505名医务人员接种甲型H1N1流行性感冒疫苗3个月内的免疫效果分析

Objective To investigate the immunization effect of influenza A/H1N1 vaccine in health care workers (HCW) in Inner Mongolia Greater Khingan Mountains area. Methods Five hundred and five HCW who received A/H1N1 influenza vaccination (immunized group) and 129 staffs who didn't receive the vaccination (unimmunized group) were randomly sampled for semiquantitative testing of serum H1N1 antibody (IgG) levels by enzyme-linked immunosorbent assay (ELISA).Results were analyzed and stratified by age, sex, occupation and the time interval between the time of vaccination and serum sample collection. The antibody positive rates of the two groups were compared by x2test. Results There were 401 (79. 4%) HCW whose H1N1 antibody were positive and 50 (9.9%) whose antibody were weak positive among 505 immunized HCW. While among 129 unimmunized HCW, there were 59 (45.7%) whose antibody were positive and 15 (11.6%) whose antibody were weak positive. The seroconversion rates of specific antibody were not significantly different among the different age groups after receiving A/H1N1 influenza vaccine (P＞ 0.05).However, there were statistical differences of the seroconversion rates among different sex groups (men 95.7% vs women 87.4% in immunized group, x2=6.40, P＜0.05; and men 73.3% vs women 52.5% in unimmunized group, x2 =4.07, P＜0.05) and different occupation groups (doctor 86.0% vs nurse 94.5% in immunized group, x2 = 9. 16, P＜0.01; and doctor 43. 8% vs nurse 75.0% in unimmunized group, x2=12.61, P＜0.01 ). The seroconversion rate was 81.5% after 80 to 89 days of vaccination, which was significantly lower than those after 30 to 39, 50 to 59 days and 60 to 69 days of vaccination, which was 100.0%, 94.7% and 93.6%, respectively (x2 =3.96, P ＜0.05; x2=7.15, P ＜0. 01; x2 = 9. 98, P＜0. 01). Conclusions A/H1N1 influenza vaccination can induce effective immune response in HCW in Greater Khingan Mountains area of Inner Mongolia. However,the level of specific antibody significantly reduces after 80 to 89 days of vaccination.     

北京市5岁及以上常住人口疫苗接种前新型甲型H1N1流感病毒人群抗体水平分析

Objective To explore the herd immunity against influenza A(H1N1)in pre-vaccinated residents aged over 5 years.and therefore to provide data for vaccination policies in high risk populations. Methods From October to December 2009,Beijing CDC conducted a serum survey of the hovel influenza A (H1N1) in the local residents,stratified in 10 age groups between 5 years to over 60 years,without H1N1 vaccination history and disease history.Hemagglutination inhibition (HI) assays were performed at Beijing CDC.Statistical significance was determined with geometric mean titer(GMT). Results 3499 serum samples were tested for HI antibody.The average level of HI antibody was 1:8.03.and 11.06%(387/3499)were sero-positive(HI antibody level≥1:40).In the group aged from 5 to 19 years,the level of HI antibody and the sero-positive rate were higber(HI antibody>1:8.9.sero-positive rate>12%). Conclusions The antibody levels in different groups were affected by age specific morbidity,and the higher antibody level of the school-age group was correlated with higher disease intensity in this population.The data showed that the herd immunity in Beijing was under the optimal level,but influenza A(H1N1)would probably become prevalent in the short coming future.     

北京市5岁及以上常住人口疫苗接种前新型甲型H1N1流感病毒人群抗体水平分析

Objective To explore the herd immunity against influenza A(H1N1)in pre-vaccinated residents aged over 5 years.and therefore to provide data for vaccination policies in high risk populations. Methods From October to December 2009,Beijing CDC conducted a serum survey of the hovel influenza A (H1N1) in the local residents,stratified in 10 age groups between 5 years to over 60 years,without H1N1 vaccination history and disease history.Hemagglutination inhibition (HI) assays were performed at Beijing CDC.Statistical significance was determined with geometric mean titer(GMT). Results 3499 serum samples were tested for HI antibody.The average level of HI antibody was 1:8.03.and 11.06%(387/3499)were sero-positive(HI antibody level≥1:40).In the group aged from 5 to 19 years,the level of HI antibody and the sero-positive rate were higber(HI antibody>1:8.9.sero-positive rate>12%). Conclusions The antibody levels in different groups were affected by age specific morbidity,and the higher antibody level of the school-age group was correlated with higher disease intensity in this population.The data showed that the herd immunity in Beijing was under the optimal level,but influenza A(H1N1)would probably become prevalent in the short coming future.     

上海地区2009年人群甲型流行性感冒病毒抗体水平检测分析

Objective To know the levels of antibodies against influenza A virus subtypes H1 and H3 of population in Shanghai during 2009, and the detection of antibodies against avian influenza virus subtypes H5 and H9 in population which contacts with avian. Methods The serological survey of the antibodies against influenza A viruses subtypes H1, H3, H5 and H9 in 356 close contacts with avian (professional population) and 332 general subjects (general population) at various age groups were carried out using hemagglutinin inhibit (HI) test. Results The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1) in general population and professional population were 82.8% (275/332) and 73.9% (263/356), respectively; those of A/Brisbane/10/2007 (H3N2)were 50.6% (168/332) and 54.8% (195/356), respectively. The positive rate of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 )was significantly higher than that of influenza A viruses subtype H3, which was consistent with etiological survey of influenza virus in Shanghai during 2008.The positive rates of antibodies against influenza A virus subtype H5 in professional population and general population were 4.2% (15/356) and 0.3% (1/332), respectively; those of influenza A virus subtype H9 were 34.6% (123/356) and 2.4% (8/332), respectively. The positive rates of antibodies against influenza virus A/Brisbane/59/2007 (H1N1 ) and A/Brisbane/10/2007 (H3N2) in age groups of 6 months-5 years and ≥60 years were lower than other age groups. Conclusions The immune protective response against seasonal influenza A subtype H1 and H3 of population in Shanghai is high,while those of children and the elders were low. The levels of antibodies against influenza A viruses subtype H5 and H9 in professinal population present obviously ascending trend, which indicates that the etiological and serological survey of influenza virus in this population should be enhanced.     

新型甲型H1N1流感聚集性发病患者的临床特点和诊治体会

Objective To describe the clinical characteristics of 3 community outbreaks of the novel influenza A (H1N1),and to compare the treatment effects of the traditional Chinese medicine with or without Oseltamivir. Method The clinical records of 234 patients in 3 community outbreaks of the novel influenga A(H1N1)infection in June (n=56),August (n=96)and October (n=82) of 2009 were analyzed,and the treatment effects of the traditional Chinese medicine with or without Oseltamivir were evaluated. Results The baseline characteristics,including age,temperature,indices of blood tests,hepatic and renal functions were distributed evenly between the 2 treatment groups.The overall analysis suggested that there was no significant difference between the 2 treatment groups in the duration of clinical symptoms(P>0.05),the duration of fever(P>0.05),and the hospitalization days(P>0.05).However,an analysis stratified by the temperature (≥39℃ or <39℃)suggested that patients treated by the traditional Chinese medicine with Oseltamivir tended to suffer a shorter duration of fever [40.5(37.3.42.0) vs 22.0(10.5,30.8)hr,P<0.01]]in the higher temperature group. Conclusions The traditional Chinese medicine was equivalent to oseltamivir in treating patients with the novel influenza A (H1N1) infection with lower temperature (<39℃).Oseltamivir was effective in shortening the duration of fever in patients with temperature higher than 39℃.     

新型甲型H1N1流感聚集性发病患者的临床特点和诊治体会

Objective To describe the clinical characteristics of 3 community outbreaks of the novel influenza A (H1N1),and to compare the treatment effects of the traditional Chinese medicine with or without Oseltamivir. Method The clinical records of 234 patients in 3 community outbreaks of the novel influenga A(H1N1)infection in June (n=56),August (n=96)and October (n=82) of 2009 were analyzed,and the treatment effects of the traditional Chinese medicine with or without Oseltamivir were evaluated. Results The baseline characteristics,including age,temperature,indices of blood tests,hepatic and renal functions were distributed evenly between the 2 treatment groups.The overall analysis suggested that there was no significant difference between the 2 treatment groups in the duration of clinical symptoms(P>0.05),the duration of fever(P>0.05),and the hospitalization days(P>0.05).However,an analysis stratified by the temperature (≥39℃ or <39℃)suggested that patients treated by the traditional Chinese medicine with Oseltamivir tended to suffer a shorter duration of fever [40.5(37.3.42.0) vs 22.0(10.5,30.8)hr,P<0.01]]in the higher temperature group. Conclusions The traditional Chinese medicine was equivalent to oseltamivir in treating patients with the novel influenza A (H1N1) infection with lower temperature (<39℃).Oseltamivir was effective in shortening the duration of fever in patients with temperature higher than 39℃.     

改良早期预警评分和SMART-COP评分预测重症甲型H1N1流行性感冒机械通气的临床研究

目的 评价改良早期预警评分(MEWS)和SMART-COP评分预测重症甲型H1N1流行性感冒(流感)患者机械通气的价值.方法 对资料齐全的50例甲型H1N1流感病毒性肺炎患者进行回顾性分析,计算MEWS、SMART-COP评分,使用受试者工作特征曲线(ROC曲线)计算曲线下面积(AUC).MEWS和SMART-COP AUC比较采用Z检验.结果 MEWS和SMART-COP评分预测患者机械通气的AUC分别为0.923和0.889,两者比较,差异无统计学意义(z＝0.548,P=0.584).结论 MEWS与SMART-COP评分对重症甲型H1N1流感患者需要机械通气有较好的预测价值.

Abstract：

Objective To evaluate the predictive value of modified early warning score (MEWS) and SMART-COP score on mechanical ventilation in patients with severe influenza A H1N1. Methods Fifty cases diagnosed with severe influenza A H1N1 were retrospectively analyzed. The MEWS and SMART-COP score were calculated. The area under the receiver operating characteristic (ROC) curve (AUC) was evaluated using ROC curve. MEWS, SMART-COP score and AUC were analyzed by Z test. Results The AUCs of MEWS and SMART-COP score for predicting mechanical ventilation were 0. 923 and 0. 889, respectively, which were not significantly different (Z=0. 548, P =0. 584).Conclusion Both of MEWS and SMART-COP score are predictive factors of mechanical ventilation in the patients with severe influenza A H1N1.     

甲型H1N1流感家庭内传播影响因素的病例对照研究

目的 探讨影响甲型H1N1流感家庭内传播的危险因素,为制定防控策略提供理论依据.方法按1:2的病例对照研究设计,通过"疾病监测信息报告管理系统"在北京市范围内选择符合条件的出现二代病例的家庭作为病例组,调查该家庭中的首发病例和二代病例;而未出现二代病例的家庭且与病例组中的病例相匹配的家庭作为对照组,调查确诊病例和与确诊病例接触频率最高的一位家庭成员.通过问卷调查,收集家庭成员的基本信息、发病及就诊情况和生活方式等.运用条件logistic回归方法分析家庭内感染甲型H1N1流感的危险因素.结果 单因素条件logistic回归分析结果显示,二代病例的文化程度、家庭人口数、家庭人均居住面积、首发病例就诊时间、最近1个月内是否出现流感样症状、是否与原发病例居住在同一房间、是否开窗通风、是否有勤洗手的习惯以及是否接种甲型H1N1流感疫苗等与感染甲型H1N1流感病毒有关.多因素条件logistic回归分析结果表明,二代病例的文化程度(OR=0.42)、是否与原发病例居住在同一房间(OR=3.29)、是否开窗通风(OR=0.28)、是否有勤洗手的习惯(OR=0.71)及是否接种甲型H1N1流感疫苗(OR=0.05)等因素与感染甲型H1N1流感病毒有关.结论 主动接种甲型H1N1流感疫苗、隔离传染源、定期开窗通风及注重个人卫生是控制甲型H1N1流感家庭内传播的重要手段.

Abstract：

Objective To explore the characteristics of transmission of pandemic influenza A/H1N1, and to analyze the possible factors of influencing transmission in families and to provide scientific evidence for formulating strategies of H1N1 prevention and control. Methods A 1∶ 2 matched case-control study was conducted. The case was defined as a household with 2 or more cases and the control was defined as that with 1 case. Face-to-face interview with questionnaire was used to collect information of work and family life of the study participants. Conditional logistic regression was used to analyze the data. ResultsUnivariate analysis showed that factors such as education level of the secondary case, the number of family members, per capita living space, flu-like symptom, insulation of case, ventilation, hand-washing, and influenza A/H1N1 vaccine immunization were all associated with infection of influenza A/H1N1. Results of multivariate logistic regression analysis showed that variables such as education level of secondary case (OR=0.42), insulation of case(OR=3.29), ventilation, (OR=0.28), hand-washing(OR=0.71), influenza A/H1N1 vaccine immunization (OR=0.05)were all correlated to infection of influenza A/H1N1. Conclusions Factors such as vaccine, insulation, ventilation, and hand-washing can help persons in protection from infection of influenza A/H1N1, suggesting the importance of good hygienic habit and immunization with influenza A/H1N1 vaccine.     

后程三维适形放疗联合紫杉醇化疗治疗老年人乳腺癌伴脑转移癌的临床观察

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.     

后程三维适形放疗联合紫杉醇化疗治疗老年人乳腺癌伴脑转移癌的临床观察

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.     

2009年北京市老年人甲型H1N1流感流行病学分析

目的 分析2009年北京市老年人感染甲型H1N1流感(甲流)分布特征.方法 采用描述性流行病学研究方法对2009年北京市老年人甲流进行流行特征分析.结果北京市老年人确诊甲流病例321例,确诊发病率为13.2/10万;11、12月份发病最多,占84.7%;地区分布中以近郊区分布最多,占53.0%;通过年龄分布分析发现,85岁以上年龄组发病率最高,为19.2/10万,并随着年龄增长病情有加重趋势(x2=7.24,P＜0.01);病例分型中轻症比例最高,占63.6%,重症和危重症病例占36.4%;轻、重、危重病例之间的体质指数(BMI)差异无统计学意义(x2=8.14,P=0.52);甲流病情有随着基础性疾病加重的趋势,病情程度与基础性疾病的数量有关(x2=123.0,P＜0.01).结论 北京市老年人甲流发病率较高,危重症比例较大,应是重点防控的人群之一.     

Th17淋巴细胞对甲型H1N1流行性感冒病毒清除作用的探讨

目的 探讨甲型H1N1流行性感冒(流感)患者Th17淋巴细胞表型、比例及其与病毒清除之间的关系.方法 将甲型H1N1流感患者70例、季节性流感患者30例、健康对照者68例分别纳入3组.通过细胞内染色,流式细胞技术测定3组人群外周血Th1、Th2、Th17、调节性T细胞(Treg)淋巴细胞比例;ELISA法测定血浆及外周血单个核细胞(PBMC)培养上清液中的IFN-γ、转化生长因子-β(TGF-β)、IL-6水平;RT-PCR检测鼻咽拭子甲型H1N1流感病毒载量.统计学方法采用单因素方差分析和线性相关分析.结果 甲型H1N1流感患者Th17淋巴细胞比例为(2.740±0.210)%,较健康对照者的(3.443±0.154)%及季节性流感患者的(3.443±0.277)%显著下降(F=4.242,P＜0.05),而3组间Th1、Th2、Treg淋巴细胞比例无明显差异;甲型H1N1流感患者血浆TGF-β水平为(10±8)ng/mL,较健康者的(43±32)ng/mL及季节性流感患者的(18±10)ng/mL显著下降(F=17.72,P＜0.01);甲型H1N1流感患者PBMC中TGF-β水平为(782±736)pg/mL,较健康者的(1462±315)pg/mL及季节性流感患者的(1481±348)pg/mL显著下降(F=5.730,P＜0.01);Th17淋巴细胞比例与病毒清除时间呈负相关(r=-0.38,P=0.02).结论 甲型H1N1流感患者Th17淋巴细胞比例显著降低,且与TGF-β水平密切相关,其降低可能导致机体延长排毒时间.     

Immunogenicity of influenza A(H1N1)pdm09 vaccine and the associated factors on lowered immune response in patients with hepatitis C

Background Patients with underlying disease represent a high‐risk group for influenza‐associated complications and hospitalization. However, few studies investigated the immunogenicity of influenza vaccine in patients with liver disease. Objective To examine immunogenicity of influenza A(H1N1)pdm09 vaccine in patients with liver disease and to explore the associated factors on lowered immune response. Patients/Methods A single subcutaneous dose of monovalent inactivated unadjuvanted split‐virus influenza A(H1N1)pdm09 vaccination was performed in 80 patients with chronic hepatitis C virus infection at Osaka City University Hospital in Japan. To measure the hemagglutination inhibition antibody titer, serum samples were collected before and 3 weeks after vaccination. Results No serious adverse events were observed. After vaccination, antibody titers ≥1:40 were observed in 56 patients (71%). The corresponding seroconversion proportion was 72%, and the mean fold rise was 10·3. Immune responses were robust regardless of severity of liver disease or existence of probable cirrhosis. However, patients with older age, lower body mass index, or receiving Stronger Neo‐Minophagen C tended to show lower antibody responses to A(H1N1)pdm09 vaccine. In addition, reduced immune responses were observed in patients who had received the 2009/10 seasonal vaccination prior to A(H1N1)pdm09 vaccination. Conclusions Single dose of A(H1N1)pdm09 vaccine achieved a sufficient level of immunity among patients with chronic hepatitis C. Antibody response may be affected by age, body mass index, Stronger Neo‐Minophagen C administration, and recent seasonal influenza vaccination.     

北京市5岁及以上常住人口疫苗接种前新型甲型H1N1流感病毒人群抗体水平分析

目的 了解北京市5岁及以上常住人口接种新型甲型H1N1流感(简称甲型流感)病毒疫苗前的人群抗体水平,为确定防控重点人群提供依据. 方法 2009年10至12月选择未接种疫苗、未明确诊断为甲型流感的北京市常住人口,按照年龄组进行分层,用血凝抑制试验检测新型甲型H1N1流感病毒抗体(简称抗体),使用抗体几何平均滴度进行不同人群的比较. 结果 共监测3499名调查对象,平均抗体水平为1:8.03,阳性率为11.06%(387/3499);5～19岁人群抗体水平和阳性率较高,其抗体水平均>1:8.9,抗体阳性率均>12%. 结论 不同人群抗体水平受该人群疫情流行强度的影响,学生人群抗体水平和阳性率高与学校疫情流行强度高有关;北京市采取的重点人群和全人群的免疫策略正确,但目前人群免疫力尚未达到理想状态,甲型流感仍有可能在北京市流行.     

儿童甲型H1N1流行性感冒病毒相关性肺炎的临床特征

目的 了解儿童甲型H1N1流行性感冒(流感)病毒相关性肺炎的临床流行特征.方法 通过描述性研究对2009年上海复旦大学附属儿科医院收治的30例甲型H1N1流感病毒所致肺炎的患儿做临床及流行病学分析.中位数比较采用秩和检验,率的比较采用精确卡方检验.结果 30例确诊为甲型H1N1流感合并肺炎的患儿中,年龄中位数为5.9岁,5例有基础疾病史,占16.7%.有明确发热病例暴露史的20例,占66.7%.所有患儿均有发热和咳嗽,11例伴气促,占36.7%,10例伴喘息,占33.3%.11例患儿WBC＜4.0×109/L,占36.7%,2例PLT减少,占6.7%.所有患儿入院时胸部X线片提示肺部有单侧或双侧片状渗出性病灶,4例危重症患儿肺部多处大片状渗出伴肺水肿,占13.3%,1例危重症肺炎患儿发病后3个月和9个月复查胸部CT提示不同程度肺纤维化,占3.3%,3例同时伴纵隔积气和皮下积气,占10.0%,6例并发急性呼吸衰竭,占20.0%,3例伴支气管哮喘急性发作,占10.0%,1例合并脑炎,占3.3%.所有患儿均给予奥司他书和抗菌药物治疗,4例接受机械通气,均治愈或好转出院.发病2 d内和2 d后接受奥司他韦治疗的患儿的热程中位数比较差异有统计学意义(2 d比5 d,Z=-8.015,P＜0.01).结论 学龄前和学龄儿童易感染甲型H1N1流感病毒,可并发严重的肺部疾病.在发病早期采用奥司他韦治疗,可缩短热程,降低危重并发症的发生.     

New live attenuated influenza A/England/42/72 (H3N2) vaccine (Alice): reactogenicity,, immunogenicity, and protection efficacy.

The Alice strain of influenza A/England/42/72 (H3N2) live attenuated vaccine, when given by the intranasal route to 133 volunteers, was relatively nonreactogenic; only 12% of the vaccinees had upper respiratory tract symptoms after immunization. Seroconversion in 87.2% of subjects whose titers of humoral hemagglutination-inhibiting antibody before immunization were less than 1:8 demonstrated the immunogenicity of the vaccine. The overall seroconversion rate was 66.1% (geometric mean titer of hemagglutination-inhibiting antibody, 1:40.9). Antibody levels were unchanged at six months in 95.5% and at 12 months in 91.7% of the vaccinees. Because of the lack of natural influenza A infection during the season monitored, an experimental challenge study with homotypic virus (influenza A/Udorn/307/72 [H3N2]) was conducted eight months after immunization of a sample population of 22 subjects. Twelve of these subjects were vaccinees whose titers of hemagglutination-inhibiting antibody were greater than or equal to 1:64, and 10 were unimmunized controls whose titers of hemagglutination-inhibiting antibody were less than or equal to 1:8. The group with titers of greater than or equal to 1:64 represented 40.2% of the immunized population. The vaccine was highly effective in this selected group, with a 91% protection efficacy against illness and a 100% rate of protection against illness associated with influenza A infection.     

轻型和重型甲型H1N1流行性感冒患者临床特征、病毒载量以及排毒时间分析比较

目的 了解轻型和重型甲型H1N1流行性感冒(流感)患者的临床和实验室特征、病毒载量及排毒时间.方法 对深圳地区70例轻型和16例合并肺炎的重型甲型H1N1流感患者采用实时荧光定量PCR方法,检测其甲型H1N1流感病毒载量.比较年龄＜14岁和≥14岁患者,以及轻型无肺炎和重型合并肺炎患者的病毒载量和病毒清除时间的差异.统计学方法采用t检验或卡方检验.结果 甲型H1N1流感患者最常见的临床表现是发热、咳嗽和扁桃体肿大.重型患者咳嗽、呼吸困难比例和最高体温较轻型患者显著增高(x2=10.9、14.3,t=3.65,均P＜0.01).重型患者WBC计数、ALT水平较轻型患者显著升高(t=3.2、2.4,均P＜0.05).重型患者胸部影像学类似间质性肺炎,多为磨玻璃样影.＜14岁患者的病毒载量和病毒清除时间较≥14岁的显著升高[(4.86±1.23)lg比(4.17±0.89)lg,t=2.3,P＜0.05]或延长[(5.33±0.49)d比(3.63±0.28)d,t=3.4,P＜0.01],重型患者病毒载量和病毒清除时间较轻型患者显著升高[(6.36±1.44)lg比(4.35±0.99)lg,t=6.1,P＜0.01]或延长[(5.75±1.77)d比(4.24±1.96)d,t=3.2,P＜0.01).结论 甲型H1N1流感患者年龄和病情严重程度与病毒载量和排毒时间存在显著相关性.     

Evaluation of a neuraminidase-specific influenza A virus vaccine in children: antibody responses and effects on two successive outbreaks of natural infection.

Three groups of children were immunized with an inactivated Port Chalmers (H3ChN2Ch) influenza vaccine (group A), a neuraminidase-specific (Heq1N2Ch) influenza vaccine (group B), or a placebo. Immunization induced seroconversion for H3Ch and N2Ch-specific antibody in group A and for N2Ch antibody in group B. The protective efficacies observed against naturally acquired illness with the Port Chalmers strain of influneza A virus were 68.7% and 37.4% in groups A and B, respectively, in comparison to the placebo group, and those against illness produced by the subsequent outbreak of the Victoria strain were 80.0% and 72.7%. These data support the role of neuraminidase-specific immunization in protection against influenza. Although the degree of protection after vaccination with the Heq1N2Ch vaccine was less than that provided by the biphasic H3ChN2Ch vaccine against the Port Chalmers strain, it appeared to be similar in the two vaccine study groups against the Victoria strain.     

2010年山东省人群甲型H1N1流感抗体血清学调查分析

目的了解2010年山东省人群甲型H1N1流感感染状况,为制定防控对策提供依据。方法以一般人群为调查对象开展个案调查,并采集血液标本,采用血凝抑制试验(HI)进行甲型H1N1流感病毒抗体检测,HI抗体滴度≥1︰40判为阳性。结果共调查13 602人,HI检测甲型H1N1流感抗体阳性3 219人,阳性率23.67%;2010年1月、3月和8月抗体阳性率分别为26.72%、18.42%和25.80%;人群流感抗体阳性率年龄、职业及区间差异有统计学意义(P<0.05)。结论山东省人群H1N1流感免疫保护水平有限,早期注射流感疫苗是保护重点人群的有效途径。     

An audit of influenza vaccination status in adults with inflammatory bowel disease

BACKGROUND

Several guidelines recommend influenza vaccination for high-risk patients, including those on immune-suppressing medications (IS).

OBJECTIVE:

To assess the vaccination status and immunization history of an outpatient inflammatory bowel disease (IBD) population for H1N1 and seasonal influenza.

RESULTS:

Among 250 patients, 104 (41.6%) had been immunized against H1N1 and 62 (24.8%) against seasonal influenza, and 158 (63.2%) were taking IS (azathioprine, 6-mercaptopurine, infliximab, adalimumab, methotrexate, cyclosporine or prednisone). Among subjects on IS, the presence of comorbidities warranting vaccination was associated with higher likelihood of H1N1 immunization (62.5% versus 35.8%; P=0.022) but not of seasonal influenza vaccination (25.0% versus 17.2%; P=0.392). Among patients without comorbidities warranting vaccination, IS was associated with a decreased likelihood of vaccination against seasonal influenza (17.2% versus 30.7%; P=0.036) but not H1N1 (35.8% versus 41.3%; P=0.46). The frequency of H1N1 vaccination was significantly higher among patients who visited a general practitioner at least once yearly (45.7% versus 20%; P=0.0027), with a similar trend for seasonal influenza vaccination (27.1% versus 12.5%; P=0.073). Among 91 patients on IS who declined vaccination, 39.6% reported fear of immediate side effects, 29.7% reported concerns about developing serious medical complications, 15.4% reported concerns about activating IBD and 15.4% were not aware that vaccination was indicated.

CONCLUSIONS:

Current strategies for vaccinating IBD patients on IS are inadequate. Primary care provider education, incentive programs and regular primary care contact may improve immunization uptake.