儿童2剂水痘疫苗不同间隔免疫程序的比较

目的了解水痘疫苗2剂不同间隔时间免疫程序的安全性及免疫原性。方法按照随机、双盲的原则,选择符合条件的1~3岁、4~6岁、7~12岁儿童各200名,每个年龄组按照2剂间隔3个月和6个月的免疫程序,分别接种2剂冻干水痘减毒活疫苗。观察各组接种后的不良反应率,用膜抗原荧光抗体法(FAMA)检测疫苗接种前、后血清抗体阳转率、GMT水平和平均增长倍数。结果接种2剂水痘疫苗后,总体不良反应率在4%~13%;同年龄组不同间隔时间接种2剂疫苗后,不良反应发生率差异无统计学意义;不同年龄组间不良反应发生率差异无统计学意义。同年龄组不同间隔时间免前及接种2剂后,血清GMT水平差异均无统计学意义;同年龄组接种1剂与2剂水痘疫苗的血清GMT水平,两者间差异有显著性统计学意义。接种2剂水痘疫苗的GMT增长倍数高于接种1剂。不同间隔时间接种第2剂水痘疫苗后抗体阳转率差异无统计学意义;同年龄组接种2剂后抗体阳转率高于接种1剂,两者差异有统计学意义。结论间隔3个月和6个月接种第2剂水痘疫苗,在安全性及免后GMT水平、增长倍数及抗体阳转率等4个方面,两者差异均无统计学意义。     

国产b型流感嗜血杆菌结合疫苗免疫原性观察

目的:了解兰州生物制品研究所研制的b型流感嗜血杆菌结合疫苗的免疫原性。方法:采用单纯随机抽样方法对柳州市709名3～59月龄婴幼儿按照规定的免疫程序接种兰州所(或巴斯德)Hib疫苗,2年内在不同时段采集血清样本,采用ELISA方法检测Hib-PRP抗体滴度。结果:基础免疫后血清Hib-PRP抗体含量平均水平为18.043μg/ml,抗体阳转率为97.19%,1年后血清Hib-PRP抗体含量为7.575μg/ml,抗体阳转率为93.75%。加强免疫后血清Hib-PRP抗体含量为130.330μg/ml,抗体阳转率为100.00%,加强免疫1年后血清Hib-PRP抗体含量为51.723μg/ml,抗体阳转率为100.00%。基础免疫后接种巴斯德Hib疫苗组血清Hib抗体含量高于接种兰州所Hib疫苗组,抗体阳转率则没有差别;免后1年,接种兰州所Hib疫苗儿童体内Hib抗体含量平均水平高于接种法国巴斯德Hib疫苗儿童;其余各时段两组儿童血清Hib-PRP抗体含量及抗体阳转率均无差别。结论:兰州所Hib疫苗有较好的免疫原性和免疫持久性。     

地鼠肾细胞狂犬病纯化疫苗临床研究观察

了解地鼠肾细胞狂犬病纯化疫苗接种安全性及有效性。分别以 1.0ml及 0 .5ml的剂量 ,按暴露后及暴露前免疫程序给 313人接种 ,用小鼠中和试验法检测血清中和抗体效价。结果显示 :临床副反应轻微 ,副反应率为0 .89%～ 15 % ;免疫全量疫苗和半量疫苗的人群均获保护力 ,抗体阳转率为 10 0 % ,免后抗体GMT滴度分别为35 .2IU/ml(n =32 )和 31.4IU/ml(n =37) ,经检验两组无显著性差异 (P>0 .0 5 ) ;免疫全量疫苗和半量疫苗两组的免疫前、后相比 ,经检验有显著性差异 (P <0 .0 5 ) ,表明疫苗安全有效     

转基因细胞分泌乙型肝炎重组疫苗在儿童中的免疫原性初步研究

本文报告用转基因细胞B43分泌的乙型肝炎病毒表面抗原主蛋白经纯化制成的87-4批重组疫苗进行临床接种观察的结果,同时用8723-1批血源疫苗作对照。疫苗接种采用0、1、2月各接种1针的方案。重组疫苗共接种111名8～13岁儿童,分为20μg、10μg及5μg 3组,血源疫苗分为20μg、10μg 2组。所有儿童接种前检查乙型肝炎病毒表面抗原、抗体及核心抗体均阴性.20μg组1针后1个月,重组疫苗阳转率60.5％,血源疫苗为31％;2针后1个月,两种疫苗的阳转率分别为100％和72.4％;血源疫苗3针后1个月阳转率也仅79.3％。3针后1个月两种疫苗的抗体几何平均滴度(GMT)分别为492.7和207.4mIU。但重组疫苗6个月后血清抗体的GMT为628mIU。10μg组1针后1个月的阳转率重组疫苗为21.7％,血源疫苗为20.9％;2针后1个月分别为87％及62.8％;3针后1个月分别为100％及81.4％。抗体GMT分别为163.7和129.6mIU.5μg组的重组疫苗免疫后6个月100％阳转,其GMT为56mIU。结论认为无论从阳转率或几何平均滴度分析判断,重组疫苗均优于血源疫苗。     

国产冻干水痘减毒活疫苗免疫原性研究与应用

对１２９名４岁儿童采用国产、进口水痘减毒活疫苗进行免疫,对疫苗的安全性和免疫原性进行研究,用ＥＬＩＳＡ进行免前、免后水痘抗体测定。结果表明国产水痘疫苗接种后无明显副反应,国产、进口疫苗血清的阳转率相似,达８５％以上,证明国产ＯＫａ株水痘减毒活疫苗具有良好的安全性和免疫性,可以推广使用。     

麻疹、腮腺炎、风疹三联减毒活疫苗的安全性和免疫原性研究

为了评价国产麻疹、腮腺炎、风疹三联减毒活疫苗(MMR)的安全性和免疫原性,按整体随机抽样原则,以进口同类疫苗和国产各单价疫苗作为对照,开展现场临床观察;比较不同疫苗组免疫后的反应率、抗体阳转率、保护率及几何平均滴度(GMT)。试验组与对照组接种后,除了试验疫苗的中、强发热反应率高于进口对照疫苗的发热反应率(8.60%与2.00%)外,未见其它有显著差异的不良反应。试验组麻疹免后抗体阳转率高于进口对照疫苗(99.5%与94.6%),麻疹抗体GMT也高于单价麻疹对照疫苗的GMT;试验疫苗与进口MMR疫苗的风疹抗体阳转率、腮腺炎抗体阳转率相比,均无显著性差异。实验研究结果显示,试验MMR疫苗与进口MMR疫苗具有相似的临床反应及良好的免疫原性。     

流感病毒裂解疫苗临床安全性和免疫原性研究

目的了解流感病毒裂解疫苗的安全性和免疫原性。方法按整群随机抽样原则,对上海市200名18~60岁健康成人进行疫苗接种后临床安全性指标(局部反应、全身反应)的监测。用微量血凝抑制试验检测血清HI抗体,比较血清抗体阳转率、抗体几何平均滴度(GMT)和增长倍数。结果接种疫苗72 h内局部反应率为7.00%;全身反应率为12.00%,其中发热反应率为7.50%,其他全身反应率为4.50%;均以轻度反应为主。H1N1、H3N2和B型免疫后抗体阳转率分别为63.49%、74.07%和56.08%,抗体GMT分别为1∶170.10、1∶128.85和1∶446.79,免疫后比免疫前分别增长到6.93倍、8.72倍和4.90倍。结论此流感病毒裂解疫苗的临床安全性和免疫原性均较好。     

流行性腮腺炎疫苗免后血清学效果及免疫方案探讨

选以往无流行性腮腺炎患病史和接种史的学龄及学龄前儿童２４３名,血清检测流腮ＨＩ抗体,阳性率为５５．６％,阳性率明显地随年龄增大而上升,而性别无差异。经用Ｓ生物所及Ｂ生物所生产的两种疫苗接种,免后ＨＩ抗体的跳高率及ＧＭＴ均较免前有明显上升。双份血清检测结果,免后ＨＩ抗体显著跳高率（≥４倍）为４４．８％;９８名免前阴性儿童免后ＨＩ阳转率５７．１％,ＧＭＴ为１１３．２９,两种疫苗均无显著差异,提示疫苗的质量和稳定性有待提高,笔者对当前免疫方案提出了改进意见。     

国产重组酵母乙型肝炎疫苗接种小学生的五年免疫效果观察

为了解国产重组酵母乙肝疫苗的免疫持久性,对接种2批国产酵母疫苗（5μg/Dose),1批进口酵母疫苗（A;10μg/Dose)和另1批进口酵母疫苗（M;5μg/Dose)的268名小学生,进行了免后5年（T60）效果随访观察。结果表明,T60时接种A疫苗组抗体GMT（几何平均滴度）（197．53）显著高于M疫苗组（110．66）和2批国产疫苗（9312645GMT78．48,9312623GMT56．06）。抗体阳转率A疫苗组（85．71％）显著高于M疫苗组及国产两批疫苗（61．76％、65．26％、63．83％）（P＜0．05）。而国产两批疫苗与M疫苗组无显著性差异（P＞0．05）。本次随访结果表明,虽然国产酵母疫苗免后5年的抗体阳转率和抗体GMT与剂量相同的进口酵母疫苗的水平相当,但抗体阳转率已降至70％以下,应考虑加强接种。     

新生儿接种流感嗜血杆菌乙型肝炎偶联疫苗（COMVAX^TM）的安全性和免疫效果研究

将出生时接种过重组酵母乙肝疫苗的131名HBsAg阴性母亲的新生儿,随机分为两组,一组接种COMVAX^TM,另一组接种单价乙肝疫苗和单价流感嗜血杆菌偶联疫苗,出生时第一针乙肝疫苗接种后,应用2,4,13月程序免疫,在2,4月免疫后,接种COMVAX^TM组和对照组新生儿中无一例发生重度副反应,接种COMVAX^TM组新生第一针免疫前（2月）和二针免后一个月（5月）的抗－HBs阳转率分别为53．73％和95．00％,抗全GMT分别为104．10和56．29,均与接种单价组无显著差异,第二针免疫后一个月接种COMVAX^TM组96．00％新生儿抗－PRP抗体达到长期保护临界值（1.0ug/ml)水平,而接种单价流感嗜血杆菌疫苗组新生儿为95．20％,结果表明,对于健康母亲所生的新生儿,接种COMVAX^TM疫苗,抗－HBs和抗－PRP抗体阳转率及滴度均不低于接种单价疫苗组。     

Immune response induced by live attenuated varicella vaccine and short term follow-up on immunity of the vaccinated children

Live attenuated varicella vaccine (Oka strain, 500 to 750 PFU) was inoculated into 234 children with various underlying diseases. Varicella-zoster virus (VZV) specific immune adherence hemagglutination antibody developed in 95% of initially seronegative subjects. VZV specific cellular immune responses were detected in 91% of subjects within 6 weeks after vaccination. A preliminary survey of 46 vaccinated normal-risk subjects during the first and the third year revealed excellent protection with the exception of one case who had not shown any antibody response at the fourth week.     

A five-year immunological follow-up study of the institutionalized handicapped children vaccinated with live varicella vaccine or infected with natural varicella

Twenty-two institutionalized handicapped children who were susceptible to varicella were vaccinated with live varicella vaccine of the Oka strain and their immune status was followed for 5 years under conditions without exposure to natural varicella. Simultaneously, 7 children infected with natural varicella were followed. Of the 22 vaccinees, 16 showed sero-positive conversion by the fluorescent antibody to membrane antigen (FAMA) test, the other 6 remaining seronegative during 5 years of observation period. All the 16 cases showing seroconversion had detectable antibody for 5 years after vaccination, and 14 of them gave a positive reaction in the varicella skin test. All the 7 cases after natural varicella gave positive reactions in both the FAMA and skin test. These results suggest that immunity conferred by the vaccination would persist long even in the absence of exposure to natural varicella, though further follow-up studies are needed.     

Development of a live attenuated varicella vaccine.

The Oka strain of varicella virus, isolated in our labolatory, was serially cultivated in guinea-pig embryo cultures (GPEC), and a considerable amount of cell-free virus was obtained from infected cell. GPEC passage virus at the 6th passage level was used in a small scale field trial. Susceptible children of 1 to 10 years old were injected subcutaneously with 100 to 1,000 PFU of virus. No clinical reactions due to the vaccination were observed in any children, and a high rate of antibody response was obtained with viral doses of more than 200 PFU. Attenuated virus obtained by passage in GPEC was propagated in human diploid (WI-38) cells, and it was also effective in inducing an immune response without clinical reactions. The results show that the Oka strain of varicella virus passaged in GPEC and human diploid (WI-38) cells may be used safely and effectively as a live attenuated vaccine.     

Complete DNA sequences of two oka strain varicella-zoster virus genomes

Varicella-zoster virus (VZV) is a herpesvirus and is the causative agent of chicken pox (varicella) and shingles (herpes zoster). Active immunization against varicella became possible with the development of live attenuated varicella vaccine. The Oka vaccine strain was isolated in Japan from a child who had typical varicella, and it was then attenuated by serial passages in cell culture. Several manufacturers have obtained this attenuated Oka strain and, following additional passages, have developed their own vaccine strains. Notably, the vaccines Varilrix and Varivax are produced by GlaxoSmithKline Biologicals and Merck & Co., Inc., respectively. Both vaccines have been well studied in terms of safety and immunogenicity. In this study, we report the complete nucleotide sequence of the Varilrix (Oka-V_GSK) and Varivax (Oka-V_Merck) vaccine strain genomes. Their genomes are composed of 124,821 and 124,815 bp, respectively. Full genome annotations covering the features of Oka-derived vaccine genomes have been established for the first time. Sequence analysis indicates 36 nucleotide differences between the two vaccine strains throughout the entire genome, among which only 14 are involved in unique amino acid substitutions. These results demonstrate that, although Oka-V_GSK and Oka-V_Merck vaccine strains are not identical, they are very similar, which supports the clinical data showing that both vaccines are well tolerated and elicit strong immune responses against varicella.     

Comparison of 4 serological tests--complement fixation, neutralization, fluorescent antibody to membrane antigen and immune adherence hemagglutination--for assay of antibody to varicella-zoster (V-Z) virus.

Four tests for antibody to varicella-zoster (V-Z) virus were compared; these were tests of complement fixation (CF), neutralization (NT), fluorescent antibody to membrane antigen (FAMA) and immune adherence hemagglutination (IAHA). Fifty-two sera from patients with varicella and zoster and from recipients of live varicella vaccine were examined by the 4 tests. The CF test was least sensitive, but the antibody titers by the NT, FAMA and IAHA tests were roughly comparable. The IAHA test was the simplest and fastest to perform, and appeared suitable for routine serological assay to V-Z virus. The correlation between the IAHA antibody titer and susceptibility of individuals to clinical varicella was investigated retrospectively using sera obtained during 2 outbreaks of varicella in an institution for children, where all the unvaccinated children had developed varicella symptoms. Most of the 25 pre-exposure sera from unvaccinated children examined by the IAHA test had tiers of less than 1:2. In contrast, all the 23 sera from vaccinated children who did not develop varicella had detectable antibody titers of 1:2 to 1:64. These results indicate that the IAHA titer reflects the susceptibility or resistance of individuals to clinical varicella.     

Tropism of varicella-zoster virus for human CD4+ and CD8+ T lymphocytes and epidermal cells in SCID-hu mice.

To investigate the cell tropism and pathogenicity of varicella-zoster virus (VZV) strains, we analyzed VZV replication by using SCID-hu mice that carry human fetal thymus/liver implants under the kidney capsule or as subcutaneous fetal skin implants. MRC-5 cells infected with wild-type VZV or the Oka strain, used in the live attenuated varicella vaccine, were injected into the implants. The implants were surgically removed 2, 7, 14, and 21 days postinfection. The VZV titer from infected thymus/liver implants peaked on day 7 for the wild-type strain and on day 14 for the Oka strain. Histological analysis showed necrotic areas characterized by thymocyte depletion and fibrosis. VZV protein synthesis was detectable by immunohistochemical staining in the necrotic areas and in distant regions that did not show cytopathic changes, and VZV DNA was detected by in situ hybridization in the same distribution. Fluorescence-activated cell sorting analysis of thymocytes harvested at day 7 postinfection showed that VZV proteins were expressed in CD4+, CD8+, and CD4+ CD8+ T cells; VZV was cultured from each T-cell subpopulation. The Oka strain had tropism for human cell types similar to that of wild-type VZV. T lymphocytes released infectious VZV, which is a novel and important observation about the replication of this otherwise highly cell associated virus. VZV-infected skin implants exhibited microscopic epidermal lesions that were indistinguishable histologically from the characteristic lesions of varicella. These experiments demonstrate a unique tropism of VZV for human T lymphocytes, explaining its capacity to cause viremia in natural disease, and demonstrate the value of the SCID-hu model for studies of VZV pathogenesis.     

Antibody responses to early antigens of varicella-zoster virus (VZV) during varicella and zoster

The antibody responses to membrane and early antigens and thymidine kinase of varicella-zoster virus (VZV) were studied in sera during both varicella and zoster by a test with fluorescent antibody to membrane antigen (FAMA), staining the biochemically transformed cells by the immunofluorescent technique and neutralization of virus-specific thymidine kinase activity, respectively. Similar increases in FAMA antibody titers were demonstrated in sera from patients with varicella and zoster. IgM was detected in both groups, but appeared earlier during varicella than during zoster. Furthermore, the antibody titers to early antigens and virus-specific thymidine kinase were higher in patients with zoster than in those with varicella. These data suggest that different types of antibody responses occur during varicella and zoster.     

Development and characterization of a live varicella vaccine (Oka strain)

A live varicella vaccine (Oka strain) was developed by serial passage of the Oka strain isolated in our laboratory, in human embryonic lung cells (11 times at 34 C) and guinea pig embryo cells (12 times at 37 C). It is slightly temperature sensitive at 39 C and shows a higher ratio of infectivity in guinea pig embryo cells to infectivity in human embryo cells than wild-type strains. The DNA digest with Hpa I enzyme of the Oka strain contained one unique fragment (K), although its mobility differed only slightly from that of the corresponding fragment of wild-type strains. Studies with clinical varicella zoster virus (VZV) isolates from vaccinees indicated that tests on the ratio of infectivity in guinea pig embryo fibroblasts (GPEF) to that in human embryo fibroblasts (HuEF) and the profile of the DNA digest with Hpa I are useful for differentiation of the vaccine strain from wild-type strains. The vaccine virus showed stable immunogenicity during at least 15 further repeated passages in human diploid cells, a character which seems helpful for production of a large quantity of vaccine virus for practical use.     

Varicella vaccination: evidence for frequent reactivation of the vaccine strain in healthy children

Wild-type varicella zoster virus (VZV) causes chickenpox, a common childhood illness characterized by fever and a vesicular rash and rare serious complications. Wild-type VZV persists in a latent form in the sensory ganglia, and can re-activate to cause herpes zoster. More than 10 million American children have received the live attenuated Oka strain VZV vaccine (OkaVZV) since its licensure in 1995. Pre-licensure clinical studies showed that mean serum anti-VZV levels among vaccinees continued to increase with time after vaccination. This was attributed to immunologic boosting caused by exposure to wild-type VZV in the community. Here, we examine the alternative, that large-scale asymptomatic reactivation of OkaVZV might occur in vaccinees. We analyzed serum antibody levels and infection rates for 4 years of follow-up in 4,631 children immunized with OkaVZV. Anti-VZV titers decreased over time in high-responder subjects, but rose in vaccinees with low titers. Among subjects with low anti-VZV titers, the frequency of clinical infection and immunological boosting substantially exceeded the 13%-per-year rate of exposure to wild-type varicella. These findings indicate that OkaVZV persisted in vivo and reactivated as serum antibody titers decreased after vaccination. This has salient consequences for individuals immunized with OkaVZV.