新生儿接种乙型肝炎疫苗后低/无应答者的再免疫效果分析

目的了解新生儿接种乙型肝炎(乙肝)疫苗(Hepatitis B Vaccine,HepB)后低/无应答者的再免疫效果。方法对北京市、浙江省、广东省2004～2005年出生的新生儿,按照0、1、6月龄免疫程序完成3剂重组HepB(酵母)[HepB Made by Recombinant Deoxyribonucleic Acid(DNA)Techniques in Yeast,HepB-Y]免疫后,出现的低/无应答者,随机分为4组,按0、1、6个月程序再次免疫不同种类和剂量的HepB。结果低/无应答儿童再免疫前、再免疫1剂和再免疫3剂后,抗乙肝病毒表面抗原抗体[Antibody to Hepatitis B Virus Surface Antigin(HBsAg),Anti-HBs]几何平均浓度(Geometric Mean Concentration,GMC)分别为18.7mIU/m(l毫国际单位/毫升)、88.8mIU/ml、178.2mIU/ml,无应答者所占比例分别为20.4%、9.1%、1.9%。103名低/无应答儿童再免疫1剂和3剂后,100mIU/ml所占的比例分别为61.2%和84.5%,差异有统计学意义(χ2=14.13,P0.01);5μg重组HepB-Y、10μgHepB-Y、10μg重组HepB(中国仓鼠卵巢细胞)[HepB Made by Recombinant DNA Techniquesin Chinese Hamster Ovary(CHO)Cell,HepB-CHO]、10μg重组HepB(汉逊酵母)(HepB Made by Recombinant DNA Techniques in Hansenula Polymorpha Yeast,HepB-HPY)四种HepB再免疫3剂后,GMC分别为168.8mIU/ml、174.7mIU/ml、184.9mIU/ml、182.9mIU/ml,四种HepB再免疫3剂后,100mIU/ml所占的比例分别为79.0%、85.7%、88.2%、84.6%,差异均无统计学意义(χ2=0.75,P0.05)。结论 HepB全程免疫三剂后,低/无应答儿童按照0、1、6个月程序再次免疫3剂HepB后,抗体阳转率和GMC均有较大的提高,再免疫3剂HepB免疫效果优于再免疫1剂。     

母亲乙型肝炎病毒表面抗原阴性婴儿接种重组乙型肝炎疫苗(酵母)后的抗体无应答分析

目的探讨母亲乙型肝炎(乙肝)病毒表面抗原(HBsAg)阴性婴儿,应用国产重组乙肝疫苗(酵母)常规接种后的乙肝病毒表面抗体(抗-HBs)应答状况及其特征。方法在河南省开封市筛选母亲HBsAg阴性的7～24月龄婴幼儿8 093例,按0、1、6个月程序接种5μg国产重组乙肝疫苗(酵母),用固相放射免疫法检测抗-HBs,对<10mIU/ml者的性别、城乡、不同月龄等特点进行分析。结果2 970例7～10月龄婴儿中,56例抗-HBs<10mIU/ml,无应答率为1.89%。其中1 911例城市婴儿中7例无应答(0.37%),1 059例农村婴儿中无应答者49例(4.63%),城乡婴儿抗-HBs无应答率的差异有非常显著的统计学意义(χ2=66.87,P<0.01),不同性别婴儿抗-HBs无应答率的差异无显著的统计学意义。城乡婴儿抗-HBs无应答率的差异与疫苗管理及接种质量综合评估呈显著负直线相关。婴儿11～24月龄间抗-HBs下降速度快,至22～24月龄时,已有15.53%抗-HBs阴转,较7～10月龄时增加8.22倍。结论母亲HBsAg阴性的婴儿常规接种5μg国产重组乙肝疫苗(酵母)后,抗-HBs无应答率为1.89%。城市低于农村。全程免疫后婴儿抗-HBs的下降速度快,提示应加大新生儿期疫苗的剂量,重组乙疫苗(酵母)可由5μg/剂提高到10μg/剂。     

新生儿接种乙肝疫苗后无(低)应答率及再免效果分析

目的了解新生儿接种乙肝疫苗后无(低)应答率,评价无(低)应答儿童再接种乙肝疫苗后免疫效果。方法在深圳市南山区、东莞市预防接种门诊按0、1、6月龄免疫程序接种5μg重组酵母乙肝疫苗后1～6个月的婴儿中,随机选择1913名作为研究对象,问卷调查儿童性别、出生体重、是否早产、母亲乙肝感染状况、乙肝疫苗接种史等,并采集其血清,用放射免疫法检测乙肝病毒表面抗原(HBsAg)、乙肝病毒表面抗体(抗-HBs)、乙肝病毒核心抗体(抗-HBc)。选择以上研究对象中无(低)应答的109名儿童分别用10μg汉逊酵母乙肝疫苗和10μg CHO重组乙肝疫苗按0、1、6月程序再免疫,接种3针后1个月再检测抗-HBs。结果1913名新生儿接种乙肝疫苗后无(低)应答率为31.42%,其中无应答率为3.24%,低应答率为28.18%。母亲HBsAg阳性或HBeAg阳性的新生儿无应答率为7.47%、18.37%,分别高于母亲阴性的新生儿(3.04%、3.05%)(均P<0.01),低体重儿的无应答率(8.06%)高于非低体重儿(3.12%)(P<0.05),母亲HBeAg阳性的新生儿抗-HBs滴度明显低于母亲阴性的新生儿(P<0.05)。无(低...     

抗-HBs衰减青少年乙肝疫苗加强免疫效果研究

目的研究乙肝疫苗(Hepatitis B Vaccine,HepB)基础免疫后12～15年乙肝病毒表面抗原抗体(抗-HBs)衰减者加强免疫前后抗体水平间的关系,比较不同剂次的加强免疫效果。方法选择婴儿期完成HepB基础免疫的1993—1997年出生的儿童,采集静脉血,使用化学发光法检测后,HBsAg及抗-HBc阴性而抗-HBs降至保护性水平(10mIU/ml)以下作为研究对象。按抗-HBs滴度水平分为3组:Ⅰ组(﹤0.1 mIU/ml)、Ⅱ组(0.1～1 mIU/ml)和Ⅲ组(﹥1 mIU/ml);按0、1、6免疫程序加强免疫3剂10μg的重组乙肝疫苗(汉逊酵母)(HepB-HPY),分别于免疫1剂和3剂后1个月采集静脉血,检测抗-HBs。结果 453名研究对象加强免疫1剂后各组抗-HBs阳转率分别为67.96%、85.61%和97.60%,抗体滴度分布差异有统计学意义(χ2=132.88,P﹤0.05),几何平均浓度(GMC)分别为37.31、152.77和1310.27 mIU/ml(F=86.11,P﹤0.05);加强免疫3剂后各组抗-HBs阳转率分别为99.00%、99.21%和99.49%(Fisher确切概率法,P﹤0.05),GMC分别为1714.67、1502.32和3383.68 mIU/ml(F=16.59,P﹤0.05)。全程采血的425名儿童在免疫1剂和3剂后抗体阳转率分别为87.76%和99.29%(χ2=46.68,P﹤0.05)。结论对于完成HepB基础免疫后抗体衰减至10 mIU/ml以下的12～15岁儿童有必要进行加强免疫,加强免疫前抗体滴度较高者加强免疫效果较好;加强免疫3剂比1剂效果好。     

儿童乙型肝炎疫苗免疫和加强免疫后保护性抗体观察

目的评价儿童乙型肝炎(乙肝)疫苗(HepB)免疫后保护性抗体应答水平及乙肝病毒表面抗体(抗-HBs)阴性儿童加强免疫后抗体的变化。方法采取多阶段整群系统抽样方法抽取调查单位和儿童,用固相放射免疫方法检测接种儿童血清乙肝病毒表面抗原(HBsAg)、抗-HBs和乙肝病毒核心抗体水平,并对抗-HBs阴性儿童进行加强免疫。结果3~12岁儿童抗-HBs平均阳性率为49.3%,几何平均浓度(GMC)为70.22毫国际单位/毫升(mIU/ml)。重组乙肝疫苗(酵母)免疫后3~6岁儿童抗-HBs阳性率为37.6%,随年龄增长而下降,GMC为55.29mIU/ml,各年龄组差异有非常显著的统计学意义。6~12岁儿童使用血源HepB,抗-HBs阳性率为51.0%,GMC为68.27mIU/ml,各年龄组差异无显著的统计学意义。抗-HBs阴性儿童加强免疫后抗体阳转率为93.9%,GMC为91.83mIU/ml。结论儿童HepB免疫后12年保护性抗体应答良好,HBsAg阳性率未随免疫时间延长而增加,目前尚不需进行加强免疫。抗-HBs阴性儿童加强免疫后有很好的回忆反应。     

威海市新生儿乙肝疫苗初免和低/无应答者再免疫效果分析

[目的]了解新生儿接种乙肝疫苗后的免疫效果和对全程免后低/无应答者的再免疫效果。[方法]2009年,在威海市3个市(区)抽取7～12月龄儿童1 102名,按"0,1,6"程序接种3剂次5μg啤酒酵母重组乙肝疫苗(HepB-SC),对其中低/无应答者分别按上述程序再次接种不同种类和剂量的乙肝疫苗,检测调查对象血清抗-HBs水平,观察变化情况。[结果]检测儿童1 102名,3剂乙肝疫苗接种后,抗-HBs阳性率为98.19%(正常应答率为84.66%、低应答率为13.52%),无应答率为1.81%;GMC为800.94mIU/ml。检测再免疫的低/无应答儿童127名(17名无应答、110名低应答),抗-HBs的GMC,再免疫前为45.72mIU/ml,1剂次再免疫后为1 373.50mIU/ml(P<0.01);3剂次再免疫后检测其中100名(14名无应答、86名低应答),抗-HBs的GMC上升为1 763.33mIU/ml,与1剂次后的差异无统计学意义(P>0.05)。[结论]按现行免疫程序乙肝疫苗全程免疫后,可以取得良好的免疫应答。对低/无应答者按相同免疫程序再次接种3针后,抗-HBs水平有较大幅度提高。     

重组乙型肝炎疫苗(啤酒酵母)和重组乙型肝炎疫苗(汉逊酵母)在成人中的抗体应答

目的观察重组乙型肝炎(乙肝)疫苗(啤酒酵母)和重组乙肝疫苗(汉逊酵母)在成人中的乙肝病毒表面抗体(抗-HBs)应答。方法对乙肝病毒表面抗原(HBsAg)阴性、且未接种过乙肝疫苗的新入学大学生,全程接种重组乙肝疫苗(啤酒酵母)和重组乙肝疫苗(汉逊酵母),观察抗-HBs应答。结果接种10μg、5μg、5μg重组乙肝疫苗(啤酒酵母)的136人,抗-HBs阳转率94.1%,几何平均浓度(GMC)105.42毫国际单位/毫升(mIU/ml);接种10μg×3重组乙肝疫苗(汉逊酵母)的136人,抗-HBs阳转率99.3%,GMC 111.49mIU/ml。接种两种疫苗均未观察到明显的不良反应。结论采取10μg×3的免疫程序接种重组乙肝疫苗(汉逊酵母)的抗-HBs阳转率和GMC均高于采用10μg、5μg、5μg免疫程序接种重组乙肝疫苗(啤酒酵母)。     

成人接种20微克重组乙型肝炎疫苗免疫应答及其影响因素的比较研究

目的比较成人接种20微克(g)重组乙型肝炎(乙肝)疫苗(中国仓鼠卵巢细胞)[Hepatitis B Vaccine(HepB)Made by Recombinant Deoxyribonucleic Acid(DNA)Techniquesin Chinese Hamster Ovary(CHO)Cell,HepB-CHO]和20g重组乙肝疫苗(酿酒酵母)(HepB Made by Recombinant DNA Techniquesin Saccharomyces Cerevisiae Yeast,HepB-SCY)的抗体应答及其影响因素。方法在山东省章丘市选择研究现场,筛选出乙肝病毒表面抗原[Hepatitis B Virus(HBV)Surface Antigen,HBsAg]、抗乙肝病毒表面抗原抗体(Antibody to HBsAg,Anti-HBs)和抗乙肝病毒核心抗原抗体全阴性者作为研究对象,随机分为两组,按照0、l、6个月免疫程序分别接种20g HepB-SCY和20g HepB-CHO。所有研究对象进行问卷调查并采集静脉血,采用化学发光微粒子免疫分析法(Chemiluminescence Microparticle Imunoassay,CMIA)定量检测Anti-HBs。比较不同HepB初次免疫后的抗体应答率和抗体水平,采用多因素分析方法确定排除其他因素影响后,HepB种类对抗体应答的影响。结果 HepB-SCY和HepB-CHO分别接种2011人和2290人。HepB-SCY无应答[相似文献   

新生儿5μg和10μg重组酵母乙型肝炎疫苗初免后抗体免疫应答比较

目的 比较新生儿接种5 μg和10 μg重组酵母乙型肝炎(乙肝)疫苗后抗-HBs血清应答状况.方法 以山东、江苏、上海、广西、北京5省(自治区、直辖市)为研究现场,采用5 μg重组啤酒酵母乙肝疫苗(HepB-SC)和l0μg重组汉逊酵母乙肝疫苗(HepB-HP),按照“0-1-6”免疫程序完成初免的7～ 12月龄健康婴儿.调查对象采用问卷调查并采集静脉血,应用化学发光微粒子免疫分析法(CMIA)定量检测抗-HBs.抗-HBs＜ 10 mIU/ml者采用CMIA检测HBsAg,HBsAg阴性者采用巢式PCR方法检测HBV-DNA.比较不同HepB初免后的抗体应答率和抗体水平,采用多因素分析方法确定HepB种类对抗体阳转率和抗体水平的影响.结果 共观察8947名5μgHepB-SC初免(5μg组)和4576名10 μg HepB-HP初免(10μg组)婴儿.5μg组无应答、低应答、正常应答和高应答率分别为1.88％、15.18％、61.42％和21.52％,10μg组分别为0.15％、2.16％、29.42％和68.26％;5 μg组无应答、低应答和正常应答率高于10μg组,高应答率低于10 μg组,各应答率之间差异均有统计学意义(P＜0.01).5 μg组和10μg组初免后抗-HBs几何平均浓度分别为354.81mIU/ml(95％CI:338.84～363.08 mIU/ml)和1778.28mIU/ml(95％CI:1698.24～1819.70mIU/ml),差异有统计学意义(F=4517.17,P＜0.001).多因素分析显示,排除采血月龄、性别、出生体重、早产、母亲分娩前HBsAg状态等因素影响,两种HepB初免后抗体阳性率和抗体水平的差异仍有统计学意义.结论 新生儿使用10 μg HepB-HP初免抗体应答优于5μg HepB-SC.     

广西壮族自治区隆安县乙型肝炎疫苗全程接种后的免疫记忆研究

目的了解接种全程乙型肝炎（乙肝）疫苗后的免疫记忆情况。方法1987-1989年出生时接种乙肝血源疫苗的1201名新生儿,以及1996-1999年出生时接种乙肝酵母重组疫苗的2484名新生儿,于2005年随访时检测乙肝表面抗原（HBsAg）、表面抗体（抗-HBs）和核心抗体（抗- HBc）,结果959名3项乙肝病毒（HBV）标志物均阴性,其中228名接种乙肝血源疫苗,731名接种乙肝酵母重组疫苗,于加强免疫1针乙肝酵母重组疫苗后15 d时检测其抗-HBs。此外,随机选择11名加强免疫后无应答和22名有应答者,应用酶免疫斑点法（ELISPOT）测定白细胞介素-2（IL-2）。有初次免疫后抗-HBs定量检测资料者190名,比较其初次免疫和加强免疫后抗-HBs水平。结果加强免疫后,79．82%接种乙肝血源疫苗者抗-HBs阳转,几何平均滴度（GMT）为325．69 mIU/ml;95．62%接种乙肝酵母重组疫苗者抗-HBs阳转,GMT为745．18 mIU/ml。加强免疫后所产生的抗-HBs水平与初次免疫后抗体滴度有关。加强免疫后抗-HBs阳转者的IL-2阳性率（40．91%）也高于无应答者（P＜0．01）。结论在乙肝疫苗初次免疫后,抗-HBs转阴者中,大部分仍具有免疫记忆,仅少部分在长期随访中丧失免疫记忆。因此,在高流行地区,对丧失免疫记忆者应进行乙肝疫苗加强免疫。     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.