苗发生淋巴结炎的原因,为减少卡介苗淋巴结炎的发生提供依据.方法 收集蒙山县接种卡介苗发生淋巴结炎资料进行流行病学方法分析.结果 对接种人员进行免疫规划技术培训前卡介苗淋巴结炎发生率为1.01%o,培训后专人接种前卡介苗淋巴结炎发生率为0.70%o,而专人接种卡介苗后,发生率为...     

接种卡介苗后淋巴结炎1例报告

目的总结卡介苗接种后发生1例淋巴结炎处置与体会。方法按预防接种异常反应调查规范对该儿童接种卡介苗后出现不良反应的事件进行调查和处理。结果发现1例儿童接种卡介苗后出现左侧腋下淋巴结脓肿,经预防接种异常反应调查诊断专家组调查诊断为卡介苗淋巴结炎。患儿淋巴结脓肿施行切开排脓,异烟肼纱布条引流、换药,45 d后痊愈。结论卡介苗接种后淋巴结炎是卡介苗接种中较为多见的接种异常反应,对此采用淋巴结脓肿切开排脓,异烟肼纱布条引流的方法简单、易行、有效。     

隆安县2010—2013年县直出生接种单位接种卡介苗发生淋巴结炎情况分析

目的了解广西隆安县2010—2013年县直出生接种单位接种卡介苗后发生淋巴结炎情况,提高该县卡介苗接种质量。方法通过收集隆安县201—2013年新生儿发生卡介苗淋巴结炎的个案调查表及各接种单位的疫苗使用报表,利用excel2003软件建立数据库进行统计分析。结果 2010—2013年三家县直医院接种卡介苗18462剂次,报告卡介苗淋巴结炎发生率为812.48/100万剂(15/18462);男性10例,女性5例;病例发生时间各不相同,最短为接种后35 d,最长为190 d,平均为接种后93.6 d;从病例发现到就诊时间,最短为发现后当天就诊,最长为180 d,平均为发现后23 d;各年间接种卡介苗后发生卡介苗淋巴结炎无差别;县人民医院卡介苗淋巴结炎发生率为1242.59/100万剂,高于其他县直医院的总发病率。结论接种人员接种卡介苗后要对家长进行告知;加强接种人员的培训,提高接种人员的理论知识和操作技能;加强接种现场的督导。     

卡介苗接种引起淋巴结炎12例临床分析

目的探讨卡介苗接种引起淋巴结炎发生的原因及预防方法。方法回顾分析1995--2010年门诊诊治的12例接种卡介苗后引起淋巴结炎病例,经诊断性穿刺,病检均为急性非特殊性淋巴结炎,分泌物结核杆菌培养均为阴性。结果12例患儿,经给患儿采用全面综合治疗,11例痊愈出院,1例患儿疗效不佳,转院治疗。结论接种前认真检查新生儿健康状况和提高卡介苗接种质量,是预防淋巴结炎的关键。接种卡介苗引起淋巴结核的可能性很小。     

一例卡介苗淋巴结炎诊断、治疗探讨

目的:为做好卡介苗淋巴结炎的监测、诊断、治疗、处理提供科学依据,对菏泽市一例卡介苗淋巴结炎诊断、治疗作一分析研究。方法 :根据该病例的疑似预防接种异常反应监测系统资料、疑似预防接种异常反应调查资料、预防接种相关资料、临床诊断治疗等资料进行分析研究。结果 :依据国家、省有关预防接种异常反应处置要求,本病例的最终诊断为卡介苗淋巴结炎。结论 :接种时未充分摇匀,皮内注射过深和受种者免疫状况可能是发病的主要原因,因此应严格执行卡介苗接种操作规程,接种时应充分摇匀,严防皮内注射过深,以减少卡介苗淋巴结炎的发生。对于严重的卡介苗淋巴结炎手术治疗是可行的,传统的药物保守治疗和手术治疗各有优缺点,应根据病情严重程度、家长意愿和医院治疗水平综合分析来决定治疗方法。     

2008—2015年田东县卡介苗疑似预防接种异常反应监测分析

目的 了解田东县卡介苗疑似预防接种异常反应(AEFI)发生的特征,评价卡介苗(BCG)预防接种的安全性.方法 通过中国免疫规划信息管理系统和广西免疫规划信息管理系统,收集2008—2015年接种后BCG AEFI个案和BCG接种数据,采用描述性方法对相关指标进行流行病学分析.结果 2008—2015年田东县共报告接种卡介苗后AEFI 15例,报告发生率为306.15/100万剂,其中不良反应15例,均属异常反应.报告最多的异常反应为BCG淋巴结炎,共14例(占93.33%),报告发生率为285.74/100万剂;部分批号BCG异常反应存在聚集性,以BCG淋巴结炎为主.结论 BCG安全性尚可,田东县BCG淋巴结炎反应报告发生率高于全国平均水平.应继续加强培训和督导,提高接种人员接种技术及BCG AEFI监测敏感性.     

接种卡介苗引起左腋窝淋巴结炎一例报告

一名新生儿预防接种卡介苗后引起左腋窝淋巴肿大。根据现场调查,综合分析患儿的接种、发病、治疗转归情况,符合预防接种异常反应遵循的一致性、特殊性、时间联系的因果关系,诊断结论为接种卡介苗引起的异常反应（淋巴结炎）。     

预防接种的反应处理

预防接种后由于机体受疫苗的刺激,可能出现某些正常反应,故在预防接种前应主动问病史,体检,并询问过敏史和免疫功能史。常见反应及处理方法如下:1接种卡介苗较常见的合并症是化脓性淋巴结炎2岁以下儿童的发生率是0.54%,反应发生率与接种用的卡介苗菌种、剂量、儿童的年龄、接种     

上海市卡介苗不良反应发生率调查

【目的】调查上海市卡介苗不良反应发生率和疾病特征,为制定本市卡介苗接种策略和预防卡介苗不良反应提供依据。【方法】采用两阶段随机抽样方法,在上海市4个区中抽取接种了卡介苗的1月龄新生儿,在其3、6、9、18月龄时各随访检查1次,观察是否发生不良反应,计算不良反应发生率。同时,对疑似卡介苗不良反应病例进行调查,分析疾病发生特征。【结果】2 411例新生儿完成随访观察,其中2例发生卡介苗不良反应,均为卡介苗淋巴结炎,不良反应发生率为8.30/万(1.39/万~27.41/万)。2例患者分别于接种卡介苗26 d和91 d后发现症状,经保守治疗后好转。【结论】主动监测的卡介苗不良反应发生率高于被动监测报告的发生率,未发现严重不良反应,上海市卡介苗接种安全性总体较好。     

婴幼儿接种卡介苗后30例淋巴结异常反应分析

目的分析婴幼儿接种卡介苗（BCG）后淋巴结异常反应的原因与处理方法。方法对2004年1月-2010年9月间武汉市医疗救治中心收治的30例接种BCG后淋巴结异常反应的患儿临床资料进行回顾性分析。30例患儿均于接种BCG3-6个月后接种侧腋下及锁骨上淋巴结肿大,胸片与血沉正常,PPD试验（＋）,均无全身结核中毒症状。结果 20例淋巴结直径≤4 cm的患儿仅给予异烟肼口服或加环形封闭治疗2-3个月痊愈;另3例淋巴结〉4 cm者行手术摘除。5例淋巴结化脓者在口服异烟肼治疗的同时,行穿刺抽脓、冲洗及并注入链霉素和异烟肼治疗,3-4周均痊愈。另2例有破溃者经切开排脓,冲洗、使用蘸有利福平粉的凡士林纱条引流及5%异烟肼软膏外敷治疗后痊愈。结论提高接种BCG的技术、接种质量和恰当处理BCG接种后的淋巴结异常反应,是预防与降低BCG接种后淋巴结异常反应发生率的关键措施。     

Vaccination of white-tailed deer (Odocoileus virginianus) with Mycobacterium bovis bacillus Calmette Guerín

Wildlife reservoirs of Mycobacterium bovis represent serious obstacles to the eradication of tuberculosis in domestic livestock. In Michigan, USA tuberculous white-tailed deer transmit M. bovis to cattle. One approach in dealing with this wildlife reservoir is to vaccinate deer in order to interrupt the cycle of deer to deer and deer to cattle transmission. Thirty-one white-tailed deer were assigned to one of three groups; 2 SC doses of 10(7)CFU of M. bovis BCG (n=11); 1 SC dose of 10(7)CFU of M. bovis BCG (n=10); or unvaccinated deer (n=10). After vaccination, deer were inoculated intratonsilarly with 300 CFU of virulent M. bovis. Gross lesion severity scores of the medial retropharyngeal lymph node were significantly reduced in deer receiving 2 doses of BCG compared to unvaccinated deer. Vaccinated deer had fewer lymph node granulomas than unvaccinated deer, and most notably, fewer late stage granulomas characterized by coalescent caseonecrotic granulomas containing numerous acid-fast bacilli. BCG was isolated from 7/21 vaccinated deer as long as 249 days after vaccination. In one case BCG was transmitted from a vaccinated deer to an unvaccinated deer. In white-tailed deer BCG provides measurable protection against challenge with virulent M. bovis. However, persistence of vaccine within tissues as well as shedding of BCG from vaccinates remain areas for further investigation.     

Loss of anti-mycobacterial efficacy in mice over time following vaccination with Mycobacterium bovis bacillus Calmette-Guérin

Mycobacterium bovis bacillus Calmette-Guérin (BCG) is the most often used vaccine worldwide and sole vaccine against tuberculosis. BCG is protective against severe form of childhood tuberculosis but less or not protective to adult pulmonary tuberculosis. Therefore, improved vaccination strategies and development of new tuberculosis vaccines are urgent demands. For those purposes, appropriate animal models that reflect human are critically useful. However, in animal models, BCG vaccination protects well against subsequent challenge of Mycobacterium tuberculosis. In this study we evaluated the duration of protective efficacy of the BCG vaccination in mice over time and found that efficacy was diminished 40 weeks after vaccination. The aged mice older than 45 weeks are protected sufficiently after the vaccination with BCG, suggesting that loss of its efficacy is not dependent on the age of mice but rather depends on the period from vaccination. The loss of protection occurred in TH1 polarized STAT6 deficient mice despite the maintenance of interferon (IFN)-gamma production activity of lymph node cells and splenic CD4⁺ T cells against M. tuberculosis antigens. Our data suggest that the duration from vaccination may explain the variation in BCG efficacy against adult pulmonary tuberculosis.     

Effect of cationic liposomes on BCG trafficking and vaccine-induced immune responses following a subcutaneous immunization in mice

While formulating Mycobacterium bovis BCG in lipid-based adjuvants has been shown to increase the vaccine's protective immunity, the biological mechanisms responsible for the enhanced potency of lipid encapsulated BCG are unknown. To assess whether mixing BCG in adjuvant increases its immunogenicity by altering post-vaccination organ distribution and persistence, mice were immunized subcutaneously with conventional BCG Pasteur or BCG formulated in DDA/TDB adjuvant and the bio-distribution of BCG bacilli was evaluated in mouse lungs, spleens, lymph nodes, and livers for up to 1 year. Although BCG was rarely detected in mouse livers, mycobacteria were found in mouse lungs, spleens, and lymph nodes for at least 1 year post-vaccination. However, at various time points during the 1 year study, the frequency of lung and spleen infections and the number of mycobacteria in infected organs of individual mice were highly variable. In contrast, mycobacteria were nearly always detected in the lymph nodes of vaccinated mice. While the frequency and extent of lymph node infections generally were not significantly different between mice vaccinated with adjuvanted or nonadjuvanted BCG preparations, multiparameter flow cytometry analysis of lymph node cells showed significantly higher frequencies of CD4+ and CD8+ T cells expressing IFN-γ and IFN-γ/TNF-α in mice immunized with adjuvanted BCG. Overall, our data suggest that the relationship between lymph node infection and the generation of anti-tuberculosis protective responses following BCG vaccination should be further investigated.     

新生儿接种卡介苗引发淋巴结强反应56例分析

目的总结56例卡介苗所致淋巴结强反应的临床表现,评价局部治疗效果。方法收集2010年1月-2014年5月结核病门诊56例由卡介苗所致淋巴结强反应患儿,根据其临床表现,分别给予热敷、清创引流及敷药等局部治疗,并分析疗效。结果 1)分型:结节未液化型7例,液化型20例,脓肿破溃型23型,术后伤口未愈者6例。2)疗效:7例未液化型经局部热敷,5例结节缩小,2例结节液化;22(20+2)例液化型经穿刺针吸及结节内注射异烟肼,均化脓破溃;45(23+22)例脓肿破溃型经清创引流,利福平外敷,伤口愈合;6例手术后伤口未愈者经清创引流、利福平外敷,伤口愈合。结论新生儿接种卡介苗所致淋巴结强反应临床表现多样,局部治疗效果好。     

Evaluating the sensitivity of the bovine BCG challenge model using a prime boost Ad85A vaccine regimen

In the absence of biomarkers of protective immunity, newly developed vaccines against bovine tuberculosis need to be evaluated in virulent Mycobacterium bovis challenge experiments, which require the use of expensive and highly in demand Biological Safety Level 3 (BSL3) animal facilities. The recently developed bovine BCG challenge model offers a cheaper and faster way to test new vaccine candidates and additionally reduces the severity of the challenge compared to virulent M. bovis challenge in line with the remits of the NC3Rs. In this work we sought to establish the sensitivity of the BCG challenge model by testing a prime boost vaccine regimen that previously increased protection over BCG alone against M. bovis challenge. All animals, except the control group, were vaccinated subcutaneously with BCG Danish, and half of those were then boosted with a recombinant adenoviral vector expressing Antigen 85A, Ad85A. All animals were challenged with BCG Tokyo into the prescapular lymph node and the bacterial load within the lymph nodes was established. All vaccinated animals, independent of the vaccination regimen, cleared BCG significantly faster from the lymph node than control animals, suggesting a protective effect. There was however, no difference between the BCG and the BCG-Ad85A regimens. Additionally, we analysed humoral and cellular immune responses taken prior to challenge for possible predictors of protection. Cultured ELISpot identified significantly higher IFN-ɣ responses in protected vaccinated animals, relative to controls, but not in unprotected vaccinated animals. Furthermore, a trend for protected animals to produce more IFN-ɣ by quantitative PCR and intracellular staining was observed. Thus, this model can also be an attractive alternative to M. bovis challenge models for the discovery of protective biomarkers.     

Assessment of safety and interferon gamma responses of Mycobacterium bovis BCG vaccine in goat kids and milking goats

Vaccination of domestic animals has emerged as an alternative long-term strategy for the control of tuberculosis (TB). A trial under field conditions was conducted in a TB-free goat herd to assess the safety of the Mycobacterium bovis BCG vaccine. Eleven kids and 10 milking goats were vaccinated with BCG. Bacterial shedding and interferon gamma (IFN-γ) responses were monitored throughout the study. Comprehensive pathological examination and mycobacterial culture of target tissues were performed.BCG vaccine strain was only isolated from the draining lymph node of the injection site of a kid euthanized at week 8 post-vaccination. The remaining animals were euthanized at week 24. Six out of 20 showed small granulomas at the injection site. BCG shedding was not detected in either faeces or in milk throughout the study. All vaccinated kids showed BCG-induced IFN-γ responses at week 8 post-vaccination.BCG vaccination of goats showed no lack of biological safety for the animals, environment and public health, and local adverse reactions were negligible.     

腹腔淋巴结结核诊疗中彩色多普勒超声的应用分析

目的:探讨腹腔淋巴结结核诊疗中彩色多普勒超声的应用。方法:选择腹部淋巴结结核60例彩色超声的病历资料进行回顾性分析。结果:60例腹部淋巴结结核患者中肿大淋巴结137枚。呈圆形肿大的占83.5%,内部回声呈低回声的占82.7%,弱回声的占17.5%;呈串珠样或融合成分叶状肿大团块的占16.2%,内部呈低回声的占59.3%,弱回声的占40.5%,全部病例包膜清晰,其中表面呈光环状及半光环状高回声的占73.4%,钙化的占26.7%。结论:腹部结核性淋巴结肿大的超声表现为表面呈光环状或半光环状高回声,圆形居多,少数融合成分叶状,内部回声不均匀且伴钙化,同时伴有多脏器结核。     

Enhanced immunogenicity of BCG vaccine by using a viral-based GM-CSF transgene adjuvant formulation

The failure of current BCG vaccine in controlling the global tuberculosis (TB) epidemic highlights an urgent need for improved TB vaccine formulations. In this study, we have investigated the effect of a novel adenoviral granulocyte macrophage-colony stimulating factor (GM-CSF) transgene-based adjuvant formulation (AdGM-CSF) on BCG vaccination in a mouse strain that is genetically weak responders to BCG vaccine. BALB/c mice were immunized subcutaneously (s.c.) with PBS, BCG, or BCG plus AdGM-CSF or control vector Addl70-3, the immunogenicity of BCG vaccine was evaluated by type 1 IFN-gamma production from lymphocytes of various lymphoid tissues upon mycobacterial antigen stimulation ex vivo. While mycobacterial antigen-specific IFN-gamma production was slightly enhanced by co-immunization BCG with Addl70-3 as compared to BCG immunization alone, a marked increase both in the magnitude and longevity of anti-mycobacterial type 1 immunity was observed in the local draining lymph nodes and spleens by immunization with AdGM-CSF-adjuvanted BCG. Furthermore, there was a significant increase in the number of mycobacterial antigen-specific IFN-gamma releasing CD4 T cells in mice immunized with AdGM-CSF-adjuvanted BCG vaccine. Consistent with these enhanced T-cell immunity and memory responses, AdGM-CSF-adjuvanted BCG vaccine significantly improved immune protection against secondary mycobacterial challenge. Our results suggest that GM-CSF transgene-based adjuvant formulation is an effective way to improve the immunogenicity of BCG vaccine.     

Immunogenicity and protective capacity of Mycobacterium bovis BCG after oral or intragastric administration in mice

After oral or intragastric administration of BCG to mice, comparable numbers of IFN gamma and TNF gamma producing cells were detected in both local (Peyer's patches) and central (spleen) lymphoid organs. Similar levels of precursors of CD8+ cytotoxic T lymphocytes specific for mycobacterial antigens were also found in the spleen and the mesenteric lymph nodes. These immune responses remained high over the course of 3 months, the duration of observation. Oral administration of BCG led to an enlargement of the cervical lymph nodes, which contained high levels of viable bacteria. In contrast, no adverse effects were observed in mice given the BCG via the intragastric route. These two routes of immunization induced similar levels of protective immunity to those observed in mice immunized via the subcutaneous route against a challenge with a virulent Mycobacterium tuberculosis strain (H37Rv).