狂犬病疫苗接种者抗狂犬病病毒中和抗体影响因素分析

目的探讨狂犬病疫苗接种后体内抗狂犬病病毒中和抗体产生的影响因素。方法采集2018年1-8月山东、江苏、河南、河北、湖南和安徽6省疑似狂犬病Ⅱ/Ⅲ级暴露后接种狂犬病疫苗的暴露者血清标本,快速荧光灶抑制实验(RFFIT)检测抗狂犬病病毒中和抗体(RVNA)水平,采用SPSS 19.0软件进行数据统计分析。结果全程接种狂犬病疫苗的血清样本为498份,RFFIT检测结果显示,RVNA几何平均滴度(GMT)为4.94 IU/ml,血清阳性率为96.18%(479/498)。不同组别抗体阳性率分析结果显示,免疫时间各组阳性率之间差异有统计学意义(χ^2=7.888,P=0.039),30~90 d组抗体阳性率高于91~180 d组,其他各组比较差异均无统计学意义。多因素分析结果显示年龄、免疫时间是RVNA水平的重要影响因素,其中年龄与RVNA水平呈正相关,免疫时间与RVNA水平呈负相关。免疫时间对RVNA水平的影响最大,影响重要性为0.62。结论接种狂犬病疫苗后能产生可靠的免疫效果,年龄、免疫时间等因素对抗体阳性率及RVNA水平有一定影响。暴露后在及时进行规范完整的暴露后处置外,应对经常暴露于狂犬病的高危人群、免疫力低下者或患有免疫抑制性疾病的人群定期检测血清抗体,对于RVNA滴度小于0.5 IU/ml的接种者应及时进行加强免疫,补接种疫苗,从而有效预防狂犬病。

Factors affecting rabies virus neutralizing antibody level after vaccination

ObjectiveTo explore the factors affecting rabies virus neutralizing antibodies in vivo after rabies vaccination.MethodsSerum samples collected from the persons who received rabies vaccination from January to August 2018 were used in rapid fluorescent focus inhibition test (RFFIT) to detect rabies virus neutralizing antibody (RVNA) levels. Statistical analysis was performed by using SPSS 19.0 software.ResultsA total of 498 serum samples collected after full course rabies vaccination were tested. The RFFIT test results showed that the RVNA geometric mean titer (GMT) was 4.94 IU/ml, and the seropositive rate was 96.18% (479/498). The analysis on the antibody positive rate showed that there were statistical differences among groups with different post vaccination times (χ2＝7.888, P＝0.039). The antibody positive rate in 30–90 d group was higher than that in the 91–180 d group. The results of multivariate analysis showed that age and post vaccination time were important factors affecting RVNA level. Among them, the age was positively correlated with RVNA level, and the post vaccination time was negatively correlated with RVNA level. The post vaccination time had the largest impact on RVNA level, with an impact importance of 0.62.ConclusionRabies vaccination can produce a reliable immune effect. Age, days after vaccination and other factors have a certain effect on antibody positive rate and RVNA level. In addition to timely and standard post-exposure treatment after rabies exposure, serum antibody level should be regularly tested for populations at high-risk, immunocompromised individuals or people with immunosuppressive diseases. For those with RVNA titers less than 0.5 IU/ml after rabies vaccination, re-vaccination should be given to effectively prevent rabies.