The immunological effect of revaccination with Bacille Calmette-Guérin vaccine at 19 months of age

Background

Bacille Calmette-Guérin (BCG) vaccination has important non-specific immune effects. In a randomized trial in Guinea-Bissau, BCG revaccination was associated with significantly increased survival in children who received diphtheria-tetanus-pertussis (DTP)-booster vaccine before enrolment and in children who did not receive micronutrient supplementation (MN). Within the trial we assessed the immunological effects of BCG revaccination.

Methods

Children were randomized to BCG or nothing. Blood was sampled 6–11 weeks after randomization (early sample group) or 5–9 months later (late sample group). In vitro cytokine responses (interferon (IFN)-γ, interleukin (IL)-13, tumor-necrosis-factor (TNF)-α, and IL-10) were assessed in whole blood cultures stimulated with lipopolysaccharide (LPS), purified protein derivative (PPD) or phytohaemagglutinin (PHA). Effect-modification by sex, DTP-booster vaccination and MN was studied.

Results

Cytokines were measured in 345 infants. BCG was associated with significantly increased IFN-γ (geometric mean ratio (GMR) = 4.54 (95% confidence interval: 3.13–6.58)) and IL-13 (GMR = 1.43 (1.00–2.05)) PPD responses, the effect being strongest in the early sample group. Across all three conditions BCG tended to increase IL-10 (LPS, PHA, PPD: GMR = 1.20, 1.12, 1.20), most pronounced in the late sample group. BCG reduced the TNF-α/IL-10 ratio in boys with DTP-booster at bleeding and increased it in those without (interaction test: p = 0.03). In children without MN, BCG was associated with reduced TNF-α response in the early sample group (p = 0.006), and increased IL-10 in the late sample group (p = 0.03).

Conclusion

BCG revaccination resulted in a strong IFN-γ response to PPD, which waned slightly over time. BCG also affected the pro-/anti-inflammatory balance, with reduced TNF-α and increased IL-10 responses to LPS, PHA and PPD. This effect depended on sex, DTP-booster vaccination and micronutrient supplementation, being most pronounced in children who had received DTP-booster before enrolment and children who had not received MN, i.e. the group of children which also had lower mortality after BCG revaccination.     

The influence of BCG vaccine strain on mycobacteria-specific and non-specific immune responses in a prospective cohort of infants in Uganda

Background

Globally, BCG vaccination varies in efficacy and has some non-specific protective effects. Previous studies comparing BCG strains have been small-scale, with few or no immunological outcomes and have compared TB-specific responses only. We aimed to evaluate both specific and non-specific immune responses to different strains of BCG within a large infant cohort and to evaluate further the relationship between BCG strain, scarring and cytokine responses.

Methods

Infants from the Entebbe Mother and Baby Study (ISRCTN32849447) who received BCG-Russia, BCG-Bulgaria or BCG-Denmark at birth, were analysed by BCG strain group. At one year, interferon-gamma (IFN-γ), interleukin (IL)-5, IL-13 and IL-10 responses to mycobacteria-specific antigens (crude culture filtrate proteins and antigen 85) and non-mycobacterial stimuli (tetanus toxoid and phytohaemagglutinin) were measured using ELISA. Cytokine responses, scar frequency, BCG associated adverse event frequency and mortality rates were compared across groups, with adjustments for potential confounders.

Results

Both specific and non-specific IFN-γ, IL-13 and IL-10 responses in 1341 infants differed between BCG strain groups including in response to stimulation with tetanus toxoid. BCG-Denmark immunised infants showed the highest cytokine responses. The proportion of infants who scarred differed significantly, with BCG scars occurring in 52.2%, 64.1% and 92.6% of infants immunised with BCG Russia, BCG-Bulgaria and BCG-Denmark, respectively (p < 0.001). Scarred infants had higher IFN-γ and IL-13 responses to mycobacterial antigens only than infants without a scar. The BCG-Denmark group had the highest frequency of adverse events (p = 0.025). Mortality differences were not significant.

Conclusions

Both specific and non-specific immune responses to the BCG vaccine differ by strain. Scarring after BCG vaccination is also strain-dependent and is associated with higher IFN-γ and IL-13 responses to mycobacterial antigens. The choice of BCG strain may be an important factor and should be evaluated when testing novel vaccine strategies that employ BCG in prime–boost sequences, or as a vector for other vaccine antigens.     

卡介苗接种后婴儿细胞免疫状态研究

【目的】 分析新生儿接种卡介苗(bacillus calmette-guerin,BCG)后细胞免疫功能变化。 【方法】 收集150例BCG接种后结核菌素纯蛋白衍生物(purified protein deriva-tive,PPD)阳性婴儿(接种成功组)和50例BCG接种后PPD阴性婴儿(接种失败组)的外周静脉血,应用ELISA方法测定血清细胞因子IFN-γ和IL-10的含量,评价细胞免疫功能。 【结果】 接种成功组和接种失败组血清细胞因子IFN-γ含量分别为(49.78±12.20)和(38.08±7.68)pg/mL,差异具有统计学意义(P=0.001);血清IL-10含量分别为(3.60±2.00)和(5.71±2.71)pg/mL,差异具有统计学意义(P<0.01)。 【结论】 BCG接种成功(PPD阳性)婴儿的细胞免疫功能增强。     

Exploring the effects of BCG vaccination in patients diagnosed with tuberculosis: Observational study using the Enhanced Tuberculosis Surveillance system

BackgroundBacillus Calmette–Guérin (BCG) is one of the most widely-used vaccines worldwide. BCG primarily reduces the progression from infection to disease, however there is evidence that BCG may provide additional benefits. We aimed to investigate whether there is evidence in routinely-collected surveillance data that BCG vaccination impacts outcomes for tuberculosis (TB) cases in England.MethodsWe obtained all TB notifications for 2009–2015 in England from the Enhanced Tuberculosis surveillance system. We considered five outcomes: All-cause mortality, death due to TB (in those who died), recurrent TB, pulmonary disease, and sputum smear status. We used logistic regression, with complete case analysis, to investigate each outcome with BCG vaccination, years since vaccination and age at vaccination, adjusting for potential confounders. All analyses were repeated using multiply imputed data.ResultsWe found evidence of an association between BCG vaccination and reduced all-cause mortality (aOR:0.76 (95%CI 0.64–0.89), P:0.001) and weak evidence of an association with reduced recurrent TB (aOR:0.90 (95%CI 0.81–1.00), P:0.056). Analyses using multiple imputation suggested that the benefits of vaccination for all-cause mortality were reduced after 10 years.ConclusionsWe found that BCG vaccination was associated with reduced all-cause mortality in people with TB although this benefit was less pronounced more than 10 years after vaccination. There was weak evidence of an association with reduced recurrent TB.     

1 999例0～2岁儿童BCG接种情况及影响因素分析

目的 了解北京市常营社区0-2岁儿童卡介苗（bacillus calmette-guerin vaccine,BCG）接种情况,分析影响接种率的因素,为提高BCG的接种率和及时接种率提供参考。方法 收集母亲孕期管理在常营社区卫生服务中心、分娩日期为2015年1月1日～2016年12月31年、北京分娩、且在北京预防接种BCG的儿童相关接种资料及母亲围产保健资料,计算研究对象BCG接种率和及时率,使用Logistic回归分析影响接种率和及时接种率的因素。结果 北京市常营社区0～2岁儿童BCG接种率为98.8%,及时接种率为86.84%。2016年出生、早产、低出生体重、剖宫产是影响BCG接种率的危险因素;早产、低出生体重、产时有并发症以及剖宫产是影响BCG及时接种率的危险因素。结论 北京市常营社区0～2岁儿童卡介苗接种率和及时接种率仍然有提升空间,加强妇女孕期保健、减少妊娠并发症及不良妊娠结局可以提高儿童BCG的接种率和及时接种率。     

8月龄内婴儿麻疹发病现状与免疫策略

随着计划免疫工作的深入开展,8月龄内婴儿麻疹发病构成和发病率呈上升趋势。其临床表现与其他年龄人群麻疹基本相同。其发病主要与疫苗免疫原性下降,稳定性差,母亲抗体低、胎传抗体衰减、人群免疫覆盖率低等因素有关,或是以上因素综合作用的结果。为此,当前控制8月龄内婴儿麻疹可从以下几个方面着手:一是提高常规免疫接种率和接种质量,提高大年龄组儿童的接种率来保证<8月龄婴儿不至暴露于麻疹感染中;二是加快适合8月龄以下婴儿适用的新型疫苗的研制;三是将育龄妇女MV复种纳入控制小月龄婴儿麻疹的措施中;四是婴儿减少暴露于医疗机构的机会。     

宣城市500名婴儿卡介苗接种效果评价

目的评价分析宣城市卡介苗接种效果,探讨提高卡介苗接种工作质量的相关方法。方法 2007～2009年、2011年期间随机抽取宣城市10个接种点的500名1岁以内健康婴儿,在接种卡介苗12w后,测量卡痕径值及进行BCG-PPD阳转试验。结果 500名婴儿的卡痕率为97.40%,结核菌素试验阳转率87.80%;不同性别、城乡接种点的婴儿结核菌素试验阳性率差异无统计学意义(P值均小于0.05);不同接种月龄婴儿间结核菌素试验阳性率无统计学差异(χ2=0.55,P=0.76)。卡痕径值≥4mm的婴儿结核菌素试验阳性率高于卡痕径值4mm的婴儿。结论宣城市卡介苗接种卡痕率、阳转率达到国家免疫规划要求,接种质量比较稳定。新生儿出生1个月后、3个月内接种卡介苗,对接种质量无明显影响。卡痕径值大小,对评价接种质量具有一定参考意义。     

Types of drinks consumed by infants at 4 and 8 months of age: sociodemographic variations

Aim To investigate the variations in sociodemographic characteristics of mothers in relation to the types of milk and supplementary drinks consumed by their infants at 4 and 8 months of age. Study design The carers of a randomly chosen population sample of over 1000 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) were asked to record all foods and drinks consumed by the child in a 24‐h period at both 4 and 8 months of age. Self‐completion postal questionnaires were used to ascertain sociodemographic characteristics of the mothers and their infants. Methods Significant differences in the types of milks and supplementary drinks consumed within sociodemographic groups were identified. Infants were also grouped according to the types of milks they were receiving at each age and further differences in sociodemographic characteristics were investigated. Results Highly significant differences existed among various sociodemographic characteristics with regard to the types of drinks used at both ages. Maternal educational level was the most influential of the sociodemographic variables in explaining the differences in consumption of all types of drinks given at 4 months, in particular for breast milk use. Maternal age was also significantly associated with breast feeding. The use of fruit drinks was significantly associated with the presence of older siblings in the family and the use of herbal drinks with the duration of breast feeding. At 8 months of age maternal educational level was again the most highly associated of the sociodemographic variables, being significantly associated with the use of most of the drinks. The presence of older siblings also had a significant independent effect as did duration of breast feeding. The feeding of cows’ (or animal) milk as a main drink at 8 months, contrary to recommendation, was most likely in the group of mothers with vocational education, those in council accommodation, those with two or more children and those with difficulty affording food. Conclusion We have identified certain characteristics of mothers who were more likely than others not to follow current recommendations on infant feeding. The educational level of mothers appears to be of major significance in the choices made about the types of drinks given to infants. It may be possible to target information about infant feeding to certain groups of mothers thus improving weaning patterns.     

Immunological responses and protective immunity in BCG vaccinated badgers following endobronchial infection with Mycobacterium bovis

European badgers (Meles meles) are a reservoir host of Mycobacterium bovis and are implicated in the transmission of tuberculosis to cattle in Ireland and Great Britain. The development of a vaccine for use in badgers is considered a key element of any campaign to eradicate the disease in livestock in both countries. In this study we have vaccinated groups of badgers with ∼5 × 10⁵ cfu of the BCG vaccine delivered via two alternative routes, subcutaneous and mucosal (intranasal/conjunctival). Following experimental endobronchial infection with ∼10⁴ cfu of M. bovis, all badgers were euthanised at 12 weeks post-infection. At post-mortem examination both vaccinated groups had significantly reduced severity of disease compared with the non-vaccinated controls. The analysis of immune responses throughout the study showed that vaccination with BCG did not generate any detectable immunological responses as measured by IFN-γ production in antigen-stimulated peripheral blood mononuclear cells (PBMC) and IgG serological responses. However, the levels of the responses increased following M. bovis infection, and the kinetic profiles corresponded to the severity of lesions recorded post-mortem. Significant differences were observed in the timing of development of the immune responses between vaccinates and controls. The results suggest that the immunological responses are associated with the levels of protective immunity and could be used as markers to monitor control of disease in badgers following vaccination.     

The novel tuberculosis vaccine,AERAS-402, is safe in healthy infants previously vaccinated with BCG,and induces dose-dependent CD4 and CD8T cell responses

Background

Efforts to reduce risk of tuberculosis disease in children include development of effective vaccines. Our aim was to test safety and immunogenicity of the new adenovirus 35-vectored tuberculosis vaccine candidate AERAS-402 in infants, administered as a boost following a prime with the Bacille Calmette-Guerin vaccine.

Methods

In a phase 1 randomised, double-blind, placebo-controlled, dose-escalation trial, BCG-vaccinated infants aged 6–9 months were sequentially assigned to four study groups, then randomized to receive an increasing dose-strength of AERAS-402, or placebo. The highest dose group received a second dose of vaccine or placebo 56 days after the first. The primary study outcome was safety. Whole blood intracellular cytokine staining assessed immunogenicity.

Results

Forty-two infants received AERAS-402 and 15 infants received placebo. During follow-up of 182 days, an acceptable safety profile was shown with no serious adverse events or discontinuations related to the vaccine. AERAS-402 induced a specific T cell response. A single dose of AERAS-402 induced CD4T cells predominantly expressing single IFN-γ whereas two doses induced CD4T cells predominantly expressing IFN-γ, TNF-α and IL-2 together. CD8T cells were induced and were more likely to be present after 2 doses of AERAS-402.

Conclusions

AERAS-402 was safe and immunogenic in healthy infants previously vaccinated with BCG at birth. Administration of the highest dose twice may be the most optimal vaccination strategy, based on the induced immunity. Multiple differences in T cell responses when infants are compared with adults vaccinated with AERAS-402, in the same setting and using the same whole blood intracellular cytokine assay, suggest specific strategies may be important for vaccination for each population.     

知信行干预降低骨科感染率的效果研究

目的 对比探讨知信行干预与常规护理干预降低骨科感染率的方法及效果.方法 将医院骨科2009年1月-2011年11月收治确诊的骨科相关病变患者185例随机分成两组,其中对照组85例行常规护理干预,试验组100例联合知信行干预；对比两组患者的骨科感染发生率,抑郁状态量表(SDS)和焦虑自评量表(SAS)评分变化.结果 试验组的SDS和SAS评分均优于对照组(P＜0.05),且试验组患者骨科感染率为3.0％,低于对照组的11.8％(P＜0.05).结论 在骨科患者预防感染的常规护理干预中运用知信行干预,临床效果显著,能够显著降低患者的骨科感染发生率,并通过一系列心理作用,减轻患者的负性心理.     

Family discipline practices with infants at six months of age

ABSTRACT

Objectives: To determine the frequency of 14 discipline strategies used by mothers (n?=?564) and fathers (n?=?335) in caring for their six-month old infant. Methods: Data on discipline practices were obtained from families participating in an obesity prevention trial (Prevention of Overweight in Infancy). Each parent was asked to indicate the frequency of using 14 different discipline strategies during the previous week with their infant. Associations between the use of these strategies and parity, deprivation, parental ethnicity, depression symptoms and infant sex were investigated. Results: Parents reported using both positive (mean: 8.8 for mothers and 7.9 for partners) and negative (0.7 for mothers and 0.7 for partners) strategies over the past week. At six months, positive strategies such as smiling, praising and distraction were most commonly reported (≥87% for both mothers and partners), negative strategies such as smacking, time out and shouting being reported infrequently (≤8% for all). Discipline requiring a level of cognitive understanding not developed at six months was reasonably common, including reasoning (17.7% for mothers, 23.4% for partners), negotiation (6.2%, 11.7%) and ignoring (26%, 19%). Multivariate analysis demonstrated that mothers with more than one child had a lower positive discipline index than those with only one child (difference, 95% C.I.: 1.05 (0.57, 1.54). An increase of one point on the 10-point hostile parenting scale was associated with an increase of 0.18 (0.04, 0.31) for the mothers and 0.47 (0.23, 0.70) for partners on the negative strategy index. Conclusions: Discipline strategies emerge early in infancy and are associated with family size and parental hostility.     

Effect of vaccine dose on the safety and immunogenicity of a candidate TB vaccine, MVA85A, in BCG vaccinated UK adults

Purpose

A non-randomised, open-label, Phase I safety and immunogenicity dose-finding study to assess the safety and immunogenicity of the candidate TB vaccine Modified Vaccinia virus Ankara expressing Antigen 85A (MVA85A) from Mycobacterium tuberculosis (MTB) in healthy adult volunteers previously vaccinated with BCG.

Methods

Healthy BCG-vaccinated volunteers were vaccinated with either 1 × 10⁷ or 1 × 10⁸ PFU of MVA85A. All adverse events were documented and antigen specific T cell responses were measured using an ex vivo IFN-γ ELISPOT assay. Safety and immunogenicity were compared between the 2 dose groups and with a previous trial in which a dose of 5 × 10⁷ PFU MVA85A had been administered.

Results

There were no serious adverse events recorded following administration of either 1 × 10⁷ or 1 × 10⁸ PFU of MVA85A. Systemic adverse events were more frequently reported following administration of 1 × 10⁸ PFU of MVA85A when compared to either 5 × 10⁷ or 1 × 10⁷ PFU of MVA85A but were mild or moderate in severity and resolved completely within 7 days of immunisation. Antigen specific T cell responses as measured by the IFN-γ ELISPOT were significantly higher following immunisation in adults receiving 1 × 10⁸ PFU compared to the 5 × 10⁷ and 1 × 10⁷ doses. Additionally, a broader range of Ag85A epitopes are detected following 1 × 10⁸ PFU of MVA85A.

Conclusion

A higher dose of 1 × 10⁸ PFU of MVA85A is well-tolerated, increases the frequency of IFN-γ secreting T cells detected following immunisation and broadens the range of Ag85A epitopes detected.     

3个月龄以内婴儿败血症病原菌分布及抗菌药物耐药状况分析

目的探讨月龄<3个月婴儿败血症的病原菌分布[排除凝固酶阴性葡萄球菌(CNS)]及其对抗菌药物耐药状况。 方法选择2012年1月1日至2016年12月31日,广州医科大学附属广州市妇女儿童医疗中心收治的924例月龄<3个月的婴儿败血症患儿为研究对象。这924例患儿经血培养,共计分离出968株病原菌。回顾性分析924例月龄<3个月的婴儿败血症患儿的病原菌分布情况,早发型败血症(EOS)与晚发型败血症(LOS)患儿病原菌分布情况,以及常见革兰阴性杆菌、革兰阳性球菌对抗菌药物耐药情况。采用χ²检验,对EOS和LOS患儿血培养分离出的大肠埃希菌、肺炎克雷伯菌、B族链球菌(GBS)、金黄色葡萄球菌、真菌所占比例进行比较。本研究遵循的程序符合广州医科大学附属广州市妇女儿童医疗中心医学伦理委员会制定的伦理学标准,并得到该委员会审查批准。 结果①本研究924例月龄<3个月的婴儿败血症患儿血培养共计分离出968株病原菌,其中革兰阴性杆菌为593株(61.3%,593/968),以大肠埃希菌(21.4%,207/968),肺炎克雷伯菌(19.6%,190/968)为主;革兰阳性球菌为318株(32.9%,318/968),以GBS(11.5%,111/968),金黄色葡萄球菌(7.7%,75/968),粪肠球菌(4.1%,40/968)为主;真菌为52株(5.4%,52/968);革兰阴性球菌为3株(0.3%,3/968);革兰阳性杆菌为2株(0.2%,2/968)。②197例EOS患儿血培养共计分离出226株病原菌,常见病原菌前3位依次为大肠埃希菌(23.9%,54/226),GBS(17.7%,40/226)和肺炎克雷伯菌(15.9%,36/226)。727例LOS患儿血培养共计分离出742株病原菌,常见病原菌前3位依次为肺炎克雷伯菌(20.8%,154/742),大肠埃希菌(20.6%, 153/742)和GBS(9.6%,71/742)。EOS患儿血培养分离出的GBS所占比例为17.7%(40/226),明显高于LOS患儿的9.6%(71/742),二者比较,差异有统计学意义(χ²＝11.280,P＝0.001)。EOS患儿血培养分离出的金黄色葡萄球菌及真菌所占比例分别为4.0%(9/226)与2.7%(6/226),均分别低于LOS患儿的8.9%(66/742)与6.2%(46/742),并且差异亦均有统计学意义(χ²＝5.849,P＝0.016;χ²＝4.282,P＝0.039)。③593株革兰阴性杆菌中,大肠埃希菌和肺炎克雷伯菌对氨苄西林耐药率均为最高,分别为81.1%和99.4%;对哌拉西林/他唑巴坦、阿米卡星、厄他培南、亚胺培南、头孢吡肟耐药率较低,为0～17.2%。④318株革兰阳性球菌中,GBS、金黄色葡萄球菌、粪肠球菌、屎肠球菌对万古霉素、替加环素、利奈唑烷的敏感性较高,耐药率均为0;金黄色葡萄球菌对青霉素G耐药率高达92.9%。 结论革兰阴性杆菌是月龄<3个月婴儿败血症患儿的主要病原菌,其次是革兰阳性球菌。临床经验性选择抗菌药物治疗月龄<3个月婴儿败血症患儿时,应高度注意病原菌耐药问题。     

不同等级2所医院新生儿卡介苗接种效果及影响因素研究

目的了解常州市不同等级的2所医院新生儿卡介苗接种效果及其影响因素,为提高接种质量和人群免疫水平提供依据.方法 选择1个市级医院,1个县级医院作为哨点,监测2013年1~12月不同批次菌苗对符合条件新生儿的接种情况,3个月后进行结核菌素试验试验(PPD),观察硬结纵横径和直径,评价接种效果;采用Logistic回归模型,对接种效果进行多因素回归分析. 结果共接种卡介苗新生儿2254例,接种成功2090人,接种成功率92.7%.单因素分析显示,不同单位,季节,疫苗批次卡介苗接种成功率差异有统计学意义(P<0.05);金坛市人民医院接种成功率为95.15%,明显大于市妇幼保健院90.17%,差异有统计学意义(P < 0.05); 经组间比较,秋季接种成功率明显高于冬季(χ²=14.080, P = 0.000).疫苗批号201003a015-1接种成功率明显低于其他各批号,批号201003a012-2接种成功率明显低于批号201101a004-1和201012a083-2,差异均有统计学意义(均P = 0.000).多因素logistic回归分析,疫苗批号(OR=1.754,95%CI:1.477~2.084)是卡介苗接种成功的影响因素. 结论常州市市县不同等级医院新生儿卡介苗接种成功率均较高,疫苗不同批次是影响接种成功的影响因素.     

胎龄小于32周早产儿解脲脲原体肺炎的临床特征分析

目的:探讨胎龄小于32周早产儿解脲脲原体(UU)肺炎的临床特征。方法:回顾性分析北京大学第三医院新生儿重症监护病房2018年1月至2019年12月住院且合并肺炎的出生胎龄<32周早产儿105例,男63例,女42例。住院期间首次诊断肺炎后即留取气道分泌物进行UU核酸检测,分为UU阳性组和UU阴性组,比较两组间围产因素、合并疾病、抗菌素治疗、临床结局等指标,两组间比较采用 t检验或卡方检验,Logistic回归进行多因素分析。 结果:105例早产儿肺炎中,确诊UU肺炎37例(35.2%),UU检测阴性的肺炎68例(64.8%)。UU阳性组与UU阴性组,患儿胎龄 [28(27,30)周 vs 29(28,30)周, Z=-0.98, P>0.05] 及出生体重[(1 282.03±292.49)g vs (1 196.62±322.89)g, t=1.34, P>0.05],差异无统计学意义。UU阳性组与UU阴性组相比,母亲单胎率(86.5% vs 50%,χ²=12.15)、绒毛膜羊膜炎发生率(10.8% vs 1.55%, χ²=4.61)、胎膜早破>12 h比例(32.4% vs 11.8%,χ²=5.37)及阴道分娩率(59.5% vs 35.3%, χ²=4.75)均较高( P<0.05);进一步的多因素Logistic回归分析显示经阴道分娩是UU阳性的独立危险因素( OR=2.694, 95 %CI: 1.113~6.525)。UU阳性组比UU阴性组,白细胞计数明显升高[12.85(9.32,17.22)×10⁹个/L vs 9.06(7.06,13.37)×10⁹个/L, Z=-3.01, P<0.05];用氧时间延长[(46.8±19.8)d vs (37.8±20.7)d],差异有统计学意义( t=2.177, P<0.05);UU阳性组血流动力学显著的动脉导管未闭发生率(29.7% vs 57.4%,χ²=6.265)和新生儿呼吸窘迫综合征发生率(54.1% vs 75.0%,χ²=4.801)低于UU阴性组,差异均有统计学意义( P<0.05)。UU阳性组与UU阴性组相比,细菌培养阴性率(62.2% vs 50.0%, χ²=8.826)以及三代头孢的使用率(48.6% vs 47.1%,χ²=1.352),差异均无统计学意义( P>0.05)。经过阿奇霉素治疗气道分泌物解脲脲原体转阴时间为(9.00±3.14)d;两组间在支气管肺发育不良(73.0% vs 69.1%,χ²=0.036)、早产儿视网膜病(10.8% vs 26.5%,χ²=2.665)、新生儿坏死性小肠结肠炎(2.7% vs 1.5%,χ²=0.195)、脑室内-脑室周围出血(69.4% vs 72.1%,χ²=0.003)和脑室周围白质软化(8.1% vs 8.8%,χ²=0.016)发生率的差异均无统计学意义( P>0.05)。 结论:胎膜早破时间超过12 h、合并绒毛膜羊膜炎,经阴道分娩出生的小于32周的早产儿,UU感染风险增加。小于32周早产儿UU肺炎,可表现为用氧时间延长,白细胞计数升高,经过口服阿奇霉素治疗后,能够有效清除UU,改善预后。     

Predictors of antibody persistence to the 7-valent pneumococcal conjugate vaccine in healthy Fijian infants at 12 months of age

Little is known about the predictors of antibody persistence to pneumococcal conjugate vaccines (PCV) in the context of reduced dose schedules. In Fiji, an RCT investigated 0, 1, 2 and 3 dose schedules of 7-valent PCV administered at 6, 10 and 14 weeks of age in 364 healthy infants. This study was a post-hoc analysis of the predictors of poor antibody persistence at 12 months, prior to a booster, using univariable and multivariable analyses.The strongest predictors of poor antibody persistence as measured by serotype-specific immunoglobulin G (IgG) and opsonophagocytosis (OI) assays were being of Indigenous Fijian ethnicity (IgG: adjusted odds ratio (aOR) 3.43, p < 0.001; OI: aOR 1.96, p = 0.013) and receipt of fewer than 3 doses of PCV.These findings may help to identify which children may be at an increased risk of pneumococcal disease in the context of reduced dose primary series PCV schedules.     

西安市≤6月龄婴儿体格发育状况及营养状态调查

目的 调查西安市≤6月龄婴儿体格发育状况及营养状态,分析相关的影响因素。方法 采用方便抽样方法随机抽取西安市10个社区或村（5个属于城镇街道办事处,5个属于村镇政府）,在每个社区或村随机选择1家社区卫生服务中心,将2021年6—8月在选中的社区卫生服务中心进行免疫规划疫苗接种的≤6月龄婴儿作为研究对象,婴儿进行体格检查（身长及体重）及血红蛋白水平检测,并对婴儿母亲进行问卷调查。采用描述性分析方法对婴儿营养不良情况进行分析,并采用单、多因素分析方法对婴儿营养不良影响因素进行分析。结果 共纳入11 714名婴儿参与本研究,男婴5 951人,占50.80%,女婴5 763人,占49.20%。≤3月龄占45.65%,4~6月龄占54.35%。共有1 972例≤6月龄婴儿检出为营养不良,营养不良发生率为16.83%。其中生长迟缓的发生率为1.15%,体重不足的发生率为0.96%,消瘦的发生率为1.47%,贫血发生率为14.90%。多因素Logistic回归分析结果显示,喂养情况（部分母乳喂养OR=1.440,人工喂养OR=1.523）、户籍所在地（OR=2.396）、添加辅食类别数量>2种（OR=1.690）、摄入蛋黄（OR=1.657）、摄入水果（OR=1.355）为≤6月龄婴儿营养状况的影响因素。结论 西安市6月龄及以下婴儿营养不良发生风险较高,贫血为主要的营养不良原因。户籍所在地、喂养方式、添加辅食类别数量、摄入蛋黄及水果是6月龄及以下婴儿营养状况的影响因素,可给予针对性的干预。