新生儿接种卡介苗后淋巴结反应分析

接种卡介苗是预防儿童结核性脑膜炎和血型播散型肺结核的有效措施之一 ,但接种卡介苗后的淋巴结异常反应给儿童造成的痛苦亦是不容忽视的问题。其异常反应的处理方法各地都有很多丰富的经验。现将武汉市结核病防治所治疗的 3 9例淋巴结异常反应的临床特点、处理方法总结如下。1　资料与方法3 9例淋巴结异常反应者均系武汉市部分综合医院产科出生的健康新生儿 ,无结核病接触史 ,生后 1周内按常规接种上海生物制品研究所生产的皮内冻干卡介苗。接种后 12～ 16周到全市各专业机构用上海生物制品研究所生产的纯结素 ( 5 IU/ m l,以下简称 PPD)…     

卡介苗接种导致淋巴结强反应

1病例资料病例：患者方某,男,2008年11月26日生,足月顺产,发育正常。出生当日给予卡介苗接种（左上臂外侧三角肌下缘附着处皮内注射,接种剂量为0．1ml）,2个月后家人发现患者左腋下出现1蚕豆样大小结节,因患儿无其他不良反应家人未予重视。4个月时其腋下结节明显增大,遂来我院就诊。     

新生儿卡介苗接种异常淋巴结反应11例报告

卡介苗接种是预防结核病的有效措施。提高卡介苗接种率、接种质量和最大限度地减少卡介苗接种后的异常反应是卡介苗接种工作值得关注的重要问题。 我县综合医院产科和妇幼保健院从１９９２年开始在婴儿出生后２４～７２小时接种卡介苗，已形成制度。１９９２年以来接种新生儿 ２３２４０人，发现淋巴结肿大１１例，发生率０．０４７％。现将其临床特点、治疗及预防报告如下。 临床资料１一般资料　１９９２年以来新生儿卡介苗接种共２３２４０人，发现１１例异常淋巴结反应，均为足月正常新生儿，体重＞３．０ｋｇ．无结核病接触史。于出生…     

卡介苗接种致腋下淋巴结强反应的临床分析

目的探讨卡介苗接种致腋下淋巴结强反应的原因,提出防治措施。方法回顾性分析卡介苗接种致腋下淋巴结强反应的临床资料。结果 4978名新生儿接种卡介苗后有12例患儿出现淋巴结肿大的强反应,发生率为0.24%。可能与剂量过大或注射过深、或菌苗稀释不均而引起的超剂量反应。结论为减少接种后异常反应的发生,要增强免疫工作人员的预防接种责任感,提高其业务素质和技术水平,如果发现异常反应,要及时采用有效的治疗措施,确保儿童的身心健康。     

卡介苗接种致异常淋巴结反应 28例报告

我所１９９８～１９９９年共收治２８例因接种卡介苗致异常反应患儿 ,现报告如下。１临床资料１．１一般资料本组２８例均为足月正常产新生儿 ,男２１例 ,女７例。２５例生后２４小时内接种卡介苗 ,３例分别在生后第３、５、６月接种（均为农村在家接生）。接种方法均为左上臂三角肌外缘皮内注射０．１ｍｌ，菌苗为兰州生物制品研究所生产。１．２淋巴结异常反应情况２８例均为家长给小孩洗澡或换衣服时发现而就诊 ,发现时间大多数在接种后２～４个月 ,最短１个月 ,最长７个月。均发生在左腋下淋巴结 ,其中淋巴结肿大１０～１９ｍｍ８例（２…     

婴幼儿接种卡介苗后30例淋巴结异常反应分析

目的分析婴幼儿接种卡介苗（BCG）后淋巴结异常反应的原因与处理方法。方法对2004年1月-2010年9月间武汉市医疗救治中心收治的30例接种BCG后淋巴结异常反应的患儿临床资料进行回顾性分析。30例患儿均于接种BCG3-6个月后接种侧腋下及锁骨上淋巴结肿大,胸片与血沉正常,PPD试验（＋）,均无全身结核中毒症状。结果 20例淋巴结直径≤4 cm的患儿仅给予异烟肼口服或加环形封闭治疗2-3个月痊愈;另3例淋巴结〉4 cm者行手术摘除。5例淋巴结化脓者在口服异烟肼治疗的同时,行穿刺抽脓、冲洗及并注入链霉素和异烟肼治疗,3-4周均痊愈。另2例有破溃者经切开排脓,冲洗、使用蘸有利福平粉的凡士林纱条引流及5%异烟肼软膏外敷治疗后痊愈。结论提高接种BCG的技术、接种质量和恰当处理BCG接种后的淋巴结异常反应,是预防与降低BCG接种后淋巴结异常反应发生率的关键措施。     

卡介苗接种强反应的处理

卡介苗(BCG)的接种是预防粟粒性肺结核和结核性脑膜炎的主要方法,一般说接种是安全的,但近年我县在接种过程中发生了多起BCG的强反应,现将处理情况报告如下。     

某院新生儿卡介苗接种及安全性监测分析

[目的]分析国际和平妇幼保健院新生儿卡介苗(BCG)疑似预防接种异常反应(AEFI)的发病流行特征,评价本院新生儿BCG预防接种安全性。[方法]通过疑似预防接种异常反应信息管理系统,收集2010-2013年报告的接种BCG后AEFI个案数据,对相关指标进行描述性流行病学分析。[结果]2010-2013年本院新生儿BCG接种率为94.54%~95.36%,新生儿BCG合计接种率为95.19%。4年间,共监测到21例,报告发生率为430.86/100万剂。BCG AEFI中,以BCG淋巴结炎为主,占95.24%,报告发生率为410.34/100万剂。[结论]本院新生儿BCG接种率维持在较高水平,新生儿接种BCG后发生AEFI以BCG淋巴结炎为主,报告发生率相对较高,在WHO估算发生率范围之内,BCG安全性尚可。     

军队停止卡介苗接种策略的综合性评价

[目的]了解部队卡介苗接种现况及效果,评价停止卡介苗接种策略的可行性.[方法]采用卡痕检查、抗体测定、病例对照研究和发病率比较等综合分析.[结果]老兵卡痕率和结核菌素阳性率均高于新兵(P＜0.01),新兵入伍前卡介苗未初种亦未自然感染者约占20%;病例组卡痕率小于对照组,比数比(OR)为0.42,95%CI为0.23～0.76;卡介苗接种后抗-PPD阳性率高于接种前(P＜0.01),但接种后结核菌素试验阴性与阳性者抗体水平无明显差异;停止卡介苗接种3年,肺结核发病率下降约50%.[结论]卡介苗预防成人结核病仍具有一定效果,但以每年对新兵普查普种作为预防和控制结核病的主要措施已不适用.     

卢湾区2007年新生儿首针乙肝及卡介苗接种情况分析

目的了解卢湾区新生儿乙肝疫苗及卡介苗接种情况，评估接种质量及接种效果。方法收集本区内产科机构上报的2007年度接种月报表作统计分析。结果乙肝、卡介苗接种率本市新生儿显著高于外来新生儿，瑞金医院产妇乙肝病毒抗原检测率为72．76％，低于其他2所医院（均为100％）。新生儿体重≤2500g均为乙肝疫苗和卡介苗末接种的主要原因。结论切实加强对育龄妇女的孕期保健指导尤为重要．可适当调整新生儿低体重标准．以大幅度提高新生儿的乙肝接种率。应大力宣传孕期体检的重要性．提高公众知晓率。提高乙肝抗原检测率。     

The association between parental and neonatal BCG vaccination and neonatal T helper 17 cell expansion

BackgroundBacille Calmette-Guérin (BCG) vaccination reduces the severity of neonatal infections; this effect appears enhanced if the mother has received BCG. We performed immunophenotyping of the T-cell subset and characterized T-cell proliferation responses to assess possible immune response pathways.MethodsHealthy BCG-vaccinated (n = 8) and unvaccinated (n = 9) neonates born by elective caesarean section were sampled 3 weeks after birth. We compared a wide panel of intracellular cytokine and cell surface expression markers as well as proliferation response in T-cells between BCG-vaccinated and unvaccinated neonates, stratified by parental BCG status.ResultsFor all BCG-vaccinated neonates and 3 of 9 unvaccinated neonates that served as controls, both parents had a BCG scar. Th17 (CD4 + IL-17+) prevalence as percentage of total CD4 + T-cells was expanded 4-fold in BCG-vaccinated compared to unvaccinated, being 11.6% [3.6–19.6%] vs 2.8% [1.0–6.6%]. Th17 counts for 3 unvaccinated neonates born to BCG-vaccinated parents was comparable to vaccinated neonates, and higher than remaining controls, parental BCG = 8.5% [4.4–8.9%] vs 1.8% [0.8–3.3%] for no parental BCG (median [interquartile range] for all data).ConclusionAmong neonates born to BCG-vaccinated parents, the prevalence of Th17 cells, important in the response against bacterial infections, was substantially elevated. The interaction between neonatal and parental BCG for Th17 responses and the importance remains to be further investigated.     

矽肺大鼠肺脏对不同侵入途径、不同抗原的免疫应答

目的 通过观察矽肺大鼠肺脏对不同途径、不同抗原的免疫应答,探讨矽肺易受感染的免疫学机制。方法分别2次通过气道、腹腔途径给予矽肺大鼠模型及正常对照动物绵羊红细胞(SRBC)或卡介苗(BCG)进行免疫后,再观察皮内注射SRBC及BCG动物迟发性变态反应;实验终期检测血清和肺灌洗回收液特异性IgG水平及细胞因子浓度。结果SRBC免疫后矽肺气道免疫组表现出异常强烈的迟发性变态反应,矽肺气道BCG免疫各组出现相同反应;两种抗原免疫后矽肺动物血清及肺灌洗液特异性IgG水平显著高于正常对照组;BCG免疫动物中,矽肺气道免疫组动物肺灌洗液IFN-γ水平显著高于矽肺腹腔免疫组及正常对照组,3个组的TNF-α水平差异无显著性;SRBC免疫动物3个组的IFN-γ水平差异无显著性。结论矽肺对肺局部以及机体免疫功能具有明显影响,导致对外来抗原产生异常强烈的体液免疫反应和迟发性变态反应;肺局部参与细胞免疫调节的细胞因子对不同抗原有不同反应。     

A BCG success story: From prevention of tuberculosis to optimal bladder cancer treatment

BCG remains the most important vaccine for tuberculosis 100 years after its first use, and over the past 4 decades it has become the most widely accepted, effective drug used in the treatment of aggressive localized bladder cancer. This review chronicles the narrow path that led to approval and world-wide acceptance of BCG immunotherapy for bladder cancer while immunotherapy trials in other malignancies were abandoned. Six intravesical instillations of 5x10^8 CFU of BCG weekly after bladder tumor resection, first reported in 1976, is superior to resection alone and resection plus intravesical chemotherapy. Maintenance of effective immune stimulation is surprisingly difficult, but 3 weekly treatments 3, 6, and 12, 18, 24, 30 and 36 months after induction produces further significant reduction in tumor recurrence. This 3 week BCG maintenance schedule alone has reduced disease progression and mortality in multicenter randomized clinical trials. In the new age of immuno-oncology patients with many types of cancer now benefit from immunotherapy, but currently these modern agents are prohibitively expensive for most of the world. In contrast, the low cost and therefore low profitability of BCG has resulted in recurrent shortages that threaten both bladder cancer patients and children at risk for tuberculosis and other serious infections. Humanity has greatly benefited from early 20th century science that developed BCG and the benevolence of doctors Calmette and Guerin who put people over profit and widely shared cultures of the vaccine. The 21st century is bringing new immunotherapies and greatly expanding the types of malignancies that can be treated. Recombinant technology is expected to improve both the efficacy and production of BCG, hopefully expanding the availability of BCG and relieving the recurring supply shortage for both vaccination and cancer therapy.     

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.     

新生儿产房卡介苗接种影响因素调查分析

目的了解产房新生儿卡介苗接种与相关影响因素。方法选择不同接种单位和多批次菌苗在不同季节对新生儿进行接种,3个月后进行PPD试验,测量PPD结果和卡痕直径,以卡痕阳性为接种成功,以PPD阳性为免疫成功,分别与不同接种单位、多批号疫苗、季节变化,以及新生儿性别、户籍、接种时体重和PPD测定月龄等因素,进行单因素和多因素logistic回归分析。结果单因素分析显示接种单位、疫苗批号、季节、PPD测定月龄对接种成功率和免疫成功率均有影响(P0.05)。多因素分析显示,上述4个因素对接种成功率影响均无统计学意义,对免疫成功率影响除接种单位为混杂因素外,其余3个均有统计学意义(P0.05)。结论 PPD测定月龄、疫苗批号和季节变化对卡介苗免疫成功率有影响。     

Complex cytokine profiles induced by BCG vaccination in UK infants

IFNγ plays an important part in immunity to tuberculosis (TB), but although it is necessary, it is not on its own sufficient for protection against TB. To identify other cytokines that play a role in the protection against TB induced by BCG vaccination, immune responses were compared between vaccinated and unvaccinated infants from the UK where BCG is known to provide protection. Twenty-one cytokines and chemokines were tested in supernatants from diluted whole blood cultures that had been stimulated for 6 days with Mycobacterium tuberculosis PPD. For 15 out of 21 of the cytokines tested responses were much higher in BCG vaccinated infants than in unvaccinated infants. These included: pro-inflammatory cytokines; IFNγ (median 1705 pg/ml vs. 1.6 pg/ml in vaccinated and unvaccinated infants, respectively), TNFα (median 226 pg/ml vs. 18 pg/ml), as well as IL-2, IL-1α and IL-6; TH2 cytokines: IL-4, IL-5 and IL-13 (median 104 pg/ml vs. 1.6 pg/ml); the regulatory cytokine IL-10 (median response 96 pg/ml vs. 8 pg/ml); the TH17 cytokine IL-17, chemokines (IP-10, MIP-1α and IL-8) and growth factors (GM-CSF and G-CSF). The greatest increase in cytokine production in BCG vaccinees compared to unvaccinated infants was seen with IFNγ. While responses for many cytokines were correlated with the IFNγ response, others including IL-17 and IL-10 were not. The pattern of cytokine induction following BCG vaccination is complex and measurement of one of two cytokines does not reveal the whole picture of vaccine-induced protection.     

Household costs of seeking BCG vaccination in rural Guinea-Bissau

In Guinea-Bissau, a vial of BCG vaccine is often not opened unless 10 infants are present for vaccination, with the aim of reducing vaccine wastage. This causes delays in vaccination, as previously demonstrated in Guinea-Bissau and other low-income countries. Reducing wastage of BCG vaccine to save money may deprive infants of important health benefits and transfer costs from the vaccination programme to mothers.Using the Bandim Health Project’s rural Health and Demographic Surveillance System, we interviewed mothers of infants aged 1–11 months about household costs of seeking BCG vaccination.On average mothers took their infant for BCG vaccination 1.26 times before obtaining the vaccine. For mothers who had sought BCG vaccine for their infants the average cost was 1.89 USD for each BCG-vaccinated infant. Among BCG-unvaccinated infants at the time of interview, 42% had brought their infant for BCG vaccination in vain at an average cost of 2.83 USD.