深圳市宝安区健康人群百日咳、白喉、破伤风抗体水平监测

目的 了解宝安区健康人群破伤风、白喉、百日咳三种疫苗血清抗体水平,评价三种疫苗的免疫实施效果.方法 2011年随机抽取宝安区7个街道不同年龄段人群,采用试管凝集试验检测血清抗体水平.结果 破伤风、白喉、百日咳抗体保护率分别为98.33％,98.06％,98.33％,各年龄组人群均达到90％以上;几何平均滴度(GMT)分别为1∶80.63、1∶80.48、1∶1 409.35,均以21～32岁组最低;三种抗体保护率和GMT有随年龄增大而明显降低的趋势.结论 宝安区人群破伤风、白喉、百日咳免疫水平都较高,免疫屏障已经形成,短期内暴发流行百日咳、白喉、破伤风的可能性不大.     

Sero-response to measles vaccination at 12 months of age in Saudi infants in Qassim Province

OBJECTIVE: To evaluate the sero-response to measles component of the first measles, mumps and rubella MMR dose given at 12 months by measuring measles antibody before and one month after the vaccination. METHODS: A follow-up study where, 57 children at the age of 12 months were recruited randomly from the Primary Health Care Centers in Qassim, Saudi Arabia using a multistage sampling techniques. Fieldwork was conducted from October until December 2006. Blood samples were collected to measure measles IgG antibody before, and one month after giving MMR using enzyme linked immunosorbent assay. Data were compared before and after vaccination using geometric mean titer GMT and seroconversion. RESULTS: In the 57 infants, positivity rate increased significantly from 3.5% (2/57) pre-vaccination to 100% one month after p=0.0001, and with a sero-conversion of 96.5% (55/57). Also, GMT increased significantly from 0.014-2.172 IU/ML, after vaccination p=0.0001. CONCLUSION: Sero conversion and GMT are significantly high after the first MMR given at 12 months and this is supported by the surveillance data in Qassim.     

Diphtheria-tetanus overimmunization in children with no records: can it be prevented?

A pilot study was undertaken to assess the validity of two new tests for predicting the immune response of Toronto schoolchildren with no acceptable evidence of prior administration of diphtheria or tetanus toxoid to a routine booster injection of diphtheria and tetanus (DT) toxoid. The tests, an inexpensive enzyme-linked immunosorbent assay (ELISA) fingerprick test for tetanus antibodies and a modification of the Schick skin test for susceptibility to diphtheria, were administered before the booster injection. One week later the ELISA test was repeated and the result of the modified Schick test read. On both occasions a diphtheria microneutralization assay was done for "gold standard" evidence of prior exposure to diphtheria toxoid or toxin. The results were used to determine the sensitivity and specificity of a single prebooster tetanus ELISA test or a modified Schick test for predicting which children with no records could be safely protected with only one DT booster dose instead of the primary series of three or four doses usually given to such children. Only 6 of the 34 subjects (18%) were totally without prior exposure to tetanus toxoid. Two of the six (6% of 33 subjects) appeared to mount a primary immune response to diphtheria toxoid as well. An initial ELISA titre of 0.01 IU/ml or lower correctly identified all six children needing a full series of tetanus toxoid (sensitivity for a primary immune response 100%) and falsely identified only 3 of 28 immune children as needing the series (specificity for immunity 89.3%). The modified Schick test appeared to have even greater accuracy for identifying children needing a full series of diphtheria toxoid. However, its use, entailing the costs of an extra nurse visit, would have prevented only seven more children from receiving an unnecessary full series of diphtheria toxoid than use of the baseline tetanus ELISA test alone.     

Immunity to diphtheria and tetanus in Australia: a national serosurvey

OBJECTIVE: To determine immunity to tetanus and diphtheria in the Australian population. DESIGN AND SETTING: Analysis, using double antigen enzyme immunoassays, of a representative sample of sera (1950 samples tested for diphtheria and 2884 for tetanus) collected opportunistically from Australian laboratories between July 1996 and May 1999. MAIN OUTCOME MEASURE: Immunity to diphtheria and tetanus, defined as negative (susceptible) when the antitoxin level was < 0.01 IU/mL, positive (immune) when it was > or = 0.1 IU/mL, and low positive (partially immune) when it was in the range 0.01-< 0.1 IU/mL. RESULTS: About 99% of children aged 5-9 years had diphtheria and tetanus antitoxin levels > or = 0.01 IU/mL (immune or partially immune). Antitoxin levels declined with age and generally more markedly for diphtheria than tetanus. For subjects aged 50 years and over, less than 60% were immune or partially immune to diphtheria and less than 75% to tetanus. Men and women had similar diphtheria antitoxin levels, while women had lower levels of tetanus antitoxin compared with men of the same age, with the difference being most marked in the age group > or = 70 years (37% v 60%; P < 0.001). CONCLUSIONS: Immunity in children appears to be good, but adults, especially older people, may not be adequately protected. Recent changes to the Australian Standard Vaccination Schedule should improve immunity in cohorts now aged < 50 years. However, additional efforts are required to protect those over 50 years (especially travellers), who are most susceptible.     

Antibody status to poliomyelitis, measles, rubella, diphtheria and tetanus, Ontario, 1969-70: deficiencies discovered and remedies required.

A serologic survey was made in 15 health unit areas, testing some 5000 individuals in the age groups 4 to 6, 11 to 13, 15 to 17 and 23 to 45 years. Two types of serious deficiency were found. Only 65% of children 4 to 6 years old had antibodies to all three types of poliovirus, the antibodies being due almost entirely to immunization with Salk vaccine. Even in children who had had six or more doses only 74% had antibodies to the three types. The high percentage of students 11 to 13 and 15 to 17 years old with poliovirus antibodies can be attributed largely to natural infection and to Sabin vaccine in the mass campaign of 1962, as well as to Salk vaccine. In children who had received Sabin vaccine as well as Salk vaccine a very high level of immunity was found. The immunity of the school-age population will decline to an insufficient level unless Sabin vaccine is used after immunization with Salk vaccine. Of children 4 to 6 years old 18% had no diphtheria antitoxin and 6% had no tetanus antitoxin. Even in those who had had six or more doses of the antigens 5% had no diphtheria antitoxin and 1 to 2% had no tetanus antitoxin. This apparently refractory state is probably due to the use of unadsorbed toxoids, and it is clear that adsorbed toxoids should be used. In the adults, diphtheria antitoxin was found in only 55% and tetanus antitoxin in only 38%.     

15岁以下免疫儿童抗体水平调查

目的　了解 15岁以下儿童人群计划免疫针对疾病的抗体水平 ,为制定免疫策略和防治措施提供科学的依据。　方法　在城区和农村共调查 2 0 2人 ,采用卫生部 1998年颁布的《计划免疫技术管理规程》中的检测方法及判定标准进行监测。　结果　白喉抗体保护率为 73 80 % ,破伤风抗体保护率 63 2 4% ;百日咳、麻疹和乙肝表面抗体保护率分别为 91 3 3 %、87 70 %和 87 5 0 %。同时显示城区和农村儿童对以上 5种疾病抗体阳性差异皆无显著性 (P >0 0 5 )。　结论　鉴于白喉、破伤风抗体阳性率水平均低于《计划免疫技术管理规程》中的指标要求 ,建议采用白破联合疫苗开展加强免疫     

河南省健康人群百日咳、白喉、破伤风抗体水平分析

目的了解河南省健康人群百日咳、白喉、破伤风抗体水平,为制定DPT免疫策略提供依据。方法2011-2012年度分4个年龄组在河南省5个县（区）抽取健康人共717名,采用间接ELISA法检测血清中百日咳、白喉、破伤风抗体水平。结果在检测的717名健康人中,百日咳IgG抗体平均阳性率为40.59％,白喉恒G抗体阳性率较高,达到82.29％,破伤风恒G抗体阳性率为7575％。结论白喉和破伤风抗体水平较高,而百日咳抗体水平过低,提示河南省存在百日咳流行隐患,要重视百日咳疫苗接种工作,扩大接种覆盖率。     

广东省部分地区人群百、白、破IgG抗体水平监测

目的了解广东省健康人群血清中百日咳、白喉和破伤风（简称百、白、破）抗体水平，为百、白、破防控提供依据。方法采取分层整群抽样法抽出潮州市、汕尾市、深圳市等三个地区部分健康人群，采用间接ELISA法（定量）检测正常人血清中百、白、破Igc抗体水平。结果三个地区健康人群百日咳IgG抗体阳性率为54．1％，白喉IgG抗体保护率为76．4％，破伤风IgG抗体保护率为77．2％。结论广东省三个地区健康人群百日咳IgG抗体阳性率较低，部分地区白喉及破伤风抗体保护率比较低，白喉及破伤风抗体保护率有随着年龄的升高而降低的趋势，提示我们要加强百、白、破的接种率和接种质量。     

Role of whole-cell pertussis vaccine in severe local reactions to the preschool (fifth) dose of diphtheria-pertussis-tetanus vaccine.

OBJECTIVE: To estimate the contribution of whole-cell pertussis vaccine to severe local reactions after the preschool (fifth) dose of adsorbed diphtheria toxoid-pertussis vaccine-tetanus toxoid (DPT) vaccine. DESIGN: Double-blind randomized controlled trial. SETTING: Urban community. PARTICIPANTS: Volunteer sample of 200 healthy children 4 to 6 years old who were eligible for the fifth dose of DPT vaccine. INTERVENTIONS: Children received, in both arms, either diphtheria toxoid-tetanus toxoid (DT) and monovalent pertussis vaccines (group A, 99 children) or DPT and meningococcal vaccines (group B, 101 children). All were licensed products from single lots. The children were assessed 24 hours later by a trained observer. Serum samples obtained before vaccination were tested for antibodies to tetanus and diphtheria toxins and five pertussis antigens by means of enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Rates of severe local reactions (an area of redness or swelling or both of 50 mm or greater) 24 hours after vaccination. Relation between serum antibody levels before vaccination and rates of severe local reactions to corresponding vaccines. RESULTS: All of the subjects were followed up 24 hours after vaccination. Severe redness was present in 38% given DPT vaccine, 29% given intramuscular pertussis vaccine and 9% given DT vaccine (p < or = 0.002, three-way comparison). Severe swelling was common after vaccination with all three products. After intramuscular pertussis vaccination a relation was evident between the prevaccination levels of antibody to whole-cell pertussis bacteria and the rates of redness (p < 0.02) but not between the prevaccination subcellular antibody levels and the rates of redness. CONCLUSION: That pertussis vaccine resembled the DPT vaccine in causing severe redness suggests that it is the principal cause of such reactions after DPT vaccination. The DT vaccine was also reactogenic; thus, cumulative sensitization to one or more of its constituents may be a factor.     

Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults

Context  Increasing reports of pertussis among US adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups. Objective  To assess the immunogenicity and reactogenicity of a tetanus-diphtheria 5-component (pertussis toxoid, filamentous hemagglutinin, pertactin, and fimbriae types 2 and 3) acellular pertussis vaccine (Tdap) in adolescents and adults. Design, Setting, and Participants  A prospective, randomized, modified double-blind, comparative trial was conducted in healthy adolescents and adults aged 11 through 64 years from August 2001 to August 2002 at 39 US clinical centers. Interventions  A single 0.5-mL intramuscular dose of either Tdap or tetanus-diphtheria vaccine (Td). Main Outcome Measures  Antibody titers to diphtheria and tetanus toxoids for Tdap and Td were measured in sera collected from subsets of adolescents and adults, before and 28 days after vaccination. For pertussis antigens, titers in sera from Tdap vaccinees were assessed vs those from infants who received analogous pediatric diphtheria-tetanus-acellular pertussis vaccine (DTaP) in a previous efficacy trial. Safety was assessed via solicited local and systemic reactions for 14 days and adverse events for 6 months following vaccination. Results  A total of 4480 participants were enrolled. For both Tdap and Td, more than 94% and nearly 100% of vaccinees had protective antibody concentrations of at least 0.1 IU/mL for diphtheria and tetanus, respectively. Geometric mean antibody titers to pertussis toxoid, filamentous hemagglutinin, pertactin, and fimbriae types 2 and 3 exceeded (by 2.1 to 5.4 times) levels in infants following immunization at 2, 4, and 6 months with DTaP. The incidence of solicited local and systemic reactions and adverse events was generally similar between the Tdap and Td groups. Conclusions  This Tdap vaccine elicited robust immune responses in adolescents and adults to pertussis, tetanus, and diphtheria antigens, while exhibiting an overall safety profile similar to that of a licensed Td vaccine. These data support the potential routine use of this Tdap vaccine in adolescents and adults.      

Efficacy of whole-cell pertussis vaccine in preschool children in the United States.

OBJECTIVE--To evaluate the efficacy of currently used whole-cell pertussis vaccines. DESIGN--Active surveillance to detect pertussis cases in Baltimore, Md, Denver, Colo, and Milwaukee, Wis, and investigation of secondary attack rates in 347 household contacts, aged 1 through 4 years, to estimate vaccine efficacy. OUTCOME MEASURE--Vaccine efficacy was estimated using different case definitions for pertussis. RESULTS--Vaccine efficacy was 64%, 81%, and 95% for case definitions of mild cough, paroxysmal cough, and severe clinical illness, respectively. Requiring laboratory confirmation increased efficacy to 95% to 98% for culture-positive children and to 77% to 95% for culture- or serology-confirmed cases, depending on disease severity. Vaccine efficacy for typical paroxysmal cough increased from 44% for one diphtheria, tetanus, and pertussis vaccine dose to 80% for four or more doses. CONCLUSIONS--The trend toward increasing vaccine efficacy with different case definitions may be due to improved efficacy in preventing severe illness and to case definitions that are more specific for pertussis. Whole-cell pertussis vaccine was highly effective in preventing pertussis in preschool children exposed to infection within their households. Direct side-by-side efficacy studies of whole-cell vaccine and the recently licensed acellular vaccine will be necessary to assure that comparable protection is afforded by the new vaccines if they are to be used for immunization of infants.     

老年人接种甲型肝炎灭活疫苗的免疫效果观察

目的观察甲肝灭活疫苗对老年人的接种效果。方法 42例甲肝患者分别于第1天,第180天注射500 IU甲肝灭活疫苗,观察接种后反应,于14 d、28 d、90 d、180 d、210 d取血清检测抗体量(GMT)。结果甲肝灭活疫苗接种反应少,初种后抗体水平较低,但90 d时血清保护率达100%;接种第2针后GMT处于较高水平。结论老年人接种甲肝灭活疫苗后反应少,能产生有效保护,值得推广应用。     

国产乙型肝炎血源疫苗免疫保护持久性及加强免疫△

目的确定国产乙肝血源疫苗低剂量免疫保护持久性及何时需要加强免疫。方法采用放射免疫（ＲＩＡ）法测定新生儿计划免疫７年后的血清学效果和加免实验的抗体反应。结果１０１８名乙肝免疫儿童的保护性抗体阳性率从免后１～２年的７５．０％下降为第７年的４８．２％,而ＨＢｓＡｇ和抗－ＨＢｃ阳性率却均始终处于低水平。１４４名免后６～７年且ＨＢｓＡｇ和抗－ＨＢｃ均阴性儿童,加免前抗－ＨＢｓＧＭＴ为１０．４ｍＩＵ／ｍｌ,抗－ＨＢｓ阳性率５４．９％;加免后１个月和１年,抗－ＨＢｓＧＭＴ分别为１９０．６和２５．３ｍＩＵ／ｍｌ,而抗－ＨＢｓ阳性率则分别为８９．６％和７５．５％。加免后１个月抗－ＨＢｓＧＭＴ和阳性率均显著高于加免前的水平（Ｐ＜０．０１）。但加免后１年时抗－ＨＢｓＧＭＴ又接近加免前水平,而阳性率仍显著高于加免前。６５名加免前抗－ＨＢｓ阴性儿童,加免后１个月有４０名儿童抗－ＨＢｓ≥１００ｍＩＵ／ｍｌ,提示乙肝疫苗免后抗体阴转者可能仍保持免疫记忆。结论国产乙肝血源疫苗低剂量免疫有很好的免疫保护持久性,初免后７年不必加强免疫。     

我国研制的乙型肝炎基因重组疫苗近期免疫效果观察

目的 考察新生儿接种国产乙型肝炎（乙肝）中仓鼠卵巢细胞（CHO）表达的基因重组疫苗的近期免疫效果。方法 1997年1月1日至1999年8月31日,在河北省正定县选择7个乡,对2969名新生儿按现生后2４h及１、６个月免疫程序接种３剂乙肝ＣＨＯ疫苗,每剂１０μg。每季度对新生儿的乙肝疫苗接种情况进行调查核实。２０００年４月对完成全程免疫的观察对象采集血清,检测ＨＢsAg、抗－ＨＢs和抗－ＨＢc三项乙肝病毒标志。结果 新生儿乙肝疫苗全程接种率为９３.74％（２７８３／２９６９）,第１剂在出生２４h内接种的及时接种率为９５.42%（２８３３／２９６９）。２０００年４月采血率为６８.4%（１９０６／２７８３）。新生儿乙肝ＣＨＯ疫苗全程免疫后第１年内抗－ＨＢs阳性率[样本值／阴性对照值（Ｓ／Ｎ）≥2.1]为９８．２５％,有效抗－ＨＢs阳性率（Ｓ／Ｎ≥10.0）为９４.26%,抗体几何平均滴度（ＧＭＴ）为７７.64;其后抗体水平随时间延长逐渐降低,第３年时抗－ＨＢs阳性率为９２.31%,有效抗－ＨＢs阳转率为６８.96%,ＧＭＴ为２２.86,３年中ＨＢsAg阳性率均小于１％,抗－ＨＢc阳性率和ＨＢＶ感染率在１％－３％之间,未见随年限延长而增加的趋势。结论 国产乙肝ＣＨＯ疫苗的免疫原性和近期保护效果良好。     

正常人群痘苗病毒抗体的测定

用ＥＬＩＳＡ方法检测了１５５例不同年龄组正常人血清中的痘苗病毒ＩｇＧ抗体，结果如下１２岁以下儿童全部为阴性，１３岁以上各年龄组抗体阳性率为３５．０％－８０．０％，总阳性率为３８．７％；在各阳性年龄组中，抗体效价分布在１：２００－１：１６００之间，几何平均效价为１：２８３，分布在１：２６９－１：２９５之间。     

Botulinum toxin versus surgical sphincterotomy in females with chronic anal fissure

OBJECTIVE: To compare the effectiveness and the morbidity of botulinum toxin (BTX) in the treatment of chronic anal fissure (CAF) versus the standard surgical sphincterotomy. METHODS: One hundred female patients with CAF were treated by either closed lateral sphincterotomy [surgical group (Group I, n=50 patients)] or BTX 40 IU [chemical group (Group II, n=50 patients)]. The study was conducted in the King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia, over 3 years between January 2004 and December 2006. RESULTS: The healing rate was 100% in surgical group with no recurrence on the period of 3 years follow up and one patient has partial permanent incontinence. While in chemical group the healing rate was 86% (p=0.006). Ten patients had transient incontinence (p=0.014). Seven patients had recurrence within 6 months 14% (p=0.006). CONCLUSION: We conclude that chemical sphincterotomy is safe, effective first line treatment in selected female patients with CAF.     

A short history of vaccination in Australia

It is almost 50 years since infant vaccination for diphtheria, pertussis and tetanus became routine in Australia. Since then, the incidence of vaccine-preventable diseases has declined dramatically. We have used existing records and the recollections of experts to compile a history of vaccination in Australia, focusing on vaccines in the current childhood schedule.     

The evaluation of Engerix-B in healthy Malaysian medical students

Fifty medical students were screened for hepatitis B serological markers of whom 42 students entered the study. Those who were found to be negative for all markers were vaccinated with 1.0 ml (20 mcg HBsAg) Engerix-B vaccine intramuscularly in the deltoid region according to the 0, 1, 6 month schedule. Blood samples were taken at 1, 2, 3, 6, 9 months. One month following the first dose, 7% showed detectable AntiHBs with a GMT of 11 IU/I. By the sixth month, just before the third dose was given, 79% seroconverted with a GMT of 2952 IU/I. Three months following the third dose all had seroconverted with a GMT of 18,381 IU/I. No serious adverse reactions were noted and none of the subjects showed evidence of hepatitis B infection during the study. This study thus confirms the high immunogenicity and safety of recombinant yeast-extract hepatitis B vaccine.     

Prevalence of symptoms and risk of sleep apnea in middle-aged Saudi males in primary care

OBJECTIVE: The prevalence of obstructive sleep apnea OSA has not been assessed in Saudi Arabia. We aimed to assess the prevalence of individuals who were at risk of OSA in a sample of middle-aged Saudi males, using the Berlin questionnaire at primary care settings. METHODS: The study was conducted at King Khalid University and King Fahd National Guard primary health care clinics in Riyadh, Kingdom of Saudi Arabia between December 2005 and March 2006. Berlin Questionnaire was administered by trained medical students to consecutive Saudi male patients in the age group 30-65 years attending the primary health care clinics, after explaining the procedure of the study. Based on the data collected and defined criteria, patients were stratified into high risk and low risk according to responses. RESULTS: Five hundred and seventy-eight middle-aged Saudi males with a mean age of 45.02 +/- 9.3 year were surveyed in this study. Snoring was present in 52.3%, and breathing pauses more than once per week was noticed in 11.3%. Based on the Berlin questionnaire stratification for risk of OSA, 33.3% were considered as high risk patients for OSA. The occurrence of daytime tiredness >once/week was reported by 35.5%. The prevalence of snoring and risk for OSA is similar to that reported in the US. CONCLUSION: In primary care setting, one in 3 middle-aged Saudi males is at risk for OSA.     

Tetanus and diphtheria immunity in urban Minnesota adults.

Tetanus and diphtheria antitoxin levels were measured in 183 urban adults, using a hemagglutination technique. Protective levels (greater than 0.01 unit/mL) of tetanus antitoxin were present in more than 85% of sera from all subjects under 40 years of age and from men between 40 and 59 years old. A minority of women (36%) between 40 and 59 years of age, and of men (41%) and women (29%) over 60 years of age, were protected. Less than one quarter of the study group had protective levels (greater than 0.01 unit/mL) of diphtheria antitoxin. The results of the study suggest that a minority of middle-aged women and older adults have been appropriately immunized against diphtheria and tetanus.