Comparison of one- and two-dose regimens of influenza vaccine for elderly men.

In November and December 1984, 102 male residents of a long-term care facility (mean age 74.6 [extremes 59 and 97] years) received 0.5 ml of trivalent inactivated whole-virion influenza vaccine, containing 15 micrograms of the hemagglutinin of each of A/Philippines/2/82 (H3N2), A/Chile/83 (H1N1) and B/USSR/83. A second dose of the vaccine was administered to a subgroup of 55 randomly chosen subjects 8 weeks later. Serum samples were collected from all the subjects before and 4, 8, 12 and 16 weeks after administration of the first dose and were assayed for hemagglutinin-inhibiting (HAI) antibody to each of the three antigens. At 8 weeks there were significant increases (p less than 0.05) in the geometric mean titre of antibody and in the proportion of subjects with HAI antibody titres of 1:40 or more (except to the B/USSR antigen) in both groups. There were no differences between the groups at 8 weeks or at 16 weeks (8 weeks after administration of the second dose of vaccine) in the frequency of seroconversion, the geometric mean titre or the proportion of subjects with HAI antibody titres of 1:40 or more. Overall, 60%, 32% and 13% of the 102 subjects had titres of 1:40 or more to the A/Philippines, A/Chile and B/USSR antigens respectively at 16 weeks. The results suggest that a second dose of influenza vaccine given 8 weeks after the first does not enhance the immune response in elderly men and that a substantial proportion of this population remains unprotected against infection (having HAI antibody titres of less than 1:40) during the influenza season.     

Antibody response in school children to live rubella vaccine (Cendehill strain)

The efficacy of an attenuated rubella virus vaccine, Cendevax, was tested on 65 school children. Forty-nine of them (75%) had pre-existing antibodies and in these there was no increase in the HAI antibody titres after administration of the vaccine. Sixteen children (25%) had no demonstrable rubella HAI antibody prior to vaccination. From the latter group, postvaccination serum samples were available from only 11, and 10 of these seronegative children showed seroconversion after vaccination. The geometric mean HAI titre was 1:180. Seven of the 10 postvaccination serum samples had complement-fixing antibodies and specific IgM antibodies were detected by the immunofluorescence test in 8. No correlation was observed between the CF and the IgM antibodies.     

Evaluation of adverse events after influenza vaccination in hospital personnel.

Reactogenicity of trivalent influenza vaccine prepared for the 1988-89 season was assessed as part of a first-time voluntary influenza prevention program among hospital staff. Of approximately 500 full-time workers in areas with the highest concentrations of patients at high risk for influenza complications offered the vaccine 288 accepted. Of these, 266 (92%) returned a questionnaire regarding any symptoms experienced within 48 hours after vaccination; 238 (90%) of the respondents reported adverse effects. Soreness at the injection site was described by 229 subjects, 58 (25%) of whom had constant aching and 123 (54%) soreness with arm movement. Symptoms resolved in 1 to 2 days, and only 21 (9%) of those who reported symptoms said they took analgesic medication. Systemic adverse effects were described by 130 subjects (49%). Intercurrent illness accounted for some of these complaints, but 65 people (24%) described at least two of the following symptoms: generalized aching, tiredness, nausea, chills or onset of fever within 12 hours after vaccination (a symptom complex previously attributed to influenza vaccine). Systemic symptoms resolved within 0.5 to 2 days. Thirteen subjects (5%) reported missing work because of arm soreness (1 subject) or systemic symptoms (12). Adverse effects were encountered more often than expected, probably because most of the workers were young and lacked immunity to influenza. Acceptability of the program could likely be improved by using a split-virus vaccine.     

Low-dose intradermal vaccination of medical and dental students

In 454 medical and dental students who were vaccinated against hepatitis B by means of a low dose (0.1 mL) of serum-derived vaccine, seroconversion rates of 27%, 70% and 89% were obtained after the first, second and third doses, respectively. These figures are comparable with the results that have been reported for the conventional intramuscular schedule, as were the final antibody titres. A fourth intradermal dose boosted the percentage of students who were protected from 82% to 87%. There was a significant variation in the response to different batches of vaccine. This study shows that the low-dose intradermal method is practicable and effective and can be used to achieve great economy in hepatitis B vaccination programmes. The possibility of adding hepatitis B to the present formula of triple antigen should be investigated as a way of extending hepatitis B vaccination to all infants in our community.     

Rubella vaccination in Australia: 2. Experience with the RA27/3 rubella vaccine and results of a double-blind trial in schoolgirls.

RA27/3 rubella vaccine (Almevax) was used for the first time in Australia. The seroconversion rate was similar to that seen with Cendehill vaccine (Cedevax), but there were fewer subjects with low antibody titres after Almevax vaccine. Although Almevax vaccine was associated with a significantly higher incidence of sore throat, rash and joint involvement in seronegative adults, the incidence of side effects in a double-blind trial in schoolgirls was similar for the two vaccines, and the morbidity was low in both groups. Almevax vaccination successfully boosted low antibody titres in 11 of 14 women who had previously responded poorly to Cendevax vaccination. It would be difficult to differentiate the better vaccine for the schoolgirl programme. In some clinical situations, however, one vaccine has advantages over the other.     

季节性流行性感冒疫苗对儿童保护效果的病例一队列研究

目的评价2010—2011年度季节性流行性感冒疫苗对儿童的保护效果。方法选择2010—2011年度实验室确诊流感病例为病例组,在广州市12个区（县级市）采用整群抽样的方法选取子队列,对子队列随访1年无流感样症状的儿童组成子队列组,进行病例一队列研究。利用广州市免疫规划信息管理系统采集流感疫苗接种信息,采用COX比例风险模型分析。结果广州市有308例和774例儿童分别纳入病例组与子队列组,流感疫苗接种率分别为16．9％和36．0％。6-59月龄组、6—23月龄组和24～59月龄组免疫的保护效果分别为61．9％（95％CI：48．5,71.8）、59-3％（95％讲：39．2,72．7）、66．2％（95％CI：46．0,78．8）,免疫和完全免疫的保护效果均在55％以上,各年龄组完全免疫的保护效果优于部分免疫（Wdd=12．042,P=0．001）,但6—23月龄和24～59月龄组间的保护效果差异无统计学意义（Wa／d=3．784,P=0．052）。结论2010—2011年度流感疫苗对6—59月龄的儿童具有一定的保护效果,完全免疫的保护效果优于部分免疫,建议儿童全程接种流感疫苗。     

Outbreak of measles in a highly vaccinated secondary school population.

OBJECTIVE: To examine the factors associated with measles vaccine effectiveness and the effect of two doses of vaccine on measles susceptibility during an outbreak. DESIGN: Retrospective cohort study. SETTING: A secondary school in the City of Toronto. SUBJECTS: The entire school population (1135 students 14 to 21 years of age). MAIN OUTCOME MEASURES: Risk of measles during an outbreak associated with age at first measles vaccination, length of time since vaccination, vaccination before 1980 and whether date of vaccination was estimated; vaccine efficacy of one dose versus two doses. RESULTS: Eighty-seven laboratory-confirmed or clinically confirmed cases of measles were identified (for an attack rate of 7.7%). The measles vaccination rate was 94.2%, and 10% of the students had received two doses of measles vaccine before the outbreak. Among those who had received only one dose of vaccine, vaccination at less than 15 months of age was associated with vaccine failure (relative risk 3.62, 95% confidence interval 2.32 to 5.66). There was no increased risk of vaccine failure associated with length of time since vaccination once the relative risk was adjusted for age at vaccination in a stratified analysis. Vaccination before 1980 and an estimated date of vaccination were not associated with increased risk of vaccine failure. Administration of a second dose of vaccine during the outbreak was not protective. Two doses of vaccine given before the outbreak conferred significant protection, and the relative risk of failure after one dose versus two doses was 5.0 (95% confidence interval 1.25 to 20.15). Of the 87 cases, 76 (87%) could have been prevented had all the students received two doses of measles vaccine before the outbreak, with the first at 12 months of age or later. CONCLUSIONS: Delayed primary measles vaccination (at 15 months of age or later) significantly reduced measles risk at later ages. However, revising the timing of the current 12-month dose would leave children vulnerable during a period in which there is increased risk of complications. The findings support a population-based two-dose measles vaccination strategy for optimal measles control and eventual disease elimination.     

200例接种流感裂解疫苗安尔来福~（TM）安全性观察

目的评价流行性感冒（流感）裂解疫苗安尔来福TM（Influenzdvirus Split Vaccine,Inactivated;InfⅤ-sp）在儿童及未成年人中使用的安全性。方法对200名受试者进行流感裂解疫苗安尔来福接种后不良反应的临床观察,于接种疫苗后30min内和24、48、72h观察不良反应,直至不良反应消失。结果接种疫苗后不良反应发生率为11.0%,主要为轻度和中度反应。儿童组不良反应发生率为17.3%,未成年组不良反应发生率为4.2%。局部反应率为2.5%,全身反应发生率为10.5%,主要为发热、头痛、头晕、恶心、呕吐、腹痛及腹泻。结论本次的接种观察结果未见由疫苗引起新的不良反应,具有良好的临床安全性。     

Purified viral neuraminidase vaccine to control influenza.

The control of influenza by immunoprophylaxis is difficult because of the antigenic mutability of the influenza virus and the unpredictability of its epidemiologic behaviour. The inactivated whole-virus vaccine currently used is not ideal. Vaccination with pure neuraminidase is suggested. The induced antineuraminidase antibody will restrict viral invasion. Mild illness may or may not occur. On subsequent exposure to influenza virus the individual will produce antihemagglutinin and antineuraminidase antibodies and will be resistant to both infection and illness. Since antigenic changes are less frequent in the viral neuraminidase than in the viral hemagglutinin, the vaccine would be usable for longer periods than the presently used inactivated whole-virus vaccine.     

Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial

CONTEXT: Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older, the benefits for healthy adults younger than 65 years are less clear. OBJECTIVE: To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenza-like illness (ILI) and reducing societal costs of ILI among healthy working adults. DESIGN: Double-blind, randomized, placebo-controlled trial conducted during 2 influenza seasons. SETTING AND PARTICIPANTS: Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company (for 1997-1998 season, n = 1184; for 1998-1999 season, n = 1191). INTERVENTIONS: For each season, participants were randomly assigned to receive either trivalent inactivated influenza vaccine (n = 595 in 1997-1998 and n = 587 in 1998-1999) or sterile saline injection (placebo; n = 589 in 1997-1998 and n = 604 in 1998-1999). Participants in 1997-1998 were rerandomized if they participated in 1998-1999. MAIN OUTCOME MEASURES: Influenza-like illnesses and associated physician visits and work absenteeism reported in biweekly questionnaires by all participants, and serologically confirmed influenza illness among 23% of participants in each year (n = 275 in 1997-1998; n = 278 in 1998-1999); societal cost of ILI per vaccinated vs unvaccinated person. RESULTS: For 1997-1998 and 1998-1999, respectively, 95% (1130/1184) and 99% (1178/1191) of participants had complete follow-up, and 23% in each year had serologic testing. In 1997-1998, when the vaccine virus differed from the predominant circulating viruses, vaccine efficacy against serologically confirmed influenza illness was 50% (P =.33). In this season, vaccination did not reduce ILI, physician visits, or lost workdays; the net societal cost was $65.59 per person compared with no vaccination. In 1998-1999, the vaccine and predominant circulating viruses were well matched. Vaccine efficacy was 86% (P =.001), and vaccination reduced ILI, physician visits, and lost workdays by 34%, 42%, and 32%, respectively. However, vaccination resulted in a net societal cost of $11.17 per person compared with no vaccination. CONCLUSION: Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI, lost workdays, and physician visits during years when the vaccine and circulating viruses are similar, but vaccination may not provide overall economic benefits in most years. JAMA. 2000;284:1655-1663.     

Frequency of adverse reactions to influenza vaccine in the elderly. A randomized, placebo-controlled trial

Concern about side effects constitutes a major deterrent to patient compliance with influenza vaccination, yet there is a paucity of data about the occurrence of adverse reactions in the population targeted for immunization. We conducted a randomized, double-blind, crossover trial to compare the frequency of adverse reactions following administration of 1988-1989 trivalent split-antigen influenza vaccine and saline placebo. Outpatient veterans 65 years of age or over (n = 336) were recruited by mail and were randomly assigned to receive vaccine followed 2 weeks later by placebo injection or placebo followed 2 weeks later by vaccine. There was no significant difference between influenza vaccine and placebo with respect ot the proportion of subjects reporting disability or systemic symptoms.     

Influenza and pneumococcal vaccination: patient perceptions

The efficacy of the influenza vaccine in reducing mortality and hospital admissions is established, particularly in the elderly. However, up to 50% of those at risk do not receive the vaccine. These patients are also at risk from pneumococcal infection and there is considerable overlap between the target group for each vaccine. This study sought to identify at risk individuals from consecutive admissions to an acute geriatric unit and to gain an insight into their perceptions with regard to vaccination. The awareness of each vaccine was recorded, together with the vaccination history. Seventy four per cent of the final cohort had heard of the influenza vaccine, while only 13% had heard of the pneumococcal vaccine. Fifty per cent perceived themselves to be at risk from influenza and its complications and 87% of the cohort believed it to be a serious infection. Influenza vaccine was judged to confer good protection by 72% of the sample and yet up to 50% believed that the vaccine can make the recipient ill. Influenza is perceived as a serious infection by patients and yet many do not believe themselves to be at particular risk. Although influenza vaccination is believed to confer protection, the decision whether, or not, to accept the vaccine is coloured by many factors, including popular myths and anecdotal information from friends and relatives. The uptake of influenza vaccine is suboptimal and the awareness of the pneumococcal vaccine certainly in the elderly is poor. The need for a comprehensive nationwide education campaign promoting both influenza and pneumococcal vaccine is highlighted.     

Comparison of adverse reactions to whole-virion and split-virion influenza vaccines in hospital personnel.

OBJECTIVE: To compare the adverse effects, particularly generalized aching, of a trivalent, inactivated whole-virion vaccine (WVV) and split-virion vaccine (SVV) for influenza in hospital personnel. DESIGN: Recipient-blinded study; first-time vaccinees were randomly assigned to receive either of the vaccines from one manufacturer in the 1989-90 influenza season. Subjects were asked to complete a symptom questionnaire during the 48 hours after immunization. SETTING: Annual influenza program for staff of a tertiary care children's hospital. PARTICIPANTS: Volunteers were sought among approximately 2200 members of the hospital staff. Of the 358 vaccinated for the first time, 333 (93%) returned the questionnaire. RESULTS: During the 48 hours after vaccination 13% of the SVV recipients reported generalized aching, as compared with 26% of the WVV recipients (p less than 0.01). Also, the SVV group reported fewer visible local reactions and more transient arm soreness, but the actual differences between the two groups were small. The occurrence of mild symptoms was equally common in the two groups (local reactions in at least 70% of cases, systemic reactions in at least 33%). In each group 1% of the subjects reported missing work because of the vaccination. CONCLUSIONS: The use of SVV reduces the rate of the most objectionable of the common adverse effects of influenza vaccination. Therefore, as with children, it might be more acceptable to health care workers than the current use of WVV.     

2013—2019年流感季北京市住院老年人流感疫苗接种趋势分析

目的: 分析2013—2019年北京市≥60岁老年人流感疫苗接种情况,探究因不同疾病住院老年人的接种趋势变化。方法: 从2013—2019年北京市老年人流感疫苗接种信息登记数据库和2013—2019年北京市城镇职工基本医疗保险数据库分别提取老年人流感疫苗接种信息和住院信息后合并分析,比较因不同疾病住院的老年人的流感疫苗接种趋势,并描述2018—2019年流感季接种人群的分布情况。结果: 北京市因心血管疾病、脑血管疾病、呼吸系统疾病和糖尿病住院的老年人的流感疫苗接种率分别为14.6%、13.4%、13.4%和11.8%,其中因心血管疾病住院老年人连续六个流感年度接种率均保持在最高,因糖尿病住院人群流感疫苗接种率保持在最低且年均下降幅度最大(-7.85%)。2018—2019年流感疫苗接种人群分布情况在不同年龄、性别、住院结局和合并症严重程度中差异有统计学意义。在因4种疾病住院的老年人中,70~79岁老年人接种率均为最高,而60~69岁老年人接种率均为最低。在因呼吸系统疾病住院的老年人中男性流感疫苗接种率优于女性,而在因糖尿病或心血管疾病住院的人群则表现相反。住院结局较差的老年人接种率更低。糖尿病患者中无共病的接种率最低(7.9%)。结论: 北京市2013—2019年因不同疾病住院的≥60岁老年人流感疫苗接种率整体呈下降趋势,应重点关注糖尿病和60~69岁老年人群的流感疫苗接种,并开展更多流感疫苗保护作用研究以支持流感疫苗在慢性病人群中的普及。     

采用间接免疫荧光法监测流行性出血热疫苗接种3年后的人群抗体水平

目的：研究接种疫苗３年后人群抗体水平及间接免疫荧光抗体检测方法在流行性出血热免疫抗体检测中的应用。方法：采用间接免疫荧光法测定特异性ＩｇＧ抗体,并对２６６例血清样本进行分析。结果：全程接种与未加得抗体阳性率分别为７０．６３％,５９．７９％,并拍摄到抗原抗体免疫荧光结合物。结论：全程接种疫苗３年后人群抗体保持较高水平,加强接种后免疫效果更佳。     

宝安区三类重点人群甲型H1N1流感疫苗接种率及其影响因素的分析

目的:了解宝安区医务人员、中小学生及托幼机构人员三类重点人群甲型H1N1流感疫苗接种率及其影响因素。方法:在宝安区所辖的医疗机构、中小学校和托幼机构中随机抽取770名医务人员、1 549名学生和530名托幼人员作为调查对象进行匿名问卷调查。采用卡方检验分别对疫苗接种率的影响因素进行单因素分析。结果:医务人员甲型H1N1流感疫苗的接种率为55.03%,宝安区中小学生接种率为30.39%,托幼人员接种率为39.96%;三类人群未接种的主要原因是怕出现疫苗不良副反应,分别占39.10%、36.81%、39.10%;医务人员不同文化程度、医疗岗位、工作年限、是否知道甲流疫苗接种时间和近3年是否接种过季节性流感疫苗间存在统计学差异(P<0.05),学生年龄、监护人职业、是否知道甲流疫苗接种时间、是否认为甲流疫苗能预防甲流和近3年是否接种过季节性流感疫苗间存在统计学差异(P<0.05),托幼机构人员不同性别、文化程度、托幼岗位、工作年限和近3年是否接种过季节性流感疫苗间存在统计学差异(P<0.05)。结论:宝安区医务人员接种率高于中小学生和托幼机构人员,应加强对医务人员、中小学生和托幼机构人员三类重点人群甲流疫苗有效性、安全性和接种相关知识宣传。     

Seroconversion after hepatitis B vaccination in healthy young adults,and the effect of a booster dose

OBJECTIVE: Previous studies have shown that 5% to 15% of healthy people do not show a protective antibody response following hepatitis B vaccination. The study was done to determine the protective efficacy of vaccination in healthy young adults 1 to 4 years after the three dose vaccination series and to study the effect of a booster dose on non-responders and hypo-responders. DESIGN: Prospective intervention study. SETTING: From January to June 2000, Faculty of Medicine, University of Colombo. STUDY GROUP: 258 volunteers from five batches of medical students vaccinated with three doses of the recombinant vaccine at 0, 1 and 6 months. RESULTS: 9.5% were non-responders. Duration of vaccination, sex and body mass index were not significantly associated with anti-HBs levels. 28.6% had potential risk factors for acquiring HBV infection. 86.3% of non-responders developed protective anti-HBs titres after a booster dose. The persistent non-responders did not have a chronic illness or past HBV infection. CONCLUSIONS: A substantial number do not seroconvert after hepatitis B vaccination. Testing of blood for anti-HBs one month after vaccination is recommended to recognise non-responders as a booster dose will be beneficial in the majority of them.     

Targeting pneumococcal vaccination to high-risk groups: a feasibility study in one general practice

The Department of Health recommends pneumococcal vaccination opportunistically or when immunising against influenza. This was a study in one general practice to assess the feasibility of targeting patients for pneumococcal vaccination in primary care. We also examined the rate of uptake of pneumococcal vaccine in identified risk groups after one year of a pneumococcal vaccination programme. A self-administered questionnaire was given to patients attending for influenza vaccine between September and December 1996. A total of 551/747 (73.8%) patients returned completed questionnaires. Few patients receiving influenza vaccination (133/509, 26%) were aware of pneumococcal vaccine. Only 55/108 (51%) of those given influenza vaccination were in a clinical risk group for pneumococcal vaccine. Attitudes towards vaccination were more positive and intention to take up pneumococcal vaccination significantly greater in high-risk patients compared to those who were not in a risk group. A targeted vaccination campaign directed at high-risk patients, both opportunistically and those attending for influenza vaccination over one year, resulted in the following proportions of patients in at-risk groups being vaccinated: coronary disease 144/312 (46%), diabetes 79/132 (60%), splenectomy 2/2 (100%), chronic obstructive airways disease and asthma 135/700 (19%), and chronic renal failure 5/9 (56%). Most doses of pneumococcal vaccine (336/463; 73%) were delivered to patients in high-risk groups. We conclude that a well-organised pneumococcal vaccination campaign can improve coverage of at-risk patients in general practice. Programmes to increase patient awareness of the vaccine, improved availability of vaccine, and practice guidelines, would help to target the vaccine to at-risk patients. Patients with chronic lung disease and asthma were particularly difficult to define and target in this study. A review of the UK guidelines, aligning those for pneumococcal and influenza vaccination and including patients over 65 years, would improve the logistics of vaccine delivery.     

开封市500例儿童流感疫苗预防效果分析

目的：探讨开封市儿童流感疫苗预防效果及安全性,总结儿童流感疫苗的应用经验,提高免疫效果。方法：收集本市疾病控制中心预防接种流感疫苗的儿童500例作为观察组,同时选择同期健康随访的健康儿童500例作为对照组,观察组于上臂三角肌肌内注射流感疫苗0.5ml,对照组不接种流感疫苗。结果：两组儿童观察12个月流感症状发生率比较：观察组有流感症状23例,流感症状发生率4.6%,对照组有流感症状63例,流感症状发生率12.6%,两组比较差异有统计学意义（P〈0.05）。结论：流感疫苗对预防儿童流行性感冒有着积极的作用,应该提倡儿童积极进行接种。