重庆市2001～2005年麻疹流行病学监测分析

[目的]掌握重庆市麻疹流行病学特点及监测系统运转情况。[方法]对2001～2005年的监测数据进行分析。[结果]2001～2005年累计发生麻疹7558例,暴发病例占30.79%,发病率为3.69/10万～6.85/10万。麻疹流行仍有一定的季节性,流行强度不均匀,存在明显计免薄弱地区。麻疹主要发生在14岁以下儿童,共6020例,占病例总数的79.65%。无免疫史1988例,8月龄～7岁以下儿童占52.06%。8月龄以下儿童麻疹呈上升趋势。麻疹监测系统运转质量不十分理想,敏感性和报告及时性较差。[结论]切实作好基础免疫、控制暴发、加强疑似麻疹及发热出疹性疾病监测是降低麻疹发病的重要策略。     

预防免疫对阻断乙型肝炎父婴传播的临床研究

[目的]探讨阻断乙型肝炎病毒父婴传播的方法。[方法]选取2003年1月～2006年1月,100例孕妇丈夫血清HBV DNA( ),孕前抗-HBs( )孕妇的病例为研究对象(观察组),并根据孕期是否肌注乙肝免疫球蛋白分2组:Ⅰ组孕期自孕24周产检起,每4周肌注乙肝免疫球蛋白200IU至分娩,Ⅱ组孕期不肌注乙肝免疫球蛋白。另筛选出孕妇无各种肝炎病毒感染,而丈夫血清HBV DNA( )的病例为对照组(Ⅲ组)。3组病例新生儿出生时均抽脐带血检测HBV DNA及抗-HBs。[结果]观察组Ⅰ组新生儿抗-HBs( ),阳性率为56.00%(28/50),观察组Ⅱ组新生儿抗-HBs( )阳性率为52.00%(26/50);对照组新生儿抗-HBs( )为O(0/45)无一例阳性。观察组抗-HBs( )率显著高于对照组(P﹤0.05)。Ⅰ组脐血HBV-DNA( )16.00%(8/50),Ⅱ组有18.22%(9/50),Ⅲ组有42.22%(19/45)。观察组新生儿感染率明显低于对照组。[结论]孕前成功获得抗-HBs( ),可有效阻断父婴传播;孕期加用HBIG未能进一步阻断父婴传播。     

Stability and activity of specific antibodies against Streptococcus mutans and Streptococcus sobrinus in bovine milk fermented with Lactobacillus rhamnosus strain GG or treated at ultra‐high temperature

Passive local immunization against dental caries is a promising approach to its prevention, as clinical evidence of active oral or nasal immunization is still limited and controversial. By means of systemic immunization of pregnant cows with a multivalent vaccine, high titres of IgG antibodies against human cariogenic bacteria, Streptococcus mutans and Streptococcus sobrinus, were produced in bovine colostrum. The purified immune product (IP) of this preparation has a number of anticariogenic properties, such as inhibition of streptococcal adherence to saliva‐coated hydroxyapatite and inhibition of glucosyltransferase enzymes. This study investigated whether IP antibodies remained active and functional when added to ultra‐high temperature (UHT)‐treated milk or to Lactobacillus rhamnosus GG (LGG)‐fermented milk stored for an extended time. LGG was chosen because of its widely known health benefits in humans and animals. A commercial UHT toddler's milk was supplemented with IP and stored for 2 months at 5, 21 and 30°C. The antistreptococcal titres in UHT milk did not decline at any temperature during storage, and UHT‐IP inhibited the adherence of S. mutans for up to 2 months. This was not the case with UHT toddler's milk without IgG antibodies. Milk was fermented with live LGG cells in the presence or absence of 5% IP. The antistrept?ococcal titres declined to about 30% of the original titres after storage. Fresh milk alone slightly enhanced streptococcal adhesion but fresh milk with IP inhibited the adherence of S. mutans by over 50%. LGG‐positive fermented milk without antibodies also inhibited (P < 0.05) the adhesion by about 40%. In both LGG‐fermented and UHT immune milk, the activity of antibodies against cariogenic streptococci was maintained during the expected shelf‐life of these products. From the anticariogenic point of view it may be beneficial to add bovine‐specific antibodies against mutans streptococci to probiotic LGG‐containing milk products.     

Repeated immunization induces the increase in fucose content on antigen-specific IgG N-linked oligosaccharides

OBJECTIVE: In order to investigate whether repeated immunization induces changes in IgG glycosylation, we analyzed the composition of oligosaccharides on antigen-specific IgGs obtained from mice that received different amounts of immunization boosts. METHODS: Three groups of mice were immunized with ovalbumin (OVA) and boosted once, twice, or three times, respectively, with an interval of 1 week. The patterns of oligosaccharides present in anti-OVA specific IgGs were analyzed using lectin-enzyme-linked immunosorbent assay (ELISA) and lectin-blot. RESULTS: The repeated injection of OVA induced both the production of specific IgGs and an increase of fucose content in N-linked oligosaccharides of the IgGs. The lowest IgG fucosylation was observed in mice boosted once, whereas the highest fucosylation rate was observed in mice boosted three times. ELISA assay demonstrated that there was a positive relationship between the fucose content and amount of immunization boosts. CONCLUSIONS: IgG fucosylation increases during repeated immunization with ovalbumin. The alteration of IgG fucosylation may have important biological significance.     

Actions and beliefs related to hepatitis B and influenza immunization among registered nurses in Texas

Studies indicate that roughly half of health care workers are not immunized against hepatitis B and influenza. Findings from a survey of 1,000 registered nurses (RNs) conducted to analyze their beliefs and actions related to immunization recommendations are reported. Only 8% of the responding RNs chose not to receive vaccination against hepatitis B. The primary reasons that nurses declined hepatitis B vaccination were because they were not working in nursing or did not believe they were at risk of exposure. Similarly, 86% of the RNs reported they had ever received a flu shot, and 69% reported of being immunized during 2 of the previous 4 years. Rationale for receiving immunization included belief in its effectiveness, belief that they were at risk of exposure, and that it was provided free of charge. Reasons for declining included concerns about side effects, lack of concern about getting the illness, and doubts about effectiveness. The nurses who responded to the survey appear to value immunizations and generally adhere to immunization recommendations. Further study needs to be conducted on related issues, including follow-up for assessment of long-term protection of hepatitis B immunization and adherence to guidelines for postexposure prophylaxis. Ongoing monitoring and further study of serious complications of hepatitis B immunizations are also needed.     

Efficient expansion of HIV-1-specific T cell responses by homologous immunization with recombinant Semliki Forest virus particles

Vaccines based on recombinant viruses represent a promising strategy for the development of a prophylactic vaccine against HIV-1. However, despite a proven capacity to stimulate potent HIV-1-specific immune responses, viral systems have limited utility in homologous prime-boost regimens due to the generation of anti-vector immune responses. It is therefore important to develop a diverse set of vaccine candidates that can be combined in different heterologous prime-boost regimens and/or to identify a vaccine candidate that is less sensitive to anti-vector mediated immunity. In this report, we describe the design and pre-clinical immunogenicity of a Semliki Forest virus-based vaccine, VREP-C, encoding Indian origin HIV-1 clade C antigens. We show that a single immunization with VREP-C stimulates HIV-1-specific IFNgamma ELISPOT responses, which were efficiently boosted by a second and a third homologous VREP-C immunization resulting in highly potent cytotoxic T cell responses. These results suggest that VREP-C may be a valuable component of a future prophylactic vaccine against HIV-1.     

Practising evidence-based occupational health in workers' groups: how to prevent sickness absence caused by influenza

BACKGROUND: Influenza remains a major cause of disease and death. In addition to its recognized health effects, influenza has socio-economic consequences, in particular sickness absence. Managing influenza in working populations remains a relevant topic. METHODS: This paper reports a case study dealing with the problem of sickness absence due to influenza-like illness epidemics in health care workers (HCWs) in a health care setting. The case was investigated and the solution was provided according to the evidence-based medicine (EBM) paradigm using the PICO model. RESULTS: The investigation was carried out by using firstly the Cochrane Library and secondly Medline. Nine papers were considered to find appropriate solutions. Two main types of interventions were suggested: (i) influenza vaccination or (ii) antiviral M2 protein inhibitors and neuraminidase inhibitors. As the latter intervention is not yet completely validated, the immunization intervention was considered. The evidence obtained was reported to the general manager and it was proposed to undertake an annual programme of vaccination for all the health care professionals. CONCLUSION: The case study shows that, as for other clinicians, the occupational physician can use the EBM paradigm according to the PICO model as a tool for providing appropriate solutions for the group of workers.     

Factors affecting influenza vaccine uptake among health care workers

BACKGROUND: In 2000, the UK Departments of Health recommended influenza immunization to employees directly involved in patient care. Uptake of this immunization had tended to be variable and usually low. AIMS: To assess personal and organizational factors associated with influenza immunization uptake among Health Care Workers (HCWs). METHODS: A cross-sectional survey of all HCWs within the Health and Social Care Trusts in Northern Ireland and a parallel-group study of nursing staff within Elderly Care using self-administered questionnaires. RESULTS: Of 203 nurses working in elderly care units 76(37%) were immunized and 127(63%) declined. Almost 70% of those not immunized perceived themselves to be 'healthy' and gave this reason for declining immunization. Nurses were more likely to be immunized by a factor of four if they believed there was benefit for healthy HCWs, three if they felt at-risk of contracting influenza and nine on a recommendation from the occupational health (OH) unit. Fifteen OH units participated in a survey of HCWs at the time of immunization. Five thousand two hundred and thirty (9.7%) HCWs were immunized. Increased uptake was correlated with immunization in area of work (r=0.74, P=0.02) and when provided out of hours (r=0.83; P<0.001) and by a factor of two with individual targeting of availability (P<0.001) and when individuals had been previously immunized (P<0.001). CONCLUSION: Uptake of influenza immunization is low. Attitudes to one's health and to the value of influenza immunization affect the uptake as does the delivery of the immunization programme.     

The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality

When the health sector variable whose inequality is being investigated is binary, the minimum and maximum possible values of the concentration index are equal to micro-1 and 1-micro, respectively, where micro is the mean of the variable in question. Thus as the mean increases, the range of the possible values of the concentration index shrinks, tending to zero as the mean tends to one and the concentration index tends to zero. Examples are presented on levels of and inequalities in immunization across 41 developing countries, and on changes in coverage and inequalities in selected countries.