糖尿病患者与流感及肺炎疫苗接种

糖尿病患者是感染的高危人群,感染后易并发急、慢性并发症,预后不佳.其主要机制包括中性粒细胞功能障碍、细胞和体液免疫功能缺陷、细菌定植率增高等.流感和肺炎是最常见的两种可预防性感染性疾病.通过接种流感和肺炎疫苗,可以安全有效地降低糖尿病患者的住院率和病死率.多国相继出台了相关文件推荐糖尿病患者接受流感和肺炎疫苗接种.但目前我国疫苗接种的现状并不理想,接种率低的原因可能与患者对疫苗的认识程度低等因素有关.     

糖尿病患者肺炎疫苗接种率和影响因素调查分析

目的探讨糖尿病患者肺炎疫苗接种意愿和相关影响因素。方法选取2012年3月—2013年3月于该社区就诊的823例糖尿病患者为研究对象,调查患者的肺炎疫苗接种率,对疫苗接种患者病例资料进行回顾性分析,并探讨疫苗接种的相关影响因素。结果 823例患者中有126例接受肺炎疫苗接种,接种率为15.31%,影响患者接种的因素有学历、病程、并发呼吸道感染疾病等因素,以并发呼吸道感染疾病的患者接种率最高。结论糖尿病患者接受肺炎疫苗接种的主动性不强,疫苗接种以并发有呼吸道感染疾病患者居多,因此应加大对糖尿病患者肺炎疫苗接种的宣传教育力度,以接种疫苗改善患者生存质量。     

HIV感染者接种灭活甲型肝炎疫苗的安全性和免疫原性

甲型肝炎对于HIV感染者的健康来说是一个主要的危险因素.接种疫苗可能是一种能够降低ⅢV感染者中甲型肝炎发病率的方法,但有关其安全性和免疫原性的数据尚不完整.     

2021年仁寿县65岁及以上老年人流感疫苗接种意愿及影响因素调查分析

目的 了解仁寿县65岁及以上老年人接种流感疫苗的意愿及其影响因素。方法 2021年8月采取分层多阶段随机抽样方法,根据仁寿县城区和农村常住人口比例抽取65岁及以上老年人进行流感及流感疫苗相关情况调查。采用SPSS 13.0软件进行描述性统计分析,检验水准α=0.05。结果 本次调查共回收问卷395份,其中有效问卷383份,有效回收率为96.96%。受访者中愿意接种流感疫苗的140名,不愿意接种流感疫苗的243名,36.55%(140/383)的老年人愿意在流感高峰到来前接种流感疫苗;在不愿意接种流感疫苗的243名调查对象中,有44.44%(108/243)的调查对象表示如果流感疫苗免费则愿意接种。结论 65岁及以上老年人对流感疫苗的认识还存在不足,应加大健康宣教和健康促进。     

非疫苗血清型肺炎链球菌发生机制及疫苗新策略

肺炎链球菌(Streptococcus pneumoniae,Sp)是社区获得性肺炎以及侵袭性疾病如脑膜炎和败血症的主要致病菌之一,到目前为止,关于肺炎链球菌感染性疾病的预防仍以肺炎链球菌多糖疫苗(pneumococcal polysaccharide vaccine,PPV)和肺炎链球菌多糖蛋白结合疫苗(pneumococcal conjugate vaccine,PCV)为主。然而靶向特定荚膜多糖的肺炎链球菌疫苗的选择性压力在一定程度上诱导了肺炎链球菌荚膜转换,导致了不同荚膜抗原突变体的产生,进而造成非疫苗血清型(non-vaccine type,NVT)及无荚膜肺炎链球菌(nonencapsulated streptococcus pneumoniae,NESp)的增加,使现有的疫苗不能有效预防肺炎链球菌的感染。本文重点介绍了肺炎链球菌非疫苗血清型的发生机制,为制备新型肺炎链球菌疫苗提供思路与策略。     

皖北农村地区HIV感染者安全套使用情况及影响因素

目的了解皖北农村地区艾滋病病毒(HIV)感染者的安全套使用现状,并探讨安全套使用的影响因素。方法整群抽取皖北某项目县197名HIV感染者和病人家属、当地防艾人员,进行面对面问卷调查及个人访谈。结果获得197人份有效问卷,其中165人为HIV感染者,84.2%(139/165)为经卖血感染。大部分感染者知道感染情况后性生活比过去减少(53.3%)或完全停止(18.3%);每次性生活都使用安全套的有111人(68.9%);最近一次与配偶过性生活时使用安全套的有133人(82.6%)。受访者大都支持使用安全套,但自觉使用安全套的人不多,一些人对安全套的正确使用并不知晓或并不注意。安全套基本是从乡镇卫生院获取,安全套的质量也可以接受。结论该县感染者存在着不正确使用安全套和使用不能持久的问题,因此要对目标人群进行有针对性、多样化的干预措施,提高安全套的正确使用率。     

肺炎链球菌蛋白质疫苗研究进展

随着肺炎链球菌(SP)耐药菌株的不断出现使得疫苗研发备受关注,但目前使用的荚膜多糖及其结合疫苗有很大局限性。因此,针对SP主要毒力因子的蛋白质疫苗迅速发展,其中SP单一蛋白质疫苗包括溶血素、表面蛋白A、表面黏附素A、三组氨酸蛋白D、黏附毒力因子A,蛋白质联合疫苗包括多价重组蛋白质联合疫苗、多价蛋白质融合疫苗,已取得一定实验和临床效果,有望替代多糖疫苗。     

HIV疫苗的研制进展

HIV属逆转录病毒科慢病毒属,该属病毒因其保护性机制尚未明确、病毒基因整合人宿主细胞、基因变异率高、病毒常通过黏膜传播及病毒可直接侵犯免疫系统等特点,使得疫苗的研制难度大大增加。有关艾滋病疫苗效果的评价有3项指标:①能产生不同血清型的中和抗体;②CTL能特异地破坏感染细胞;③免疫过的黑猩猩对试验性感染有抵抗力。目前研制HIV疫苗的方法主要为以下6种。     

新型冠状病毒肺炎流行期间广州市HIV感染者的心理状态

目的 了解HIV感染者在新型冠状病毒肺炎(COVID-19)流行期间的心理健康状态及其影响因素.方法 采用医院焦虑抑郁量表(HADS)对广州市550名HIV感染者进行测评,采用Logistic回归模型分析焦虑或抑郁的影响因素.结果 在515份(93.6％)有效问卷中,焦虑或抑郁发生率占32.8％,焦虑发生率为21.7％...     

Reevaluation of antibody titers 1 year after influenza vaccination in patients with rheumatoid arthritis receiving TNF blockers

Abstract

The aim of this study was to estimate the effective administration procedure of fondaparinux for prevention of venous thromboembolism after cemented total hip replacement (THR) in Japanese patients. The study included 471 Japanese patients. The dose regimens were 2.5 mg daily for 14 days (2.5 mg/14 day group) or 10 days (2.5 mg/10 day group), 1.5 mg daily for 10 days (1.5 mg group), 2.5 mg daily for the first 3 postoperative days and 1.5 mg daily for the subsequent 7 days (Mixed group), and no administration of fondaparinux (Control group). Deep venous thrombosis (DVT) was diagnosed by ultrasonography on postoperative day 3 or 4 and day 14. The 2.5 mg/14 day, 2.5 mg/10 day and Mixed groups were regarded as one group in the assessment on postoperative day 3 or 4, and denoted as the 2.5 mg group. The incidence of DVT on postoperative day 3 or 4 in the 2.5 mg group was significantly lower than that in the Control and 1.5 mg groups. On postoperative day 14, the incidence of DVT in the 1.5 mg and Mixed groups was significantly lower than that in the Control group in both the intention-to-treat and per-protocol analyses. The incidence in the 2.5 mg/10 day and 2.5 mg/14 day groups was significantly lower than that in the Control group in only the per-protocol analysis. The results suggest that the administration protocol of the Mixed group is effective in preventing DVT in Japanese patients undergoing cemented THR.     

Hepatitis A and B vaccination and public health

Summary.  The introduction and implementation of hepatitis B vaccination programmes in areas of high endemicity has been very stressful. However, this initial accomplishment has led to the reassessment of priorities in some countries which could undermine these early successes. Work still remains to be done to support and implement interventions that will bring us closer to the WHO goal and to the control of hepatitis B in the community at large. Hepatitis A vaccine strategy for immunizing toddlers is shifting to those countries with intermediate endemicity where increasing morbidity in adults is being observed. Accumulating evidence indicates that such programmes can result in impressive reductions in the incidence of hepatitis A by herd immunity. Monitoring of these populations to determine durability of protection will be important to avoid shifting the infection to the older age population, when symptoms are more likely to occur. National policies need to consider hepatitis A vaccination in the context of other public health priorities.     

Pneumococcal and influenza vaccination in patients with rheumatic conditions and receiving DMARD therapy

SIR, It was interesting to read your editorial ‘Vaccinateyour immunocompromised patients!’ [1] and we would liketo outline an audit performed at Wrightington Hospital, UK,which highlights this problem. Streptococcus pneumoniae, themost common cause of adult community-acquired pneumonia, hasan annual incidence rate of     

Pneumococcal and influenza vaccine uptake in adults with inflammatory bowel disease in France: Results from a web-based study

BackgroundDespite specific immunization guidelines for immunocompromised patients, there is a dearth of studies on inflammatory bowel disease (IBD) population in France.AimsTo estimate the prevalence and predictors of influenza and pneumococcal vaccination rates in a sample of French IBD adults.MethodsAn anonymous online survey was submitted to members of several French immunocompromised patients’ associations during the winter 2016.ResultsOverall, there were 199/1625 (12%) participants with an IBD. Among these, 32% were <30 years old, 85% were male, and 62% were treated with immunosuppressive therapy. Self-reported influenza vaccine uptake was 34% (95% CI [28–41]) and 38% (95% CI [31–44]) for pneumococcal vaccines. Healthcare provider’s (HCP) recommendation for vaccination (adjusted OR 12.7 95% CI [5.6–28.8]), immunosuppressive therapy (aOR 2.3 [1.1–5.3]), better knowledge of vaccination (aOR 3.2 [1.1–9.2]) and favorable attitudes towards vaccination (aOR 3.4 [1.2–9.5]) were positively associated with influenza vaccine uptake. Vaccine recommendation by HCPs was the only independently associated factor with pneumococcal vaccines uptake (OR 187.7 [24.8–1422.5]).ConclusionImmunization rates in our sample do not reach recommended levels. Factors associated with vaccination included high knowledge, favorable attitudes towards vaccination and recommendation for vaccination. This underlines the role of health care providers in contact with IBD patients.     

Mandatory influenza vaccination of health care workers: A first-year success implementation by a community health care system

Poudre Valley Health System is a private, not-for-profit health care system of more than 5,300 employees. Poudre Valley Health System increased its influenza vaccination coverage rate among health care workers from 68% in 2009 to 95.5% in 2010 after implementing a mandatory influenza vaccination program.     

Reactive arthritis after influenza vaccination: report of a case

We describe a patient with reactive arthritis (ReA) induced by influenza vaccination. A healthy 79-year-old Japanese man began suffering from migrating polyarthritis 2 days after receiving influenza vaccine. He proved negative for rheumatoid factor, showing no evidence for microbial infections such as Streptoccocci, Chlamydia, or Parbovirus B19. Human leukocyte antigen (HLA) typing analysis revealed positive results for HLA-B54 (22), which is one of the cross-reactive antigens to HLA-B27. His arthritis improved with administration of nonsteroidal anti-inflammatory drugs, and recovery was attained within 6 weeks. Reactive arthritis is a rare adverse effect induced by influenza vaccination; however, it is important that it is recognized by all physicians.