Achieving compliance with influenza immunization of medical house staff and students. A randomized controlled trial.

OBJECTIVE--To determine the optimal method to increase influenza immunization rates of medical house staff and students. DESIGN--Prospective randomized trial and cross-sectional survey. STUDY GROUP--Four hundred forty-two internal medicine, obstetrics-gynecology, and general surgery residents and junior medical students. MEASUREMENTS--The four interventions employed were (1) an educational memorandum outlining vaccine indications sent to all study group members, (2) a personal letter mailed to a random sample of half of the remaining unimmunized persons, (3) a telephone call to half of the unimmunized letter recipients, and (4) vaccine offered directly to the remaining unimmunized persons in clinics and conferences. In addition, a questionnaire was administered to all persons requesting or offered vaccine. MAIN RESULTS--During the 3 weeks after the memorandum, 87 (20%) of 442 persons were immunized. Five weeks after the letter, 61 (34%) of persons receiving a letter and 30 (17%) of the no-letter controls (P = .0005) had been immunized. After the telephone call, there was a statistically insignificant trend toward increased compliance. In clinics and conferences, 90% of persons reached were immunized and 10% refused, largely extinguishing the effect of prior interventions. At completion of the study, 275 (62%) of 442 participants were immunized, 29 (7%) refused, and 138 (31%) were not reached. Questionnaire results revealed that only 32% had ever been previously immunized against influenza, yet 70% stated that they had worked despite having influenzalike symptoms. CONCLUSION--A high rate of immunization of house staff and medical students can be achieved most effectively by offering vaccine in clinics and conferences. Continued education about influenza immunization is necessary for physicians and medical students.     

Age-related response to 1000 CCA unit zonally purified, inactivated influenza vaccines in volunteers in the U.S.A

Response to 1000 CCA unit Aichi/68 and Japan/57 influenza vaccines was studied in 687 volunteers from ages 6-101 in the summer of 1971. The vaccines, prepared by zonal ultracentrifugation, were well tolerated in all age-groups. Antibody responses were comparable with each vaccine and were strongly influenced by age of the volunteer. Persons born since 1940 (age 31 and under) had a much more impressive response as determined by both overall geometric mean titre rise and% with ≥ four-fold increase in titre than persons born before 1940. The most reasonable explanation for this phenomenon seems to be the greater prior exposure of the younger age-groups to the strains in the vaccines. It is concluded that more attention needs to be given in the future to assessing vaccine potency in the age-groups for which the maximum protection is desired, namely, the elderly.     

Influenza vaccination in Australia: a review of the economic evidence for policy recommendations

The National Health and Medical Research Council recommends that persons who are believed to be at a higher risk of the complications and of dying of influenza should receive annual vaccinations against the disease. The Council refers specifically to persons who are over the age of 65 years and to those with chronic medical conditions. Recommendations such as these place demands on scarce health resources and it is important to determine if such policies result in the efficient utilization of resources. Accordingly, this article reviews the evidence on the economic efficiency of different vaccination strategies. Two major conclusions emerge. First, even allowing for variability in vaccine effectiveness due to viral antigenic drift, influenza-vaccination programmes, in general, are more cost-effective than are many other interventions that are undertaken as a routine in Australia. Secondly, vaccinating healthy persons who are 45 years of age to 64 years of age is more cost-effective than is vaccinating persons in some of the high-risk groups. Thus, there is likely to be a case for reconsidering whether healthy persons who are younger than 65 years of age also should be included in the official recommendations.     

Influenza and pneumococcal pneumonia immunization. Protecting our high risk population

Pneumonia and influenza (P & I) constitute Florida's sixth leading cause of death. The P & I death rate in 1987, 10.5 per 100,000, was the highest since 1978. Major target groups for one or both vaccines used in prevention, as recommended by the Immunization Practices Advisory Committee (ACIP), include persons with chronic diseases of the heart or lungs, residents of nursing homes and other chronic care facilities, and persons aged 65 and older. Despite well-defined recommendations, vaccine coverage rates in Florida are as low as 30% in persons greater than or equal to 65 years of age. Knowledge and attitude surveys demonstrate that low coverage among various population groups may be due largely to insufficient awareness and/or negative attitudes regarding pneumococcal and influenza vaccines. Conversely, recommendations by physicians and other health care providers are strongly associated with receiving either vaccine. If the incidence of P & I is to decrease substantively in Florida, much wider use of the vaccines must occur. Because so many high-risk patients depend on private physicians for health care, their role is critical to the success of Florida public health strategies to reverse P & I trends.     

医务人员对北京市老年人接种流感疫苗的影响质性研究

背景　老年人接种流感疫苗可有效预防流感及其并发症。医务人员是老年人获取流感或流感疫苗知识的重要信息来源之一,其态度与行为影响老年人的流感疫苗接种。目的　了解医务人员对流感、流感疫苗以及免费政策的知识、态度、行为,探讨医务人员对北京市老年人接种流感疫苗的影响。方法　2017年1月选取北京市基层社区卫生服务中心或乡镇卫生院从事老年人流感疫苗接种工作的医务人员、全科诊室医务人员21名进行深度访谈,使用Excel主题框架法进行资料整理和分析。结果　医务人员对于流感及流感疫苗认识程度参差不齐,大部分医务人员自身未接种流感疫苗,科室间合作宣传机制较少,流感疫苗结合慢性病管理的宣传效果一般,医务人员建议老年人接种疫苗态度偏于保守。结论　医务人员会影响老年人流感疫苗接种,加强医务人员流感及流感疫苗相关知识培训,提升医务人员对流感疫苗的信心,有助于流感疫苗接种工作的顺利开展,进而促进老年人群疫苗接种率的提高。     

云南省保山市甲型H1N1流感病毒裂解疫苗接种情况及控制疫情效果评价

目的了解人群甲型H1N1流感病毒裂解疫苗(下称甲型H1N1流感疫苗)接种情况及其免疫效果,为甲型H1N1流感防控及疫苗的科学使用提供依据。方法回顾性分析2009年10月～2011年7月我市进行甲型H1N1流感疫苗接种人群的分布特征,并与同期未接种人群比较甲型H1N1流感发生情况。结果我市总人口接种率为6.26%,其中学生接种率最高为73.44%。我市近3年来所有接种人群均未发病,接种人群甲型H1N1流感发生率明显低于未接种人群(χ2=4.134,P<0.05)。结论实施对易感人群进行甲型H1N1流感疫苗接种对控制甲型H1N1流感有较好的效果。     

Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial

CONTEXT: Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older, the benefits for healthy adults younger than 65 years are less clear. OBJECTIVE: To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenza-like illness (ILI) and reducing societal costs of ILI among healthy working adults. DESIGN: Double-blind, randomized, placebo-controlled trial conducted during 2 influenza seasons. SETTING AND PARTICIPANTS: Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company (for 1997-1998 season, n = 1184; for 1998-1999 season, n = 1191). INTERVENTIONS: For each season, participants were randomly assigned to receive either trivalent inactivated influenza vaccine (n = 595 in 1997-1998 and n = 587 in 1998-1999) or sterile saline injection (placebo; n = 589 in 1997-1998 and n = 604 in 1998-1999). Participants in 1997-1998 were rerandomized if they participated in 1998-1999. MAIN OUTCOME MEASURES: Influenza-like illnesses and associated physician visits and work absenteeism reported in biweekly questionnaires by all participants, and serologically confirmed influenza illness among 23% of participants in each year (n = 275 in 1997-1998; n = 278 in 1998-1999); societal cost of ILI per vaccinated vs unvaccinated person. RESULTS: For 1997-1998 and 1998-1999, respectively, 95% (1130/1184) and 99% (1178/1191) of participants had complete follow-up, and 23% in each year had serologic testing. In 1997-1998, when the vaccine virus differed from the predominant circulating viruses, vaccine efficacy against serologically confirmed influenza illness was 50% (P =.33). In this season, vaccination did not reduce ILI, physician visits, or lost workdays; the net societal cost was $65.59 per person compared with no vaccination. In 1998-1999, the vaccine and predominant circulating viruses were well matched. Vaccine efficacy was 86% (P =.001), and vaccination reduced ILI, physician visits, and lost workdays by 34%, 42%, and 32%, respectively. However, vaccination resulted in a net societal cost of $11.17 per person compared with no vaccination. CONCLUSION: Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI, lost workdays, and physician visits during years when the vaccine and circulating viruses are similar, but vaccination may not provide overall economic benefits in most years. JAMA. 2000;284:1655-1663.     

甲型H1N1流感疫苗接种不良反应调查

目的分析甲型H1N1流感病毒裂解疫苗接种后不良反应（ADR）的发生情况,为安全性评价提供依据。方法对辖区2009年11月10日～20日接种甲型H1N1流感病毒裂解疫苗的人员进行调查,包括被接种人员的一般情况、ADR发生率、临床表现、转归、ADR发生的严重程度等进行统计分析。结果 1 346例接种者中ADR发生率为31.56%（425/1 346）,其中局部反应占58.35%（248/425）,持续时间中位数为3d;全身反应41.65%（177/1 346）,持续时间中位数为2d;男女性接种者ADR发生率分别为28.02%（195/696）和35.38%（230/650）（χ2=8.44,P〈0.05）。甲型H1N1病毒裂解流感疫苗所致ADR多为轻度和中度（轻度占56.94%）。结论接种甲型H1N1流感病毒裂解疫苗后ADR发生率虽高,但多为轻度和中度反应,接种相对较安全。     

甲型H1N1流感裂解疫苗的接种反应及免疫效果观察

目的观察甲型H1N1流感裂解疫苗接种反应及其免疫效果。方法对不同组别的健康人群43 648人进行免疫接种,观察接种反应及完成接种后6个月内甲型H1N1流感发病情况。结果所有接种对象均未发生即时反应和严重异常反应,出现疑似预防接种异常反应以一般反应为主,未有出现异常和全身强副反应;完成免疫接种后6个月内随机抽查出现发热伴咳嗽、咽痛等症状86人检测甲型H1N1流感病毒核酸均为阴性。结论甲型H1N1流感裂解疫苗具有良好的安全性和免疫原性。     

Targeting pneumococcal vaccination to high-risk groups: a feasibility study in one general practice

The Department of Health recommends pneumococcal vaccination opportunistically or when immunising against influenza. This was a study in one general practice to assess the feasibility of targeting patients for pneumococcal vaccination in primary care. We also examined the rate of uptake of pneumococcal vaccine in identified risk groups after one year of a pneumococcal vaccination programme. A self-administered questionnaire was given to patients attending for influenza vaccine between September and December 1996. A total of 551/747 (73.8%) patients returned completed questionnaires. Few patients receiving influenza vaccination (133/509, 26%) were aware of pneumococcal vaccine. Only 55/108 (51%) of those given influenza vaccination were in a clinical risk group for pneumococcal vaccine. Attitudes towards vaccination were more positive and intention to take up pneumococcal vaccination significantly greater in high-risk patients compared to those who were not in a risk group. A targeted vaccination campaign directed at high-risk patients, both opportunistically and those attending for influenza vaccination over one year, resulted in the following proportions of patients in at-risk groups being vaccinated: coronary disease 144/312 (46%), diabetes 79/132 (60%), splenectomy 2/2 (100%), chronic obstructive airways disease and asthma 135/700 (19%), and chronic renal failure 5/9 (56%). Most doses of pneumococcal vaccine (336/463; 73%) were delivered to patients in high-risk groups. We conclude that a well-organised pneumococcal vaccination campaign can improve coverage of at-risk patients in general practice. Programmes to increase patient awareness of the vaccine, improved availability of vaccine, and practice guidelines, would help to target the vaccine to at-risk patients. Patients with chronic lung disease and asthma were particularly difficult to define and target in this study. A review of the UK guidelines, aligning those for pneumococcal and influenza vaccination and including patients over 65 years, would improve the logistics of vaccine delivery.     

甲型流感病毒分类与通用流感疫苗及广谱中和活性抗体的研究

流感是对人类危害极大的传染病,疫苗接种被认为是预防流感的最有效手段.为解决流感病毒变异导致现有疫卣时效性与有效性的问题,研制能够预防所有流感病毒毒株、可诱导持久保护性免疫的通用流感疫苗一直是流感研究的热点,同时,能中和所有甲型流感病毒的广谱中和活性抗体的研究也已成为目前关注的重点,因此对甲型流感病毒分类研究也提出了相应...     

季节性流感疫苗对小鼠感染H7N9禽流感病毒的保护效力

目的 评价季节性流感裂解疫苗对流感病毒H7N9的免疫保护效力。方法 用我国2012～2013年度季节性流感裂解疫苗,以腹腔注射方式免疫BALB/c小鼠,并设PBS免疫模型组,末次免疫14 d后以5 LD₅₀ A/Anhui/1（H7N9）进行攻试验。感染后观察记录小鼠临床表现,体重变化,并分别于第2天和第4天每组处死3只小鼠,取肺组织和鼻甲骨测病毒滴度和载量。结果 感染后疫苗与模型组小鼠体重下降明显,疫苗组存活率为10%,模型组全部死亡。感染后第4天疫苗组鼻甲骨滴度显著低于模型组。血凝抑制试验及中和实验表明免疫小鼠血清无中和H7N9病毒抗体。结论 季节性流感疫苗在小鼠中对于H7N9流感病毒感染无明显保护作用。     

Surveillance of the swine influenza vaccination program at the Royal Military College, Kingston

In a prospective study symptoms appearing in a previously healthy population within 6 weeks after inoculation with monovalent swine influenza vaccine (A/New Jersey/76) were tabulated. Of the 703 persons (ranging in age from 17 to 55 years) participating in the follow-up 54% reported experiencing symptoms, usually within 24 hours of vaccination; the symptoms were usually minor and none of the participants displayed evidence of Guillain-Barré syndrome.     

Influenza and pneumococcal vaccination: patient perceptions

The efficacy of the influenza vaccine in reducing mortality and hospital admissions is established, particularly in the elderly. However, up to 50% of those at risk do not receive the vaccine. These patients are also at risk from pneumococcal infection and there is considerable overlap between the target group for each vaccine. This study sought to identify at risk individuals from consecutive admissions to an acute geriatric unit and to gain an insight into their perceptions with regard to vaccination. The awareness of each vaccine was recorded, together with the vaccination history. Seventy four per cent of the final cohort had heard of the influenza vaccine, while only 13% had heard of the pneumococcal vaccine. Fifty per cent perceived themselves to be at risk from influenza and its complications and 87% of the cohort believed it to be a serious infection. Influenza vaccine was judged to confer good protection by 72% of the sample and yet up to 50% believed that the vaccine can make the recipient ill. Influenza is perceived as a serious infection by patients and yet many do not believe themselves to be at particular risk. Although influenza vaccination is believed to confer protection, the decision whether, or not, to accept the vaccine is coloured by many factors, including popular myths and anecdotal information from friends and relatives. The uptake of influenza vaccine is suboptimal and the awareness of the pneumococcal vaccine certainly in the elderly is poor. The need for a comprehensive nationwide education campaign promoting both influenza and pneumococcal vaccine is highlighted.     

Guillain-Barré syndrome in recipients of A/New Jersey influenza vaccine

In late 1976, when 32% of the eligible population of Ohio received the A/New Jersey influenza (swine flu) vaccine, systematic contact of neurologists was used to evaluate the possible association of Guillain-Barré syndrome (GBS) with receipt of the vaccine. The overall rate of GBS was significantly higher among vaccine recipients (13.3/10(6)) than in nonrecipients (2.6/10(6)). Peak time of onset was two to three weeks after receiving the vaccine, and cases among vaccinees were less likely to have a history of antecedent infection than were cases in unvaccinated persons. Even when the effect of one highly associated vaccine lot was removed, an elevated risk of GBS remained in vaccinees regardless of manufacturer or vaccine type (bivalent or monovalent). Systematic surveillance is needed for rare serious reactions from all vaccines.     

Immunological Effect of Subunit Influenza Vaccine Entrapped by Liposomes

Objective To elevate the immunological effect of subunit influenza vaccine in infants and aged people (over 60) using liposomal adjuvant in the context of its relatively low immunity and to investigate the relation between vaccine antigens and liposomal characteristics. Methods Several formulations of liposomal subunit influenza vaccine were prepared. Their relevant characteristics were investigated to optimize the preparation method. Antisera obtained from immunizinged mice were used to evaluate the antibody titers of various samples by HI and ELISA. Results Liposomal trivalent influenza vaccine prepared by film evaporation in combinedation with freeze-drying significantly increased its immunological effect in SPF Balb/c mice. Liposomal vaccine stimulated the antibody titer of H3N2, H1N1, and B much stronger than conventional influenza vaccine. As a result, liposomal vaccine (mean size: 4.5-5.5 μm, entrapment efficiency: 30%-40%) significantly increased the immunological effect of subunit influenza vaccine. Conclusion The immune effect of liposomal vaccine depends on different antigens, and enhanced immunity is not positively correlated with the mean size of liposome or its entrapped efficiency.     

邯郸市大规模接种甲型H1N1流行性感冒病毒裂解疫苗的安全性观察

目的评价甲型H1N1流行性感冒裂解疫苗(简称甲流疫苗)大规模接种的安全性。方法通过儿童预防接种信息管理系统和全国疑似预防接种异常反应(Adverse Events Following Immunization,AEFI)信息管理系统,收集邯郸市2009年10月29日～2010年5月4日接种甲流疫苗个案信息和接种后AEFI个案信息,采用描述性方法对相关指标进行流行病学分析。结果邯郸市共接种甲流疫苗717 288人,发生AEFI 105例,发生率14.64/10万,其中不良反应102例(含一般反应93例、异常反应9例),偶合症2例,心因性反应1例,无严重不良反应和接种事故发生。一般反应中主要为发热61例(65.59%),且以38.5℃以下的低热为主(44例,70.97%)。报告AEFI有地区差异,无年龄和性别差异。报告AEFI主要在接种后24h内发生。3个生产企业生产的甲流疫苗的AEFI报告发生率差异有统计学意义(χ2=85.6,P单侧<0.01)。结论接种甲流疫苗后不良反应报告发生率低,无严重不良反应,较安全。接种后AEFI的发生与年龄、性别无关系。不同生产企业报告AEFI发生率差异有统计学意义。     

真皮内显微注射对比肌肉内注射疫苗预防流感的Meta分析

目的评价真皮内显微注射对比肌肉内注射疫苗预防流感的临床疗效和安全性。方法计算机检索Cochrane图书馆（2009年第2期）、Pubmed、EMBASE,同时检索CBM、CNKI、VIP和万方数据库,检索时间截止2009年4月,收集真皮内显微注射对比肌肉内注射疫苗预防流感效果的随机对照试验,按Cochrane协作网推荐的方法进行系统评价。结果共纳入7个随机对照试验,5032例患者。Meta分析结果显示,采用真皮内显微注射3μg流感疫苗时可获得与肌肉内注射15μg流感疫苗相近的预防效果,但将真皮内显微注射流感疫苗剂量增加到6μg和9μg时,其预防效果并未随剂量的增加而提高。结论真皮内显微注射3μg流感疫苗可以引发比较满意的免疫应答,获得较好的预防效果,在流感大流行期间以及疫苗供应不足的情况下,是一种较好的接种策略。     

Purified duck embryo rabies vaccine. An accelerated schedule for preexposure immunization against rabies

Seroconversion and adverse reaction rates were studied in 92 persons given four or five doses in a two-week period of duck embryo rabies vaccine (DEV) or duck embryo rabies vaccine purified by ultracentrifugation (P-DEV). Mouse-neutralizing antibodies developed in 78 of 92 (84.8%) persons in these accelerated schedules. There were no significant differences in the frequency of antibody conversion or in geometric mean titers of antibody between persons given either vaccine. However, local and systemic adverse reactions were substantially less common with P-DEV. These data suggest that four of five doses of DEV or P-DEV given in a two-week course can be used for preexposure prophylaxis in situations where the more drawn-out regimens would result in continuation of a high-risk of rabies exposure. The antibody response of persons given this more accelerated regimen must be determined.     

禽流感病毒H5N1亚型基因工程疫苗设计、表达制备及动物实验研究

目的设计并获得一种安全、高效,并能对以H5N1亚型为主的多种禽流感病毒亚型产生保护的复合基因工程疫苗。方法利用分子生物学和分子免疫学方法对国内以及周边国家流行的禽流感毒株进行全面分析,利用生物信息学技术合理设计亚单位加表位的全新复合结构疫苗的氨基酸序列;利用大肠杆菌密码子优化技术根据疫苗氨基酸序列获得基因序列;通过全基因合成的方法获得该疫苗的基因,并通过大肠杆菌表达系统对该疫苗进行表达;目的蛋白经过包涵体洗涤和色谱纯化后复性;通过ELISA评价其抗原特异性,并乳化制备成禽流感蛋白疫苗,通过小鼠体内免疫试验检测其免疫效力。结果设计了包含通用性的辅助性T细胞表位、B细胞表位以及CTL表位的串接疫苗结构;全基因合成获得了该复合疫苗的基因序列;该基因在大肠杆菌表达系统中得到了高效表达,目的蛋白表达量约占菌体总蛋白30%;经过粗纯和精纯后的目的蛋白纯度达到95.5%,复性后获得可溶性蛋白溶液,浓度可达2.4 mg/mL。结论通过小鼠实验,验证了该H5N1亚型基因工程疫苗的抗原性,证实该基因工程疫苗在免疫小鼠体内激发体液免疫的同时调动了细胞免疫。小鼠免疫试验证明,该疫苗可以在小鼠体内有效诱发免疫应答。