2015年许昌市部分健康人群百日咳、白喉、破伤风抗体水平及免疫成功率监测

目的了解许昌市健康人群百日咳、白喉、破伤风免疫水平现状及百白破疫苗(DPT)免疫成功率,为制定DPT免疫策略提供依据。方法2015年5月对许昌市健康人群分8个年龄组抽取140名健康人群,用酶联免疫吸附实验(ELISA)检测血清中百日咳、白喉、破伤风抗体水平。免疫成功率监测选择未接种过DPT基础免疫的2月龄儿童30人作为观察对象,比较DPT基础免疫前后抗体水平及免疫成功率。结果调查140人,百日咳、白喉、破伤风的抗体阳性率分别为14.29%(20/140)、76.43%(107/140)、73.57%(103/140),不同年龄组百日咳、白喉、破伤风抗体阳性率差异均有统计学意义(P<0.01);完成DPT基础免疫(3次)后儿童百日咳、白喉、破伤风免疫成功率分别为3.33%、100.00%、100.00%。结论白喉、破伤风免疫效果良好,百日咳发病风险较高。     

吸附精制百白破混合制剂两针接种的血清学效果免疫持久性观察

预防百日咳、白喉、破伤风的方法是注射百白破混合制剂,共注射三针,吸附制剂注射两针,每针间隔一个月。于1978~1984年在江苏省东海县应用吸附精制百白破混合制剂进行两针注射观察。经血清学效果测定表明:白喉、破伤风、百日咳三种抗体均显著上升,且达到保护水平以上,百日咳抗体仅能维持六个月左右,一年后大多数低于保护水平,但经加强免疫后又能达到保护水平以上。基免三年至五年结果表明,两针免疫后白喉和破伤风可产生满意的血清学效果,百日咳抗体水平上升尚可。     

西安市无细胞百白破混合制剂免疫成功率观察

目的 了解在无细胞百白破混合制剂(新DPT)的免疫接种效果。方法 于2000年上半年,在我市部分门诊接种点,随机抽取零岁组健康婴儿84人,进行新DPT免疫成功率观察。结果 免前抗体保护率,百日咳、白喉为零,破伤风为2.38％;免后抗体保护率,百日咳、白喉、破伤风分别达42.86％、82.14％、100％。新DPT免疫成功率高于1998年志DPT免疫成功率。结论 新DPT是目前我国预防百日咳、白喉、破伤风发病的安全有效的换代产品。     

吸附百白破混合制剂不同针次免疫效果监测报告

为了解兴化市吸附百白破混合制剂(DPT)在儿童中的接种质量和效果,确保免疫成功,进一步推动计划免疫工作的规范化管理,我们于1999年对我市3个镇的适龄儿童在接种DPT前后随机采血,进行了百日咳、白喉、破伤风抗体水平监测,现报告如下:     

中国不同区域婴儿抗百日咳白喉破伤风母体抗体水平的调查

目的调查中国不同区域婴儿抗百日咳、白喉、破伤风母体抗体水平。方法在10年内分别在中国6个不同区域,对3月龄左右未接种过百白破联合疫苗(DPT)的健康婴儿体内抗百日咳、白喉、破伤风抗体水平进行了8次调查。分别检测了抗百日咳凝集原(Aggs)抗体1 602人,抗百日咳毒素(PT)和抗丝状血凝素(FHA)抗体790余人,白喉、破伤风抗体1 196人。结果未接种过DPT健康婴儿体内的抗百日咳Aggs抗体和抗PT、FHA抗体都分别<1∶320和<20EU/ml的保护水平;抗白喉、抗破伤风抗体水平都<0.01HAU/ml的保护水平,而且在婴儿群体中这种低抗体水平不随时间、不依城市或农村、发达地区或不发达地区而变化。结论DPT的初免月龄建议提前至2月龄,推广使用无细胞DPT,在低龄婴儿达到有效预防百日咳、白喉、破伤风的目的。     

常山县2008年百日咳、白喉、破伤风免疫成功率监测

百白破联合疫苗自（DPT）纳入免疫规划以后，百日咳、白喉、新生儿破伤风的发病率大大降低。为评价吸附百日咳、白喉、破伤风联合疫苗及其接种的质量和效果，我县在2008年进行了百日咳、白喉、破伤风免疫成功率监测，本文就2008年监测资料分析如下。     

2015年新建县948例入园儿童计划免疫效果评价

目的 了解入园儿童接种乙型肝炎(乙肝)、脊髓灰质炎(脊灰)、百日咳、白喉、破伤风疫苗(以下简称“五防”疫苗)后抗体阳性率与疫苗“首针及时接种率、全程接种率、全程及时接种率”的吻合程度,评价儿童预防接种效果和免疫状况。方法 选取2015年新建县长堎地区新近入园的948例儿童作为研究对象,利用间接ELISA法检测血清标本中抗体阳性水平,通过查验儿童预防接种证收集预防接种信息,并进行比较分析。结果 948例入园儿童中,脊灰、百日咳、白喉、破伤风抗体阳性率均超过90%,乙肝抗体阳性率低于65%。除城镇儿童白喉、破伤风抗体阳性率显著高于农村(P<0.05)外,性别、户籍、居住地对“五防”疫苗的抗体阳性率影响不大(P>0.05)。全程接种乙肝、百白破三联疫苗的入园儿童乙肝、白喉、破伤风IgG抗体阳性率显著高于未全程接种者(P<0.05)。首针、全程是否及时接种“五防”疫苗对入园儿童这5种IgG抗体阳性率的影响不大(P>0.05)。结论 948例入园儿童脊灰、百日咳、白喉、破伤风免疫效果较好,而乙肝抗体阳性率相比较低。全程接种率相比首针及时接种率和全程及时接种率对评价儿童乙肝、白喉、破伤风疫苗免疫效果更有意义,值得关注并推广。     

接种百白破疫苗的常见反应与处理

吸附百日咳疫苗、白喉和破伤风类毒素混合制剂称吸附百白破制剂(DPT)是世界卫生组织(WHO)扩大免疫规划规定使用的4种疫苗之一,用于预防百日咳、白喉和破伤风。DPT中的白喉和破伤风类毒素是一种异性蛋白成分,而百日咳菌苗的生物学形状也较复杂,故接种后可能对极少数人引起一些异常反应。本文对常见的DPT引起的一般反应与处理报告如下。     

深圳市健康人群白喉百日咳破伤风抗体水平监测

目的了解深圳市健康人群白喉、百日咳、破伤风抗体水平和百日咳-白喉-破伤风联合疫苗（Diphtheria,Tetanus,Pertussis Combined Vaccine：DPT）的免疫效果,为制订DPT免疫策略提供依据。方法百日咳抗体检测采用微量凝集试验法,白喉、破伤风抗体检测均采用间接血凝试验法。结果检测的650人中,白喉抗体阳性率为88．31％,保护率为87．38％,几何平均浓度（Geometric Mean Concentration,GMC）为0．2595IU／ml（国际单位／毫升）;破伤风抗体阳性率为71．54％,保护率为64．15％,GMC为0．5607IU／ml;百日咳抗体阳性率为92．77％,保护率为37．23％,几何平均滴度为1：156．87。结论儿童完成DPT基础免疫后,1．5-2岁DPT加强免疫和小学一年级学生白喉．破伤风联合疫苗（Diphtheria,Tetanus Combined Vaccine;DT）加强免疫收到了良好的效果。因抗体水平随着年龄的增长呈下降的趋势,〉10岁以后抗体明显下降,故需对初中一年级学生、高中三年级学生或大学新生、成人接种降低抗原含量的DT进行加强免疫。     

江苏省健康人群百白破免疫水平和儿童免疫成功率监测

目的:了解江苏省健康人群百日咳、白喉、破伤风免疫状况,评价江苏省吸附百白破三联制剂(DPT)的免疫效果。方法:用百日咳微量凝集方法、白喉间接血凝方法和破伤风间接血凝方法,进行百日咳、白喉、破伤风抗体水平及免疫成功率监测。结果:2005年全省4个年龄组445份健康人群白喉、破伤风保护率较高,分别为79.33%、75.74%,百日咳较低为46.44%。采集免疫前免疫后标本各122份,白喉、破伤风、百日咳免疫成功率分别为98.36%、100.00%、97.57%。结论:江苏省健康人群对白喉、破伤风已经形成了较好的免疫屏障,儿童百白破基础免疫成功率较高,人群对百日咳的免疫力还有待提高,必要时可开展重点人群的强化免疫。     

The use of mixed diphtheria-pertussis-tetanus antigens

The author reviews the use of mixed diphtheria-pertussis-tetanus antigens in the light of the information which has become available in recent years. When diphtheria toxoid and tetanus toxoid, adsorbed or unadsorbed, are added to either plain or adsorbed pertussis vaccine, a satisfactory level of diphtheria antitoxin can be obtained in children over 6 months of age and of tetanus antitoxin in children of any age. As to the duration of immunity, it appears that provided three doses of mixed antigens are given for the primary immunization of children 6 months old a substantial proportion will have effective antitoxin titres three years later, but that with two doses only the antitoxin levels fall more rapidly.     

Simultaneous vitamin A administration at routine immunization contact enhances antibody response to diphtheria vaccine in infants younger than six months

A randomized, double-blind, placebo-controlled trial was conducted to evaluate the effect of simultaneous vitamin A supplementation and diphtheria, pertussis and tetanus (DPT) vaccination on the antibody levels. Infants aged 6-17 wk (n = 56) were randomly given 15 mg oral vitamin A or placebo at the time of their DPT immunization. Three such doses were given at monthly intervals. Immunoglobulin (Ig) G antibodies to diphtheria, pertussis and tetanus were assayed on enrollment and 1 mo after the third dose. Baseline antibody concentrations to diphtheria, pertussis and tetanus did not differ between the vitamin A-supplemented and placebo-treated groups. The postdose antibody to diphtheria level was significantly greater in the vitamin A than in the placebo-treated group. The geometric mean +/- SEM antibody levels (mg/L) were 22.9 +/- 1.2 and 11.0 +/- 1.3 in the vitamin A and placebo groups, respectively (P = 0.029). The postsupplementation concentrations of antibodies to pertussis and tetanus did not differ between the two groups. These results suggest that antibody response to diphtheria vaccination was potentiated by simultaneous vitamin A administration and DPT immunization.     

Adequate immune response to tetanus toxoid and failure of vitamin A and E supplementation to enhance antibody response in healthy children

The effects of vitamin A and vitamin E supplementation on the IgG response to tetanus toxoid after primary immunization were evaluated in a prospective, randomized controlled clinical trial involving 89 healthy infants with normal serum vitamin A and E levels at 2 months of age. Before the first dose of DPT vaccine, the infants were randomly enrolled into four different study groups [Group I (n=24): 30,000 IU vitamin A for 3 days just after each three doses of primary vaccination, Group II (n=21): 150 mg oral vitamin E for only 1 day after the injections for primary immunization, Group III (n=21): vitamins A and E together in the same order, Group IV (n=23) no vitamin after DPT vaccines]. Serum tetanus antitoxin (IgG) titres were measured three times; initially at 2 months of age before the first dose of DPT, secondly at 5 months of age 1 month after primary immunization and thirdly at 16-18 months of age before the booster dose of DPT. Before the first dose of the DPT vaccine, 1 month after the third DPT injection and at 16-18 months before the booster dose of DPT, there was no significant difference in serum tetanus antitoxin levels between these four groups. A significant increase was observed in all the groups when serum tetanus antitoxin levels before (2 months) and after (5 months) primary immunization were compared. In addition, serum antibody levels against tetanus significantly decreased in the four groups before booster vaccination. Before the beginning of primary immunization, 15 infants (16.8%) had serum tetanus antitoxins (IgG) below protective level. After three doses of DPT, all the infants had protective antitoxin levels. At 16-18 months of age before booster dose, four infants (10%) also had serum tetanus antitoxins (IgG) below the protective level. No side-effects were observed except bulging fontanelle in two infants in Group I.     

Immunogenicity of a low-dose diphtheria,tetanus and acellular pertussis combination vaccine with either inactivated or oral polio vaccine compared to standard-dose diphtheria,tetanus, acellular pertussis when used as a pre-school booster in UK children: A 5-year follow-up of a randomised controlled study

This serological follow up study assessed the kinetics of antibody response in children who previously participated in a single centre, open-label, randomised controlled trial of low-dose compared to standard-dose diphtheria booster preschool vaccinations in the United Kingdom (UK). Children had previously been randomised to receive one of three combination vaccines: either a combined adsorbed tetanus, low-dose diphtheria, 5-component acellular pertussis and inactivated polio vaccine (IPV) (Tdap–IPV, Repevax^®; Sanofi Pasteur MSD); a combined adsorbed tetanus, low-dose diphtheria and 5-component acellular pertussis vaccine (Tdap, Covaxis^®; Sanofi Pasteur MSD) given concomitantly with oral polio vaccine (OPV); or a combined adsorbed standard-dose diphtheria, tetanus, 2-component acellular pertussis and IPV (DTap–IPV, Tetravac^®; Sanofi Pasteur MSD). Blood samples for the follow-up study were taken at 1, 3 and 5 years after participation in the original trial (median, 5.07 years of age at year 1), and antibody persistence to each vaccine antigen measured against defined serological thresholds of protection.All participants had evidence of immunity to diphtheria with antitoxin concentrations greater than 0.01 IU/mL five years after booster vaccination and 75%, 67% and 79% of children who received Tdap–IPV, Tdap + OPV and DTap–IPV, respectively, had protective antitoxin levels greater than 0.1 IU/mL. Long lasting protective immune responses to tetanus and polio antigens were also observed in all groups, though polio responses were lower in the sera of those who received OPV.Low-dose diphtheria vaccines provided comparable protection to the standard-dose vaccine and are suitable for use for pre-school booster vaccination.     

Humoral immunity 10 years after booster immunization with an adolescent and adult formulation combined tetanus, diphtheria, and 5-component acellular pertussis vaccine

Persistence of antibodies after a single dose of Tdap vaccine (tetanus, diphtheria, and 5-component acellular pertussis vaccine) was evaluated in a follow-up study of adolescents (N=324) and adults (N=644) who had received Tdap in earlier clinical trials. Outcome measures were seroprotection (tetanus and diphtheria) or seropositivity (pertussis) and geometric mean concentrations. Humoral immune responses to all antigens were robust 1 month after initial immunization, decreased at subsequent measurements, but continued to exceed pre-immunization levels 1, 3, 5, and 10 years later. Protective levels of diphtheria and tetanus antitoxin persisted in 99.3% of adolescents 10 years after a booster dose of Tdap. Seropositivity to 1 or more pertussis antigens also persisted in most adolescents for 10 years. Although tetanus antitoxin responses were similar in adults to those observed in adolescents, diphtheria antitoxin titers were lower, reflecting the fact that a smaller proportion of adults had received diphtheria toxoid in the previous 10 years compared to adolescents. These data will contribute to the selection of the optimal interval for repeat doses of Tdap.     

Long-term anti-rabies antibody persistence following intramuscular or low-dose intradermal vaccination of young Vietnamese children

Vietnamese children received purified Vero cell rabies vaccine 1 year after a primary series (Y0) and again 5 years later (Y5), either as intramuscular or 1/5th dose intradermal injections concomitant with diphtheria, tetanus, pertussis and oral poliomyelitis vaccines. Antibody levels were assayed annually for 5 years. All subjects in both groups had anti-rabies antibody titres considered protective after the Y0 booster. Rabies seroprotection rates and geometric mean titres gradually decreased similarly in both groups. Seroprotection after the Y5 booster was 100% in both groups. Satisfactory immunogenicity, long-term antibody persistence and an anamnestic response were conferred by both routes, greatly simplifying any future post-exposure prophylaxis.     

Humoral immunity 5 years after booster immunization with an adolescent and adult formulation combined tetanus, diphtheria, and 5-component acellular pertussis vaccine

Persistence of antibodies following a single dose of Tdap vaccine (tetanus, diphtheria, and five-component acellular pertussis vaccine for use in individuals past childhood) was evaluated in a follow-up of adolescents (N=324) and adults (N=644) who had received Tdap in earlier clinical trials. Outcome measures were seroprotection (tetanus and diphtheria) or seropositivity (pertussis) and geometric mean titers. Humoral immune responses to all antigens were robust 1 month after initial immunization; antibodies exceeded pre-immunization levels 1, 3, and 5 years later. These data will contribute to selecting the optimal interval for booster doses of Tdap.     

Serological evaluation of poliomyelitis oral and inactivated vaccines in an urban low-income population at Rio de Janeiro, Brazil

Oral and inactivated poliomyelitis vaccines (OPV and IPV), were given to 160 children two months old, in a low income population at Rio de Janeiro. The vaccination was repeated 2 and 4 months later, always in association with diphtheria, tetanus and pertussis (DPT) vaccine. Blood specimens were collected before vaccination at the time of the third dose of vaccine and later at the time of measles vaccination, when the children were nine months old. The serological response to two doses of IPV showed high titres of antibody in all but one child and 100% conversion after three doses. Although poliomyelitis has been controlled in Brazil by the use of OPV in large mass campaigns, the results obtained with IPV support the possibility of its use in the basic immunization schedule, providing lower costs could be achieved for the inactivated vaccine.