广州市海珠区有含麻疹成分疫苗免疫史麻疹病例特征

目的 了解广州市海珠区有含麻疹成分疫苗（MCV）免疫史的麻疹病例特征,为制定和完善麻疹防控策略和措施提供依据。方法 收集法定传染病报告系统及麻疹专项监测系统中广州市海珠区2009—2018年麻疹确诊病例相关资料,并对其中2014年起报告的病例增加静脉血定量检测麻疹IgM、IgG抗体和2015年4月起增加采集咽拭子检测麻疹病毒RNA资料进行统计分析。结果 2009—2018年广州市海珠区共报告有MCV免疫史麻疹病例57例,占总病例15.6%。不同年份有免疫史病例占当年总病例的比例不同（P<0.01）,与总病例的年龄分布不同（P<0.01）,但与总病例月份分布一致（r =0.81,P=0.021）。以IgM/IgG浓度比值为判断方法,2014年起报告病例中原发性、继发性免疫失败分别占有MCV免疫史病例的61.1%、38.9%。从2015年4月起报告的10例有免疫史病例的咽拭子中均未检出麻疹病毒RNA。有MCV免疫史与无免疫史病例的发热、皮疹、咳嗽、卡他、结膜炎及“麻疹典型症状”等症状发生率分别为70.2%和84.0%、71.9%和86.4%、54.4%和76.5%、36.8%和64.2%、40.4%和61.1%、57.9%和77.7%,差异均有统计学意义。结论 广州市海珠区有MCV免疫史的麻疹病例占比较高,症状较不典型,以原发性免疫失败为主,且传染性低。     

Toxoplasmosis among pregnant women: High seroprevalence and risk factors in Kinshasa,Democratic Republic of Congo

Objective

To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo.

Methods

Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity.

Results

A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed.

Conclusion

In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.     

惠州市麻疹患者血清流行病学调查

目的 了解惠州市麻疹病例血清流行病学特征，探讨麻疹发病原因。方法 对2003～2005年收集的390例麻疹疑似病例血清标本，采用酶联免疫吸附实验（ELISA）检测麻疹IgM抗体，麻疹IgM抗体阳性病例再用ELISA法检测麻疹IgG抗体。结果麻疹IgM抗体阳性率为76．6％，合格标本采集率34．1％。麻疹IgM抗体阳性病例麻疹IgG抗体阳性率64．9％；出疹与采血间隔天数长，IgG抗体阳性率和GMT高，≤1岁组病例IgG抗体阳性率和GMT水平最低。结论 麻疹发病主要原因是未接种麻疹疫苗（MY）和接种后原发性免疫失败，提高血清样本采集率和开展风疹血清学鉴别诊断是惠州市加强麻疹实验室监测亟待解决的问题。     

育龄人群孕前强化麻疹疫苗对阻断“双相移位”的应用价值

目的探讨育龄人群强化麻疹疫苗（MV）注射前后麻疹免疫水平,进一步分析育龄男女麻疹免疫水平对消除麻疹的影响,为最终实现消除麻疹目标提供科学依据。方法选择本院22-35岁育龄医护人员60名,观察MV注射前及注射后26个月的麻疹免疫水平的差异,并采用酶联免疫吸附试验（ELISA）,对其MV免疫前后的血清分别检测IgM和IgG抗体。结果育龄男女接种MV前后χ2检验结果：在1 200水平上,χ2=7.32,P〈0.05;在1 800水平,χ2=10.25,P〈0.05;注射前后麻疹免疫水平有统计学差异。结论育龄男女或夫妻双方孕前及时、安全接种MV,既可提高育龄人群麻疹抗体水平,同时也可提高出生8月龄婴儿麻疹疫苗初免之前胎传麻疹抗体水平,从而有效降低25岁以上人群及8月龄内婴儿麻疹发病,达到＂一代免疫,两代受益＂的效果,对阻断＂双相移位＂具有重要意义。     

Comparison of two commercially available avidity tests for toxoplasma-specific IgG antibodies

BACKGROUND: IgG anti-Toxoplasma avidity tests have proven useful to discriminate between recent and distant infection in management of pregnant women with anti-Toxoplasma-IgM antibodies. This study was performed to compare two commercially available IgG anti-Toxoplasma avidity test kits. METHODS: Sixty-four samples positive for IgM and IgG anti-Toxoplasma antibodies were analyzed with two IgG anti-Toxoplasma avidity tests: VIDAS Toxo IgG avidity kit (BioMérieux, Marcy-l'Etoile, France) and Toxoplasma gondii IgG avidity EIA kit (Labsystems, Helsinki, Finland). Samples were obtained from both pregnant women and subjects in different clinical settings. RESULTS: Of 64 sera positive in both VIDAS Toxo IgG and VIDAS Toxo IgM tests, 19 (29.7%) had high avidity antibodies in VIDAS and 17 (26.6%), high avidity antibodies in Labsystems kit. A total of 48 (75.0%) of 64 sera showed concordant results between VIDAS and Labsystems Toxo IgG avidity tests; one (1.2%) serum sample showed discordant results and in 15 (23.4%) sera, results were high or low in one test and borderline in the other. Overall correlation coefficient for results obtained in both tests was 0.80 (0.60 in sera of pregnant women and 0.88 in sera of other patients, respectively). CONCLUSIONS: Correlation between results obtained in BioMérieux and Labsystems Toxo IgG avidity kits in sera from pregnant women as well other individuals was high. BioMérieux assay possesses the advantage of automatization but requires the VIDAS machine; in contrast, Labsystems assay is less costly but requires time-intensive manual performance and calculation of test results.     

内蒙古自治区15岁以下儿童麻疹疫苗强化免疫分析

目的内蒙古自治区在麻疹疫苗强化免疫前、后的现场调查、评估,并对麻疹监测系统和传染病报告系统的疫情资料进行了分析。方法所有8月龄～14岁儿童接种1剂麻疹疫苗,每剂次0.5ml;结果这次强化免疫接种儿童3086839人,报告接种率和调查接种率均>97%;接种后麻疹发病人数明显减少,发病率仅为5.84/10万,较强化免疫前发病率9.82/10万下降了40.53%;2008年4月-2009年3月麻疹监测系统数据显示,62%的麻疹病例发生在8月龄-14岁,约有85%病例为无免疫史或免疫史不详。结论在较大范围内开展高质量MV强化免疫能迅速降低麻疹发病,以形成有效的人群免疫屏障来阻断麻疹病毒的传播。     

Measles,mumps, and rubella: A cross-sectional study of susceptibility to vaccine-preventable diseases among young people in India

BackgroundGlobal elimination of vaccine preventable diseases, such as measles, mumps and rubella is a priority. Many countries have reported diminishing of antibody titres against these diseases among young population as immunization coverage of adolescents and adults in not monitored. The objective of this study was to determine the susceptibility against measles, mumps and rubella among young adults.MethodsIn this cross-sectional study serological evidence of susceptibility to measles, mumps and rubella was determined by qualitative detection of IgG antibody titres by commercially available enzyme linked florescence assay (VIDAS, bioMerieux) in serum samples young adults.ResultsA total of 335 young individuals (mean age: 20.54 ± 1.37 years) participated voluntarily between May 2017 to September 2018, of which 183 (54.63%) were males. Seroprotection against measles, mumps and rubella were 87.16%, 82.69% and 79.10% respectively.ConclusionSerological surveillance is important to monitor immune status in population. Susceptibility of young adults to measles, mumps, and rubella indicates need for booster vaccination. With the recent launch of measles-rubella vaccination campaign in India, country specific data will be required to plan periodicity of such campaign, which in turn would be based on accumulation of susceptible individuals in a community. Lastly, inclusion of mumps vaccine in the national universal immunization program needs consideration.     

重症肌无力患者免疫指标检测及其临床评价

目的探讨重症肌无力（MG）患者的免疫指标与病情、分类及疗效之间的关系,评价其临床意义。方法在治疗前后动态采用流式细胞仪检测外周血CD3、CD4和CD8及比浊法检测IgG、IgA和IgM,进行分类比较其变化。结果全身型MG患者的IgG、IgA较眼肌型高,P〈0．05,差异有统计学意义。在体液免疫低下组中,用丙种球蛋白治疗的缓解率为95．2％,仅用吡啶斯的明组缓解率为28．8％,二者比较差异有统计学意义（P〈0．01）。CD4／CD8比值降低占48％,比值升高占24．4％,比值正常占27．6％。根据IgG、IgA、IgM的值进行分类,低下组占48．9％,升高组占20．4％,紊乱组占9．7％,正常组占21％。各免疫指标在治疗前后的比较差异无统计学意义,各免疫分组的临床资料比较差异也无统计学意义。结论MG患者的免疫状态比较复杂,以低下或抑制为主,还有相当比例在正常范围。IgG、IgA、IgM、CD3、CD4、CD8不能作为MG病情、疗效的惟一评价指标,但对指导治疗具有一定的参考价值。     

Measles in the 1980s

We detail aspects of measles immunization programmes in several countries. Live measles vaccine has been available in Australia for 16 years, yet, in 1981, there were outbreaks of measles in the State of New South Wales (population 5 200 000) which led to 2200 admissions to hospital and five deaths. In response to complaints of "vaccine failure", a survey determined that 22.5% of children with measles seen by general practitioners and 10.3% of those admitted to hospitals had been previously immunized. There was no evidence of waning immunity, and noparticular batch of vaccine was implicated. The vaccine failures are attributed in part to failure of seroconversion in some recipients when immunized at 12 months of age as a result of interference by transplacentally acquired antibodies. As more of the susceptible population is vaccinated, there will be fewer cases of measles, but among these cases will be an increasing proportion of cases occurring in previously vaccinated individuals. The equation to calculate this expected proportion of "vaccine failures" is given. We support the measures to increase immunization compliance.     

育龄妇女接种麻疹疫苗对婴儿麻疹抗体及麻疹疫苗接种的影响

目的：研究育龄妇女接种麻疹疫苗后所生婴儿的胎传麻疹抗体的动态变化,并了解其对婴儿接种麻疹疫苗的影响。方法：选择2012年1月1日至2012年12月31日300位育龄妇女纳入本研究,检测麻疹IgG抗体后进行随机对照试验（RCT）,设立高抗体无疫苗接种组（I组,52例）、高抗体疫苗接种组（II组,53例）、低抗体无疫苗接种组（III组,98例）和低抗体疫苗接种组（IV组,97例）。I组和III组不接种疫苗,II组和IV组接种麻腮风联合减毒活疫苗,各组均于待产时检测麻疹IgG抗体。检测育龄妇女所生婴儿出生时、8月龄大时、接种麻疹疫苗后半个月和接种麻疹疫苗后3个月血麻疹IgG抗体,于接种麻疹疫苗后半个月同时检测麻疹IgM抗体。分析育龄妇女待产时麻疹IgG抗体水平与婴儿出生时IgG抗体水平的相关性,分析婴儿麻疹IgG抗体的动态变化及IgM抗体的情况。结果：对育龄妇女待产时麻疹IgG抗体水平与新生儿脐带血麻疹IgG抗体水平进行pearson相关分析,显示相关系数为0.85,P=0.00,提示存在相关性。重复测量方法分析结果显示,I组和II组、III组和IV组之间婴儿麻疹IgG抗体变化差均异有统计学意义（均P=0.00）,而I组和III组、II组和IV组之间差异无统计学意义（分别为P=0.11和P=0.45）。接种后3个月各组间比较,F=1.36,P= 0.26,提示各组间此时间点上差异无统计学意义。婴儿IgG抗体趋势图显示,婴儿的胎传麻疹抗体水平随时间逐步减少,在接种麻疹疫苗3个月时又明显升高。I～IV组婴儿麻疹IgM抗体样本/临床值比值（S/CO值）经单因素方差分析,F=0.95,P=0.42,提示各组间差异无统计学意义。结论：育龄妇女接种麻疹疫苗可提高所生婴儿胎传麻疹抗体水平,使婴儿在接种麻疹疫苗前获得足够的保护性抗体,也不会影响婴儿接种麻疹疫苗的效果。     

巨细胞病毒在炎症性肠病中的临床意义及其诊治策略

目的 探讨巨细胞病毒（cytomegalovirus,CMV）在炎症性肠病（inflammatory bowel disease,IBD） 临床意义及其诊治策略。方法 从IBD患者[其中溃疡性结肠炎（UC）39例,克罗恩病（CD）15例]及对照组患者（肠易激综合征患者55例）血液中检测CMV抗体,并从 UC患者（其中手术标本11例,肠镜下活检标本39例）,以及克罗恩病患者（其中手术标本4例,肠镜下活检标本15例）,及对照组肠镜下活检标本55例,检测CMV抗体及CMV包涵体。结果 IBD伴CMV感染肠道病变更广泛,多为全结肠炎或右半结肠炎。IBD组CMV抗体阳性率高于对照组（P<0.01）,重度、激素难治性UC组全身激素治疗多于非激素难治性UC组（P<0.05）,重度、激素难治性UC组CMV IgM抗体阳性率高于非重度和（或）激素难治性UC组（P<0.05）,手术UC组血清CMV抗体阳性率高于非手术IBD组（P<0.01）,重度、激素难治性UC组CMV包涵体（HE染色）阳性率与非重度和（或）激素难治性UC组比较,差异无统计学意义（P>0.05）,重度、激素难治性UC组CMV包涵体（IHC）阳性率高于非重度和（或）激素难治性UC组（P<0.01）,手术UC组CMV包涵体（IHC）阳性率高于非手术IBD组（P<0.01）,重度或难治性IBD常合并或继发有CMV感染经适当的抗病毒治疗可明显改善病情。结论 血清学和组织学（特别是IHC） 联合检测可提高CMV感染诊断的准确性。在重症或激素难治性UC患者检测CMV是特别重要的,如果检测到CMV感染,更昔洛韦抗病毒治疗应立即开始,逐渐减弱激素剂量,并停用免疫抑制剂。     

银川市人群麻疹抗体水平检测分析及发病原因探讨

目的了解银川市健康人群麻疹抗体水平,结合麻疹发病情况,分析发病原因,为进一步制订麻疹防制策略提供科学依据。方法采用酶联免疫吸附试验(ELISA)对银川市0~29岁不同年龄组健康人群进行麻疹IgG抗体水平血清学检测,并对结果进行几何平均滴度(GMT)、F检验及x2检验分析。结果本次共检测1312份血清标本,阳性率为73.40%,抗体几何平均滴度(GMT)为1:420.58,保护率为51.75%。0~8月龄及25~29岁组抗体阳性率、保护率及GMT均较低,2~15岁组则较高;四类人群中城市人群保护率最高为72.88%,农村及流动人群较低,分别为65.82%和66.81%。结论今后应采取必要的措施加强我市0~8月龄和25~29岁年龄段人群麻疹疫苗的接种工作;定期对四类人群的接种效果进行评价,并加强流动及农村人口的强化免疫及麻疹疾病的监测,是控制麻疹流行的主要手段。     

济宁市某县麻疹爆发实验室早期诊断结果分析

目的摸清麻疹爆发的原因及发病特点，为控制麻疹提供科学的实验室依据。方法采用酶联免疫捕获法，对疑似病例血清标本进行麻疹IgM抗体，风疹IgM抗体检测，同时，对孕妇血清标本进行IgG抗体检测。结果408例麻疹疑似病例IgM抗体阳性率为91．18％，风疹IgM抗体全部阴性，0—10、20—30岁年龄组发病较高，分别占45．71％（170／372）、30，38％（113／372）。性别上总体无显著性差异，但20—25岁年龄组，女性发病较高，其发病比例，男女之比为1：2．9（14／41），同时，在疫区采集的未发病的孕妇血清标本，麻疹IgG抗体阳性率仅为25％（7／28）。结论应加强0—10、20—30岁年龄组、尤其2岁以下幼儿和育龄妇女的麻疹疫苗免疫接种。其次，应加强基层人员的专业技术培训，确保麻疹疫苗的接种质量。同时也要加大麻疹保护性抗体的监测力度，随时掌握全市不同年龄组人群的麻疹免疫水平，为制定全市的麻疹免疫规划提供科学的依据。     

巨细胞病毒IgG抗体亲合力分析与IgM抗体检测的评价

目的评估IgM抗体检测及IgG抗体亲合力分析对于巨细胞病毒(CMV)原发性感染诊断的意义。方法 80例标本经间接免疫荧光法检测CMV IgG抗体,免疫捕获法检测CMV-IgM抗体,ELISA法进行CMV IgG抗体亲合力分析,计算亲合力指数(AI)。结果 40例标本的抗CMV IgG抗体阳性、IgM抗体阴性,AI在56%～97%之间,平均为79%。40例标本的抗CMV IgG、IgM抗体均阳性,AI为5%～99.3%,平均61.72%,其中9例(22.5%)标本的AI值低于30%,为低亲合力抗体;4例(10%)AI值介于30%～60%之间,为中等亲合力抗体;其他27例(67.5%)标本的AI值均高于60%,为高亲合力抗体。两组数据的AI均值有显著性差异。结论大部分CMV IgM抗体阳性的患者不是近期原发感染,单纯一项血清学检测不能进行诊断,结合IgM抗体检测及IgG抗体亲合力分析可以大大提高检测效率。     

Altered Reactivity to Measles Virus in Previously Vaccinated Children

In children vaccinated with killed measles vaccine, exposure to natural rubeola within two to four years can result in a clinical syndrome of altered measles reactivity.

During a small epidemic of measles in Edmonton, Alberta, 51 children who had received their last killed measles vaccination 27 to 45 months before, were admitted to hospital with this syndrome.

The syndrome consists of a prodromal cough and high fever followed by a maculopapular rash appearing on the extremities and progressing centrally. Pulmonary consolidations with or without pleural effusions were evident, but these cleared rapidly in four or five days. Initial WBC and ESR values suggested a bacterial etiology, but no pathogens could be isolated.

Complement fixation titres for rubeola are present in acute and convalescent sera and indicate a definite measles infection.

Previous killed measles vaccination excites a delayed hypersensitivity which is activated by the natural measles infection to account for this syndrome.

It is recommended that killed measles vaccine be no longer used in routine vaccinations.

     

2008年安阳市麻疹流行特征和强化免疫效果分析

目的了解安阳市2008年麻疹流行病学特征和麻疹疫苗(MV)强化免疫控制麻疹流行的效果,为麻疹防控提供依据。方法对安阳市2008年麻疹病例进行描述流行病分析及对2009年1月MV强化免疫效果进行分析。结果2008年安阳市麻疹发病率为16.50/10万。<10岁儿童病例占总病例的84.11%,<2岁儿童病例占总病例的54.86%。8月龄~10岁儿童无免疫史者占同年龄病例的54.75%。实施MV强化免疫,共接种301 389人次,快速评估接种率为100%。结论无MV免疫史致使易感人群的大量积累,是造成麻疹疫情流行的根本原因。保持高的常规免疫接种率,保持高的免疫成功率,适时开展MV强化免疫,以及敏感的麻疹监测系统是加速控制麻疹的主要措施。     

86例儿童麻疹发病特点临床分析

目的分析我院近年儿童麻疹发病特点,探讨早期诊断麻疹的实验室方法.方法对2003年确诊的86例麻疹患儿的发病特点进行分析.留取的咽拭子、新鲜尿标本采用逆转录聚合酶链反应(RT-PCR)方法检测麻疹病毒N基因相关片段,静脉血标本用传统的ELISA方法检测麻疹病毒IgM抗体,并对两种实验室检测结果进行比较.结果外地打工人员子女为主要患病人群,1岁以内婴儿发病率居各年龄段发病率之首,轻型和不典型病例增多,重症和死亡病例减少.在病程早期,麻疹病毒N基因相关片段检测阳性率为87.5%(28/32),MV特异性IgM阳性率为67.9%(19/28),两者无显著性差异.结论近年儿童麻疹发病有其新特点.用RT-PCR方法检测麻疹病毒N基因留取标本方便,无痛苦,在病程早期即可检测到,且单份标本就可进行检测,故在麻疹早期,对不典型麻疹病例检测麻疹病毒N基因较检测MV特异性IgM更有助于明确诊断和鉴别诊断.     

浙江省6~15岁儿童高浓度抗麻疹病毒抗体影响因素分析

目的: 了解浙江省6~15岁儿童抗麻疹病毒高浓度抗体阳性率及其影响因素,为制订麻疹防控策略提供科学依据。方法: 采集浙江省湖州市长兴县和丽水市莲都区2069名6~15岁儿童的血清,ELISA法定量检测麻疹IgG抗体水平,抗体浓度800 mIU/mL以上为达到高浓度抗体。利用χ²检验或趋势χ²检验比较不同特征人群麻疹高浓度抗体的阳性率;多因素logistic回归分析麻疹疫苗接种儿童麻疹高浓度抗体的影响因素。结果: 2069名调查对象中,麻疹高浓度抗体阳性率为36.06%（746/2069）。多因素logistic回归分析结果显示,年龄和起始接种月龄是麻疹疫苗接种儿童麻疹高浓度抗体的影响因素。随着年龄的增长,高浓度抗体阳性率呈现下降趋势（OR：0.866,95%CI：0.830~0.904,P < 0.01）;12月龄及以上接种者的高浓度抗体阳性率高于8月龄接种者（OR：0.633,95%CI：0.498~0.805,P < 0.01）。结论: 为维持高水平人群免疫屏障,建议疫情低发地区可以适当延迟麻疹疫苗首剂次接种时间,并对于大龄儿童适时进行补种。     

延安市麻疹疫苗强化免疫血清学效果观察

目的探讨麻疹疫苗强化免疫效果。方法采用酶联免疫吸附试验对279名观察对象采集麻疹疫苗强化免疫前、免疫后的双份血清进行麻疹IgG抗体检测。结果麻疹抗体阳性率由麻疹疫苗强化免疫前的78.49%上升到强化免疫后的100%,麻疹IgG抗体几何平均滴度(GMT)由1∶497.84上升到1∶1289.57。结论麻疹疫苗强化免疫可以迅速提高人群麻疹抗体水平。     

卡介菌多糖核酸与特异性脱敏联合治疗128例支气管哮喘

用卡介菌多糖核酸注射液与特异性脱敏联合治疗１２８例支气管哮喘，观察其临床疗效及对免疫球蛋白的影响。结果显示：联合治疗组总有效率为９６．９％，明显高于８５例单用脱敏治疗组的７６．５％，差异有高度显著性（Ｐ＜０．０１），对混合性、内源性哮喘的疗效明显优于外源性哮喘（Ｐ＜０．０１）。治疗前ＩｇＧ显著升高（Ｐ＜０．０１），ＩｇＡ、ＩｇＭ略高于健康人。脱敏治疗后，ＩｇＧ有所下降（Ｐ＜０．０５）。联合治疗后则ＩｇＧ显著下降（Ｐ＜０．００１）。ＩｇＡ、ＩｇＭ治疗前后变化不明显。