全球应对流行性感冒大流行的疫苗策略

2009年4月墨西哥出现一种新的甲型H1N1流行性感冒(简称流感)暴发,并在短短的2个月内传播到全球.6月11日世界卫生组织(WHO)把流感大流行警戒级别提升为最高的6级,表明世界正处在2009年流感大流行的开端[1].     

流行性感冒大流行的变迁

人们开始真正认识到流行性感冒（简称流感）给人类健康造成的巨大危害始于1918年的西班牙流感大流行。然而,在科技和经济飞速发展的今天,尽管流感的防治措施较百年前有了质的飞跃,其发病率及死亡率依然维持在一定水平,并造成严重的社会负担。此文对流感病毒的致病性、危害及防治措施的变迁进行回顾和总结。     

流感大流行及其应对策略

内容：介绍流感病毒的特点、危害、流行情况、流感的预防与治疗、世界卫生组织制定的“国家流感大流行计划指南”以及流感信息相关国际机构的网址。目的：引起人们对未来流感大爆发的普遍关注，便于流感相关信息的查询，为我国预防医学工作者应对可能爆发的流感疫情提供参考。     

北京市某区医院应对流行性感冒大流行救治能力的现状

目的了解和分析北京市某区医院应对流行性感冒(流感)大流行准备现状,为制定流感大流行应对策略和措施提供基础信息。方法 2010年4月12—23日由接受过培训的疾病预防控制部门工作人员按照统一的调查表对辖区内18家医疗机构进行问卷调查。结果全区有10家发热门诊能正常运转;16家二级以上医院呼吸相关科室平均医护人员比例为1∶1.64,其中13家不足1∶2;16家有病床的医院呼吸相关科室病床占全院病床的比例为11.51%;14家医院有ICU病房,其中8家医院ICU病床占全院病床比例低于2%;10家三级医院中有4家ICU病房呼吸机数量与病床数之比不低于100%;18家医院均无负压隔离病房,13家有普通隔离病房;5家可以开具神经氨酸酶抑制剂类药物。结论全区发热门诊数量和呼吸相关科室病床数不足;ICU病床数占全院病床数比例偏低:抗病毒药物储备不足。目前全区医院应对流感大流行能力有限。     

全球电子烟流行情况及应对策略

目前,人们对电子烟本身的知晓率较高,但对于使用的相关健康知识知晓率较低。社交网络是人群知晓电子烟的主要途径;世界各国的数据均显示,电子烟的使用普遍,且使用的主要原因是戒烟、减少烟害、预防复吸以及好奇心、产品设计时尚等。应对策略包括从电子烟的认知情况入手,弥补电子烟健康教育的缺口;从电子烟使用的原因入手,加快电子烟监管的进程;从电子烟使用的影响因素入手,寻找电子烟防控的着力点,降低电子烟的使用率。     

全球电子烟流行情况及应对策略

  目的  了解中国在校青年电子烟使用情况及其风险因素,为落实控烟目标提供实证参考。  方法  于2022年9月 — 2023年3月,采用多阶段分层整群抽样方法在华北、长三角、珠三角和西南等4个地区的13个城市抽取 ≥ 15岁在校青年2 405人进行电子烟使用现状和相关因素分析。  结果  受访对象使用电子烟人数为153人（6.36%）,其中曾经和现在使用电子烟者分别为110人（4.57%）和43人（1.79%）;首次使用年龄均值为（15.92 ± 2.03）岁;使用时友伴人数均值为（2.10 ± 1.34）人。多因素非条件logistic回归模型结果显示,男性（OR = 4.81,95%CI = 3.24～7.15）、心理压力得分较高（OR = 1.63,95%CI = 1.15～2.33）、半年内遭遇失恋等情感问题（OR = 2.82,95%CI = 1.89～4.21）、失去朋友等友谊问题（OR = 1.67,95%CI = 1.17～2.38）和较高的可支配零用钱（OR_800～1500 = 1.90,95%CI = 1.23～2.95;OR _{> 1500} = 2.22,95%CI = 1.44～3.41）是受访青年使用电子烟的风险因素,而父母在婚状态（OR = 0.44,95%CI = 0.29～0.67）则是约束受访青年使用电子烟的保护性因素。  结论   我国受访青年电子烟使用率较低,性别、心理健康状况、生活负性事件经历、消费能力和家庭关系稳定性是受访青年电子烟使用行为的主要影响因素。     

流行性感冒疫苗

在过去的 10年里 ,随着使用疫苗预防流行性感冒 (流感 ) ,并使用抗流感药物的增加 ,人们逐渐认识到这些措施对健康及社会经济产生了有利影响。在很多国家由于人们寿命的延长 ,使得更多的人患并发症的危险性增加 ,这在流感流行期间给卫生系统造成了很大的负担。同时 ,随着国际间交流的增加 ,也增大了病毒流行的可能性 ,因此人们需要新的预防和治疗流感的方法。本文主要是帮助健康工作权威人士每年为国家制定预防流感的策略 ,包括一切可减少流感发病率、死亡率和严重症状的方法 ,另外还指出目前需加强监测 ,以提供关于流感的更多的数据 ,特别…     

流行性感冒疫苗

1 背景甲型和乙型流行性感冒(流感)病毒都是重要的呼吸道病原体,但甲型是引起高病死率的大规模流行的主要原因.世界各地均有流感发生,每年全球的罹患率大约是成人5%～10%、儿童20%～30%.在气候温和的地区,流感爆发主要在冬季;而在热带地区,流感的发生较难预测.     

流感大流行与应对策略分析

20世纪人类发生了三次全球性流感大流行,即1918年西班牙型流感（H1N1亚型）、1957年亚洲型流感（H2N2亚型）和1968年香港型流感（H3N2亚型）.其中第一次流感大流行,在短短的6-9个月时间内席卷了全球,全世界有20%的人口--4亿人感染,死亡4千万至5千万,超过了第一次世界大战的死亡人数,成为人类传染病史上最大的灾难.目前,全世界正面临着禽流感大流行的威胁,人们更关心是否有可能由此引发席卷全球的人类流感大流行.     

A global pandemic influenza vaccine action plan

In case of an influenza pandemic, the world will be in a situation where potential vaccine supply will fall short by several billion doses from global needs. The World Health Organization (WHO) convened in Geneva on May 2-3, 2006 a consultation of all stakeholders in influenza vaccines and immunization to identify practical solutions to fill this gap. The consultation resulted in a global action plan outlining promising specific strategies to increase influenza vaccine production and surge-capacity before and during an influenza pandemic. Although the timing and severity of the next influenza pandemic cannot be predicted, vaccines are considered the one of the most important medical interventions for reducing morbidity and mortality if and when such an event occurs. Despite this acknowledged role, current limitations on influenza vaccine manufacturing capacity mean that, should a pandemic virus emerge in the near future, vaccine supplies would fall short of the anticipated global demand by several billion doses. Concern about this situation was formally acknowledged in May 2005, when the World Health Assembly approved a resolution [1] on strengthening pandemic influenza preparedness and response. That resolution called on the World Health Organization (WHO) to seek solutions with international and national partners, including the private sector, to reduce the present global shortage of influenza vaccines. More specifically, the resolution asked WHO to look at strategies for economizing on the use of antigen and transferring production technologies from industrialized to developing countries. In response to this request, WHO convened a consultation from 2-3 May 2006 attended by representatives of the major stakeholders in the area of influenza vaccines and immunization. The consultation had two main objectives: (1) To prepare a global action plan with specific short-, medium-, and long-term activities designed to increase influenza vaccine production and surge-capacity, to identify key obstacles and driving forces, and to estimate funding needs.(2) To strengthen the engagement and collaboration of key partners and stakeholders.     

Technology transfer hub for pandemic influenza vaccine

Increase of influenza vaccine production capacity in developing countries has been identified as an important element of global pandemic preparedness. Nevertheless, technology transfer for influenza vaccine production to developing country vaccine manufacturers has proven difficult because of lack of interested technology providers. As an alternative to an individual provider–recipient relationship, a technology and training platform (a “hub”) for a generic non-proprietary process was established at a public sector European manufacturer's site. The conditions for setting up such a platform and the potential applicability of this model to other biologicals are discussed.     

Seasonal split influenza vaccine induced IgE sensitization against influenza vaccine

Although anaphylaxis is an extremely rare vaccine-associated adverse event, it occurred in young children following administration of the 2011/12 seasonal split influenza vaccine, which contained 2-phenoxyethanol as the preservative. These children had high levels of IgE antibodies against influenza vaccine components. We herein investigated why these children were sensitized. One hundred and seventeen series of serum samples were obtained immediately before, and one month after the first and second immunizations with the HA split vaccine of 2011/12. Forty-two sequential serum samples were collected in the acute and convalescent phases (2 and 4 weeks) after natural infection with H1N1 Pdm in 2009. IgE antibodies developed following the vaccination of young children with seasonal split vaccines, whereas no significant IgE response was observed following natural infection with H1N1 Pdm 2009. The prevalence of IgE antibodies was not influenced by outbreaks of H1N1 Pdm. Repeated immunization with the HA split vaccine induced IgE sensitization against the influenza vaccine irrespective of the H1N1, H3N2, or B influenza subtypes. The reasons why anaphylaxis only occurred in recipients of the influenza vaccine containing 2-phenoxyethanol are still being investigated, and the size distribution of antigen particles may have shifted to a slightly larger size. Since the fundamental reason was IgE sensitization, current split formulation for the seasonal influenza vaccine needs to be reconsidered to prevent the induction of IgE sensitization.     

The development of vaccine viruses against pandemic A(H1N1) influenza

Wild type human influenza viruses do not usually grow well in embryonated hens’ eggs, the substrate of choice for the production of inactivated influenza vaccine, and vaccine viruses need to be developed specifically for this purpose. In the event of a pandemic of influenza, vaccine viruses need to be created with utmost speed. At the onset of the current A(H1N1) pandemic in April 2009, a network of laboratories began a race against time to develop suitable candidate vaccine viruses. Two approaches were followed, the classical reassortment approach and the more recent reverse genetics approach. This report describes the development and the characteristics of current pandemic H1N1 candidate vaccine viruses.     

Protection of trivalent inactivated influenza vaccine against hospitalizations among pandemic influenza A (H1N1) cases in Argentina

The aim of this study was to estimate the effectiveness of 2009 seasonal trivalent inactivated vaccine in reducing hospitalizations due to the novel influenza A H1N1 virus among positive cases. Data collected from Argentina's national epidemiological surveillance system were analyzed. All patients had a clinical diagnosis and underwent positive serological tests for pandemic influenza A H1N1. Logistic regression was used to estimate vaccine effectiveness to prevent severe cases of the disease, measured as hospitalizations. The adjusted effectiveness of the vaccine was 50% (95% CI: 40–59%). Vaccination was significantly associated with hospitalizations in all age groups, and within groups that had and had not received antiviral treatment. These results suggest that seasonal influenza vaccine might have conferred partial protection against severe cases due to the novel pandemic influenza.     

Development of pandemic influenza vaccine production capacity in Viet Nam

The Institute of Vaccines and Medical Biologicals (IVAC), a state-owned vaccine manufacturer, initiated research into avian influenza vaccines in the early 1990 s in response to the threat of a highly pathogenic avian influenza pandemic. Successful results from laboratory studies on A(H5N1) influenza virus attracted seed funds and led to participation in the WHO technology transfer project to enhance influenza vaccine production in developing countries. IVAC's goal is to produce 500,000 doses of inactivated monovalent whole-virion influenza vaccine per year by 2012, and progressively increase capacity to more than 1 million doses to protect essential populations in Viet Nam in the event of an influenza pandemic. The WHO seed grants, supplemented by other international partner support, enabled IVAC to build in a very short time an influenza vaccine manufacturing plant under Good Manufacturing Practice and relevant biosafety standards, a waste treatment system and a dedicated chicken farm for high-quality eggs. Much of the equipment and instrumentation required for vaccine production has been installed and tested for functional operation. Staff have been trained on site and at specialized courses which provided comprehensive manuals on egg-based manufacturing processes and biosafety. Following process validation, clinical trials will start in 2011 and the first domestic influenza vaccine doses are expected in 2012.