国产血源乙肝疫苗成人不同免疫程序的效果观察

<正> 血源乙肝疫苗成人免疫已有较多报道,多数认为效果比较满意。但由于使用剂量不同、方法不一,尚未取得一致意见。本文侧重血清学研究,并对免疫后抗-HBs 效价提出讨论。为制定国产疫苗成人免疫计划提供参考依据。 材料和方法 观察对象为20～54岁,其HBsAg、抗-HBs、抗-HBc(SPRIA法)三项均阴性的健康成年人。观察时间(T)为16个月(T_(0-16))。随机分三组:甲组54例,10μg次,T_0、T_1、T_6三次肌注;乙组72例,20μg/次,T_0、T_1二次肌注;丙组为未注射组。抗-HBs     

CpG ODN增强乙型肝炎表面抗原免疫小鼠的抗体产生

目的：探讨合成含CpG基序的寡核苷酸（CpG ODN)对重组乙型肝炎表面抗原（rHBsAg)及乙型肝炎疫苗增强小鼠特异性抗体产生的效应。方法：采用非纯系（Km)及纯系（Balb/c)小鼠作为免疫对象，经后腱胫骨前肌免疫2次，ELISA法检测血清乙型肝炎表面抗体（抗－HBs)效价。结果：加CpG ODN组，其抗-HBs效价均较单独注射rHBsAg和疫苗组明显增高，持续时间长，且纯系鼠的抗体效价明显高于非纯系鼠。结论：CpG ODN对小鼠抗－HBs产生具有增强作用，具与疫苗中的铝佐剂有协同效应。     

空肠弯曲菌外膜蛋白亚单位脂质体佐剂疫苗的免疫原性研究

目的 初步探讨自制的空肠弯曲菌（campylobacter jejuni）亚单位（M，28 000-31 000外膜蛋白）脂质体佐剂疫苗的免疫原性，为该疫苗的临床前研究打下基础。方法 用双向免疫琼脂扩散试验、试管凝集试验、ELISA（间接法）分别检测经GJ疫苗免疫后的新西兰兔血清IgG抗体效价。结果 GJ阴离子组与GJ阳离子组比较，血清IgG A值显著增高（P〈0．01），与GJ弗氏组无统计学差别（P〉0．1）；CJ阴、阳离子组脂质体疫苗接种剂量在0．50mg／kg时，血清IgGA值最大；CJ阳离子皮下注射组与肌肉注射组IgGA值无统计学差别（P〉0．1）；特异性IgG抗体经6个月动态观察，5个月后抗体效价下降。结论 实验组全程免疫后均有特异性抗体产生；同一剂量的阴离子脂质体疫苗比阳离子脂质体疫苗血清抗体水平显著增高；脂质体疫苗最佳接种剂量为0．50mg／kg，肌肉注射与皮下注射免疫效果无显著差异；特异性抗体高水平维持5、6个月后应加强免疫。     

空肠弯曲菌外膜蛋白亚单位疫苗的研制及免疫原性研究

目的 探索用脂质体包裹空肠弯曲菌(Campylobacter jejuni,CJ)Mr 28 000～31 000外膜蛋白制备安全、稳定、有效的CJ亚单位脂质体佐剂疫苗及其免疫原性、免疫剂量和途径.方法 采用薄膜-超声-冻融法制备阴离子脂质体(AL)、阳离子脂质体(CL)CJ疫苗后对其进行质量鉴定;用ELISA(间接法)检测经CJ疫苗免疫后的新西兰兔血清IgG抗体水平.结果 ①疫苗无菌试验及热原质试验均合格,均无明显不良反应;②阴、阳离子脂质体疫苗冻融前包裹率分别为32.1%、22.5%,冻融后分别是38.3%、28.4%;③CJ阴离子组比CJ阳离子组血清IgG的OD值显著增高(P<0.01),与CJ弗氏组无统计学差别(P0.1);CJ阴、阳离子组0.50 mg/kg的免疫剂量血清IgG的OD值最大;CJ阳离子皮下注射组与肌肉注射组IgG的OD值无统计学差别(P0.1);特异性IgG抗体经6个月动态观察,5个月后抗体效价下降.结论 ①采用薄膜-超声-冻融法制备CJ亚单位佐剂疫苗安全、稳定,冻融法可以提高脂质体疫苗包裹率;②同一剂量的阴离子脂质体疫苗血清抗体水平明显高于阳离子脂质体疫苗;③脂质体疫苗最佳接种剂量为0.50 mg/kg,肌肉注射与皮下注射免疫效果无显著差异;④较高水平的特异性抗体维持5个月,6个月后应加强免疫.     

新生儿乙型肝炎疫苗免疫后13年效果观察

目的 研究乙型肝炎的远期免疫效果。方法 采用单纯随机方法连续13年对1986年出生并接种乙型肝炎疫苗的儿童进行隔年随访,采血检测HBsAg、抗-HBs、抗-HBc。结果 13年间HBsAg阳性率在0.46%-0.97%之间,未随免疫时间的延长而上升,乙型肝炎疫苗的远期保护效果为81.67%,与近期免疫效果相当。结论 免疫后13年仍无需加强免疫。     

乙肝疫苗无（低）应答加大剂量再免疫效果分析

目的探讨乙肝疫苗接种后无（低）应答者加大剂量再免疫的效果,以提高乙肝疫苗预防接种的保护率。方法对近3年已完成标准乙肝疫苗免疫接种程序至少一年、复查乙肝病毒标志物均为阴性的健康人群,随机地接受3种再免疫方案,按常规程序（0、1、6个月）予肌肉注射。A组40例：进口重组乙肝疫苗（安在时）,每次剂量40μg;B组40例：安在时,每次剂量20μg;C组40例：国产重组乙肝疫苗,每次剂量20μg。在首针乙肝疫苗接种前及接种后第1、2、7个月（T1、T2、T7）采血检测抗-HBs。结果T1时,进口40μg组、进口20μg组和国产20μg组复种后应答率分别为45．0％（18／40）、37．5％（15／40）和30．0％（12／40）,3组应答率差异无统计学意义（χ^2=1．920,P=0．383）;T2和T7时,3组复种后应答率分别为67．5％（27／40）、47．5％（19／40）、40．0％（16／40）和77．5％（31／40）、55．0％（22／40）、50．0％（20／40）,进口40μg组应答率高于其余两组（χ^2为4．014～6．545之间,P均〈0．05）。T2和T7时,进口40μg组应答率差异无统计学意义（χ^2=1．003,P=0.317）。各组患者复种后均未出现严重副反应。结论对乙肝疫苗无（低）应答者增加疫苗剂量加强免疫是有效的措施,抗-HBs应答率随疫苗剂量增加而提高。进口40μg组加强2针即可,加强3针未能较加强2针明显提高抗-HBs应答率。     

GM—CSF促进乙肝病毒基因疫苗诱导的抗体产生

将构建的编码乙肝病毒PreS2+S蛋白的真核表达质粒注射于C57BL/6小鼠胫前肌内,3d后,在同一部位注射rhGM-CSF。基因疫苗接种2周后,血清中可测到抗-HBs,两月后,抗体水平达到高峰,并保持高水平至少2月以上;肌内注射GM-CSF可提高血清抗-HBs水平,提示GM-CSF可作为基因疫苗的佐剂。     

乙型肝炎病毒Ⅱ型感染的初步探讨

1978年先后在西非塞内加尔发现HBsAg阳性,而抗-HBc阴性的乙型肝炎患者,人体内单项抗-HBs阳性也不一定能保护机体免受HBV感染,从而表明了乙型肝炎疫苗免疫后所产生的高滴度抗-HBs不能防止一种新的乙型肝炎病毒感染。1987年将这种病毒命名为乙型肝炎病毒Ⅱ型(HBV_2)。我院于1992年～1996年对1800例乙型肝炎病人进行HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc检测,现将结果报告如下。     

分子佐剂C3d增强hCGβ基因免疫体液免疫效应

目的：该实验室前期工作已成功构建真核表达质粒pcDNA3-hCGβ、pcDNA3-hCGβ-C3d3且证明其能在真核表达系统中有效表达。通过动物DNA免疫，以期证实分子佐剂C3d增强免疫避孕疫苗免疫原性。方法：抽提与纯化pcDNA3、pcDNA3-hCGβ、pcDNA3-hCGβ-C3d3质粒，进行动物DNA免疫。免疫剂量分别为5、10、20pmol，共免疫2次，每次间隔3周。末次免疫后6周采血，用间接ELISA分析实验动物外周血抗hCGβ抗体效价。结果：C3d分子佐剂能明显提高抗hCGβ抗体滴度；且其作用呈剂量依赖性。结论：分子佐剂确实能增强hCGβ免疫原性；此结果将有助于免疫避孕疫苗的技术进步及实际应用。     

高致病性人禽流感H5N1疫苗滴鼻免疫应答效果的初步研究

目的 通过高致病性人禽流感H5N1全病毒-MF59佐剂疫苗滴鼻免疫Balb/c小鼠,评价该疫苗所诱导的系统免疫与黏膜免疫应答效果.方法 以不同剂量抗原按比例与MF59佐剂配伍制成粘膜疫苗,滴鼻免疫Balb/c小鼠,二免2周采血检测血清IgG、IgM效价及血清中HAI(HA inhibitor)的中和抗体效价,同时收集鼻、肺灌洗液,检测其lgG和slgA抗体效价.结果 H5NI+MF59组血清抗体效价较H5NI组有显著升高(P＜0.01);在各剂量组中,随着剂量的增加抗体效价呈上升趋势.12μg腭后抗体效价呈下降趋势,以HSNI+MF59(12μg)组效价最高;肺鼻灌洗液中,均可检测到特异性分泌型IrA、IsG,其中特异性分泌型IgA效价略高于IgG;抗体亚型的分布以IgG1、IgG2b为主.结论 灭活高致病性禽流感全病毒H5N1在佐剂MF59作用下可诱导机体产生体液免疫应答,同时还可以在黏膜局部产生特异性分泌型IgA、IsG,为高致病人禽流感病毒I-15N1黏膜疫苗的研制奠定了基础.     

High affinity human monoclonal antibodies directed against hepatitis B surface antigen

Peripheral blood mononuclear cells from donors immunized with hepatitis B vaccine (Pasteur Hevac B) were transformed with Epstein-Barr virus. Two polyclonal cell lines, producing antibodies to hepatitis B surface antigen were established and cloned. Seven clones were isolated; they secreted between 10 and 20 micrograms/ml of HBs specific IgG1 kappa or lambda antibody with anti-HBs titer of 300-800 IU/ml. These human antibodies expressed the anti 'a' specificities and had high affinity and avidity; their potential use as reagents for hepatitis B virus detection and for passive immunotherapy is under study.     

Vaccination against hepatitis B virus at the Lyon Pasteur Institute. A seven-year evaluation]

Results of immunization against hepatitis B among Pasteur Institute staff members are reported. Prior to immunization, 439 subjects were tested for hepatitis B virus (HBV) markers, including HBs antigen, anti-HBs antibody, and anti-HBc antibody (Ausria, Ausab, Corab assays; Abbott). Forty-seven subjects tested positive for anti-HBs antibody. 317 subjects negative for all the HBs markers studied were given three intramuscular doses of Hevac B (Pasteur vaccins) at one-month intervals. Anti-HBs antibodies were assayed after the third injection with the following results: mean titer, 1,454 mIU/ml, standard deviation, 5,349 mIU/ml, and range, 4 to 41,100 mIU/ml. Anti-HBs titers above 10 mIU/ml were found in 879.4% of subjects. Non-responders and weak responders (anti-HBs titer under 10 mIU/ml) were given a fourth dose of vaccine. Ultimately, after the last (third of fourth) injection 97.6% of subjects had protective antibody titers. No case of HBV infection was seen during the seven-year follow-up period.     

Reactogenicity, safety and immunogenicity of a recombinant bivaccine against smallpox and hepatitis B in limited clinical trials

The reactogenicity of the embryonic live recombinant variola and hepatitis B bivaccine as tablets (Revax-BT) as well as its safety and immunogenicity were evaluated in clinical trials made in volunteers who had previously immunized or not with variola vaccine. A preliminary conclusion was made on a lack of side effects and drug safety in primary vaccination and been revaccination with low and high doses. Primary immunization of volunteers and as bivaccination with high doses stimulated the most pronounced immune response to the vaccine virus versus such effect observed in immunization of volunteers with low vaccine doses. Humoral immune response to HBs was observed in 75% of volunteers of both groups after as bivaccination. Such response was most pronounced in examinees immunized with low vaccine doses versus those who received high bivaccine doses. At the same time, no protective levels of humoral immunity response to HBs Ag were observed in volunteers first vaccinated.     

Antibody persistence and immune memory in adults, 15 years after a three-dose schedule of a combined hepatitis A and B vaccine

A combined hepatitis A and B vaccine is available since 1996. Two separate open‐label primary studies evaluated the immunogenicity and safety of this hepatitis A and B vaccine (720 EI.U of HAV and 20 µg of HBsAg) in 306 healthy subjects aged 17–43 years who received three doses of the vaccine following a 0, 1, and 6 months schedule. These subjects were followed up annually for the next 15 years to evaluate long‐term persistence of anti‐HAV and anti‐HBs antibodies. The subjects whose antibody concentrations fell below the cut‐offs between Year 11 and Year 15 (anti‐HAV: <15 mIU/ml; anti‐HBs: <10 mIU/ml) were offered an additional dose of the appropriate monovalent hepatitis A and/or B vaccine. In subjects who received the additional vaccine dose, a blood sample was collected 1 month after vaccination. At the Year 15 time point, all subjects in Study A and Study B were seropositive for anti‐HAV antibodies and 89.3% and 92.9% of subjects in the respective studies had anti‐HBs antibody concentrations ≥10 mIU/ml. Four subjects (two in each study) received an additional dose of monovalent hepatitis B vaccine and mounted anamnestic responses to vaccination. No vaccine‐related serious adverse events were reported. This study confirms the long‐term immunogenicity of the three‐dose regimen of the combined hepatitis A and B vaccine, as eliciting long‐term persistence of antibodies and immune memory against hepatitis A and B for up to at least 15 years after a primary vaccination. J. Med. Virol. 84:11–17, 2011. © 2011 Wiley Periodicals, Inc.     

新生儿单纯乙型肝炎血源疫苗的免疫持久性和远期保护效果

目的 掌握我国新生儿单纯接种乙型肝炎血源疫苗后的免疫持久性和远期预防效果；观察新生儿免疫较长时间后是否需加强免疫。方法 在湖南湘潭市等4个乙型肝炎疫苗试点区间，对1986－1988年出生并接种乙型肝炎血源疫苗的新生儿，连续14－15年按免疫儿年龄分层随机抽样采血随访，累计随访21680人次，观察免疫儿HBsAg、抗－HBs和抗－HBc的动态变化。结果 新生儿单纯乙型肝炎血源疫苗全程基因免疫后，在15年随访中没有加强免疫，各试点区免疫儿童HBsAg携带率低于1．66％，携带率没有随免疫后的延长而增加；阻断HBV慢性感染的效果持续在90％左右（95％可信限为：83．1％－97．2％）；免疫后不同年限间HBsAg携带率、HBV感染率和保护效果差异均无显著性（P＞0．05）。免疫儿抗－HBs阳性率随免疫后年限延长而逐年明显下降，至第9－10年下降为40％－50％，之后数年内下降幅度不大，至免疫后13－14年抗－HBs阳性率维持在30％－42％；抗－HBs滴度下降了90％。结论 新生儿单纯乙型肝炎疫苗接种后抗－HBs阳性率与滴度的下降不影响其远期预防效果；就群体而言，新生儿及时完成全程免疫后，无需加强免疫可有效阻断HBV感染后成为HBsAg慢性携带者，而很有可能终生受益。     

Comparison of antibody- and cell-mediated immune responses after intramuscular hepatitis C immunizations of BALB/c mice

Current treatments for hepatitis C infection have limited efficacy, and there is no vaccine available. The goal of this study was to compare the immune response to several immunization combinations against hepatitis C virus (HCV). Six groups of mice were immunized at weeks 0, 4, and 8 with different combinations of a candidate HCV vaccine consisting of 100 microg recombinant HCV core/E1/E2 (rHCV) DNA plasmid and/or 25 microg rHCV polyprotein and 50 microL Montanide ISA- 51. Four weeks after the last injection, all groups of mice were sacrificed and blood samples and spleens were collected for measuring the levels of specific HCV antibodies (total IgG, IgG1, and IgG2a). Cell proliferation and intracellular interferon-gamma were also measured. Among the groups of immunized mice, only the mice immunized with rHCV DNA plasmid, rHCV polyprotein, and montanide (group D) and mice immunized with rHCV polyprotein and montanide (group F) demonstrated a significant increase in the total IgG titer after immunization. IgG1 was the predominant antibody detected in both groups D and F. No IgG2a was detected in any of the groups. Proliferation assays demonstrated that splenocytes from group D and group C (rHCV DNA primed/rHCV polyprotein boost) developed significant anti-HCV proliferative responses. The combination of an rHCV DNA plasmid, rHCV polyprotein, and montanide induced a high antibody titer with a predominance of IgG1 antibodies and recognized the major neutralization epitopes in HVR1. In contrast, group C did not show an increase in anti-HCV antibodies, but did show a proliferative response.     

Antibody responses of splenectomized patients with non-Hodgkin's lymphoma to immunization with polyvalent pneumococcal vaccines.

The serum antibody responses of splenectomized patients with non-Hodgkin's lymphoma (NHL) who had been immunized with a polyvalent pneumococcal vaccine (Pneumovax 23) were evaluated by an enzyme-linked immunosorbent assay with the 23-valent pneumococcal vaccine as the antigen. A response to immunization, defined as a twofold-or-higher rise of the prevaccination titer of antibodies against Streptococcus pneumoniae polysaccharide, was elicited in 5 of 11 patients with NHL. No significant difference in the level of antibodies against S. pneumoniae polysaccharide between lymphoma patients and patients who had undergone splenectomy for other reasons was detected (P = 0.83 and 0.87 before and after vaccination, respectively). NHL patients who did not respond to the first immunization received a booster dose of the polysaccharide vaccine. This injection did not increase the pneumococcal-antibody titer significantly (P = 0.7). We conclude that vaccination with pneumococcal polysaccharides in splenectomized patients with NHL elicits an adequate antibody response in 45.4% of the cases and should therefore be administered. Revaccination of the nonresponders does not further increase the pneumococcal-antibody levels.     

HBV and HCV infection in Japanese dental care workers

Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in dental care workers. To determine the best way to protect these workers, our study examined viral hepatitis infection in dental care workers in regions with a high prevalence of HCV infections in Japan. In total, 141 dental care workers (including dentists, dental hygienists and dental assistants) were enrolled. After a questionnaire to elicit demographic information was administered by an oral surgeon, hepatitis B surface antigen (HBsAg), antibody to HBs (anti-HBs), antibody to hepatitis B core antigen (anti-HBc) and antibody to HCV (anti-HCV) were measured. When necessary, HBeAg, anti-HBe, levels of HBV DNA, anti-HBc IgM and HCV RNA in serum were measured. Of the dental care workers included, 68 (48.2%) had been immunized with a HBV vaccine. Only 9 wore a new pair of gloves for each new patient being treated, 36 changed to a new pair only after the old gloves were torn and 24 did not wear any gloves at all. No one was positive for HBsAg or anti-HCV, though 73 (51.8%) and 17 (12.1%) workers were respectively positive for anti-HBs and anti-HBc. The positive rate of anti-HBc varied directly with worker age and experience. Of the 68 workers immunized with HBV vaccine, 51 (75%) were positive for anti-HBs. Of the 63 workers who were not so immunized, 17 (27%) were positive for anti-HBs and 15 of these were also positive for anti-HBc. Immunized workers were more protected against HBV infection than non-immunized workers, indicating that HBV vaccine was a useful measure for protection against the infection. The anti-HBc positive rate was significantly higher among dental care workers than general blood donors, suggesting that frequency of exposure to HBV was greater in dental care workers. HBV vaccination should be made compulsory for all dental care workers who handle sharp instruments.     

Prevalence of serum markers of hepatitis B and C virus in blood donors of Nouakchott, Mauritania]

This preliminary survey was intended to collect transversal data to ensure a better understanding of the hepatitis B and C epidemiology in Mauritania. The authors have studied the seroprevalence rate of HBs antigen and HCV antibodies among 349 blood donors. Data of this study showed that anti-HCV antibody was detected in 1.1% and HBs antigen in 20.3% blood donors.     

Long‐term immunogenicity of preservative‐free hepatitis B vaccine formulations in adults

Vaccination with recombinant hepatitis B vaccines is highly effective in preventing hepatitis B infection. Recently, a preservative‐free (PF) formulation of hepatitis B vaccine [GlaxoSmithKline (GSK) Biologicals, Rixensart, Belgium] has been licensed. The immunogenicity of the PF hepatitis B vaccine and antibody persistence 6 years later was assessed in this study. This formulation was compared with the preservative‐ containing (PC) formulation of the vaccine and a low‐preservative (LP) content formulation. Five hundred forty‐one healthy adult subjects were evaluated in the primary study. Over 94% of the subjects in the three study groups had seroprotective anti‐HBs antibody concentrations (≥10 mIU/ml) 1 month after completing primary vaccination. Antibody measurements in 242 healthy adults who returned for the follow‐up study and who had received primary vaccination 6 years earlier showed that over 81% of subjects in the three study groups still had anti‐HBs antibody concentrations ≥10 mIU/ml. No apparent differences in antibody decline or distribution between the study groups were observed. These results indicate that the removal of preservatives from the hepatitis B vaccine does not affect adversely its immunogenicity both in the short and in the longer term. J. Med. Virol. 81:1710–1715, 2009. © 2009 Wiley‐Liss, Inc.