亚洲b型流行性感冒嗜血杆菌疾病和疫苗的使用

综述亚洲b型流行性感冒(流感)嗜血杆菌(Hib)疾病和疫苗推广使用情况。流感嗜血杆菌是全世界儿童发病和死亡的主要原因之一,Hib常引起儿童严重感染。Hib结合疫苗的问世,大大减少了发达国家Hib疾病的发病率。尽管认识到Hib疾病的重要性,亚洲绝大多数国家仍未考虑使用这一疫苗,主要原因:亚洲国家Hib疾病负担不清楚和疫苗的价格。亚洲国家如何对待Hib疫苗问题:已知有高发病率的国家和地区应考虑使用;已经着手使用的国家应及时评价其免疫效果;疾病负担不清楚的国家与地区应与政府和专门机构积极合作,进一步开展相关研究。Hib疫苗使用应该提到决策机构的议事日程上来。     

社区儿童接种b型流行性感冒嗜血杆菌结合疫苗的前瞻性队列研究

目的评价社区儿童接种b型流行性感冒嗜血杆菌[Haemophilus Influenzae(Hi)Type b,Hib]结合疫苗的免疫效果。方法采用前瞻性队列研究方法分为疫苗接种组与非疫苗接种(对照)组,用细菌培养法、巢式聚合酶链反应检测两组儿童Hi携带状况,分析Hi携带率及下呼吸道疾病罹患率。结果两组儿童Hib携带率均较低;对照组未定型Hi阳性率显著高于接种组,以2～3岁尤为明显;各年龄组中对照组儿童支气管炎罹患率均显著高于接种组,Hib结合疫苗对儿童支气管炎发病的保护效果>90%;对照组中Hi培养阳性者气管炎发病显著高于Hi培养阴性者。结论儿童支气管炎的发病与Hi携带率高有关,接种Hib疫苗后导致Hi携带率下降以及支气管炎发病减少。     

山东省某地儿童b型流行性感冒嗜血杆菌疫苗接种现状及其影响因素

目的了解儿童b型流行性感冒（流感）嗜血杆菌（Haemophilus InfluenzaeTYpe b,Hib）疫苗接种现状,探讨其影响因素,为制定Hib疫苗免疫策略提供基线资料。方法采用按容量比例概率抽样法（Probability Proportional to Size,PPS）,在山东省某地随机抽取30个预防接种单位,每个预防接种单位调查10名儿童家长。采用自编结构式问卷,调查儿童和家长的一般情况,以及儿童家长对Hib疾病和疫苗的知识、态度和行为。结果64．05％（196/306）儿童接种过Hib疫苗。儿童家长对Hib疾病和疫苗的基本知识回答正确率均〈50％。“接种Hib疫苗容易引发不良反应”[比值比（OddsRatio,OR）=0．57,95％可信区间（ConfidenceInterval,CI）：0．32～1．03]、“特别反对接种Hib疫苗”（OR=0．41,95％CI：0．17～0．97）、“医生说自己孩子有必要接种Hib疫苗”（OR=4．44,95％CI：1．59～12．37）与儿童接种Hib疫苗相关性有统计学有意义。结论有必要针对儿童家长开展H1b疫苗预防接种知识的健康促进和健康教育,提高公众对Hib疾病和疫苗知识的知晓率和主动接受预防接种服务的意识。     

接种b型流行性感冒嗜血杆菌结合疫苗致婴儿过敏反应1例报告

患儿5月龄，男性。2008年5月接种第3剂b型流行性感冒嗜血杆菌结合疫苗（Haemophihis Influenzae Type b Conjugate Vaccine，Hib：兰州生物制品研究所生产，每瓶0．5ml，含纯化Hib荚膜多糖≥10mg），按常规消毒，上臂三角肌肌内注射0．5ml。约10min后，婴儿面部出现痒感，烦燥，呼吸急促，T37℃，P100／min，R28／min，BP压70／40mmHg（10mmHg=1．33Kpa），急性病容。     

杭州市儿童接种b型流行性感冒嗜血杆菌多糖结合疫苗影响因素的调查分析

目的探讨影响杭州市儿童接种b型流行性感冒嗜血杆菌(Haemophilus influenzae Type b,Hib)多糖结合疫苗(Polysaccharide Conjugate Vaccine)(Hib疫苗)的因素,提出促进儿童接种Hib疫苗的策略。方法采用多级抽样方法,对杭州市4个区(县)458名儿童家长开展接种Hib疫苗影响因素的问卷调查。结果 458名儿童Hib疫苗接种率为55.68%。将是否接种Hib疫苗进行单因素分析,户籍为常住儿童[比值比(Odds Ratio,OR)=0.634,95%可信区间(Confidence Interval,CI):0.437~0.918,P=0.016]、参加医疗保险(OR=0.580,95%CI:0.393~0.856,P=0.006)、母亲文化程度高(OR=0.631,95%CI:0.435~0.915,P=0.015)、家庭人均年收入高(OR=0.484,95%CI:0.305~0.768,P=0.002)、收到接种Hib疫苗的告知(OR=0.196,95%CI:0.156~0.244,P0.001)、知晓Hib可引起多种疾病(OR=0.055,95%CI:0.031~0.097,P0.001)、知晓Hib疫苗(OR=0.031,95%CI:0.018~0.052,P0.001)是接种Hib疫苗的促进因素,而Hib疫苗价格高(OR=1.980,95%CI:1.311~2.994,P=0.001)是接种Hib疫苗的阻碍因素。在单因素分析的基础上,进行非条件逻辑斯谛回归分析,户籍为常住儿童(OR=0.512,95%CI:0.3~0.876,P=0.015)、收到接种Hib疫苗告知(OR=0.218,95%CI:0.094~0.505,P0.001)是接种Hib疫苗的促进因素,而Hib疫苗价格高(OR=1.403,95%CI:1.116~1.894,P=0.036)是接种Hib疫苗的阻碍因素。结论影响杭州市儿童接种Hib疫苗的因素主要有户籍、家长是否收到接种Hib疫苗的告知、Hib疫苗的价格等。     

推广b型流行性感冒嗜血杆菌疫苗免疫接种的可行性调查

对苏州市两个街道 2 5 45名 1～ 5周岁儿童接种b型流行性感冒嗜血杆菌 (Hib)疫苗的情况和未接种原因作了调查。在2 5 45中人接种了 1398人 ,接种率 5 4 93 %。年龄越小 ,接种率越高 (χ2 =175 ,P<0 0 1)。干部、外来人员、个体户、工人、经济收入较低家庭及家长低学历家庭的儿童接种率较高 (P <0 0 1)。全身反应和局部反应分别为 1 0 7%和 1 5 0 % ,表明该疫苗是安全的。人们对Hib危害的认识、医务人员的宣传及疫苗的价格是影响Hib疫苗推广的重要因素     

黑龙江省婴幼儿b型流行性感冒嗜血杆菌多糖抗体水平监测

为了解黑龙江省婴幼儿b型流行性感冒 (流感 )嗜血杆菌 (Hib)的感染状况 ,对哈尔滨、大庆、齐齐哈尔、佳木斯、鸡西、牡丹江6个市的 0～ 48月龄婴幼儿共 3 0 0份血清 ,用放射免疫方法进行了流感嗜血杆菌多糖 (Hib -PRP)抗体水平的监测。结果显示 :该人群抗体阳性率平均为 42 0 0 % ,其中男性为 3 6 94% ,女性为 47 5 5 % ;Hib -PRP抗体几何平均滴度 (GMT)为 0 18μg/ml。Hib-PRP抗体的年龄别分布是 :出生后抗体稍高 ,4～ 6月龄降至最低 ,8月龄后抗体阳性率和GMT随年龄增长而逐渐增高。按城市分 ,Hib -PRP抗体阳性率和GMT最高的是哈尔滨 ,其次为大庆、鸡西、牡丹江 ,最低的是齐齐哈尔、佳木斯。按采样地可分为医院组、城镇组和农村组 ,婴幼儿Hib -PRP抗体水平以医院组的明显高于城镇组 ,城镇组明显高于农村组。     

胸腺淋巴体质婴儿接种b型流行性感冒嗜血杆菌结合疫苗后死亡1例报告

1调查情况1．1死婴背景男,2011年11月9日出生,足月顺产,体重3．5千克（kg）,新生儿Apgar评分9．0分。婴儿既往无患病史,接种前精神状态良好,无过敏史,家庭成员无遗传病史和传染病史。婴儿此前曾接种过乙型肝炎疫苗、卡介苗、口服脊髓灰质炎减毒活疫苗,未出现过不良反应。1．2死亡经过生前于2012年2月10日9：00在预防接种门诊接种1剂b型流行性感冒嗜血杆菌结合疫苗（Haemophilus Influenzae Type b Conjugate Vaccine,Hib）,留置观察30min无异常回家。     

盐城市健康儿童b型流行性感冒嗜血杆菌带菌率调查

目的了解盐城市儿童b型流行性感冒嗜血杆菌（Hib）带菌率状况。方法用PCR法检测900份不同年龄组健康儿童咽拭子标本。结果盐城市14岁以下健康儿童Hib总带菌率为55．44％，男女性别间无明显差异，春季带菌率比冬季高，人员流动性大的地区带菌率较高，带菌率随年龄的变化是：1～3月龄最低，4～6月龄上升到56．00％，7～12月龄逐步下降，1岁以后随年龄增长而逐步增高，10～14岁年龄组最高。结论盐城市儿童Hib带菌率较高，存在相关疾病流行的可能性。     

世界卫生组织关于b型流行性感冒嗜血杆菌结合疫苗的立场文件（2013年7月）

依据为各成员国提供卫生政策方面指导意见这一职责,世界卫生组织（World Health Organization,WHO）就预防具有全球公共卫生影响疾病的疫苗及联合疫苗问题,发布一系列定期更新的立场文件。这些文件着重关注疫苗在大规模免疫规划中的使用,归纳了各相关疾病与疫苗的基本背景信息,并就如何在全世界范围内使用这些疫苗表明了WHO目前的立场。这些文件经外部专家和WHO工作人员审阅,     

接种Hib疫苗偶合血小板减少性紫癜一例报告

1病例资料患儿,男,2005年2月3日生。出生24小时内接种乙肝疫苗第1针,2005年3月5日接种卡介苗和乙肝疫苗第2针,2005年4月8日16时在县疾病预防控制中心预防接种门诊接种B型流感嗜血杆菌结合疫苗(H ib,安尔宝),疫苗系安万特·巴斯德公司生产,由深圳安万特巴斯德生物制品有限公司分包装,批号Y 0354-1,生产日期20040419,失效期200703,每支1人份。接种门诊医生在进行常规检查后,认为其符合接种条件,由专职护士接种,接种部位左上臂外侧三角肌处,皮肤经常规消毒后,用预填充稀释液注射器(0.5 m l)将B型流感嗜血杆菌结合疫苗10μg(1支)稀释后肌肉注…     

b型流感嗜血杆菌结合疫苗临床研究

目的 评价b型流感嗜血杆菌(Hib)结合疫苗在3月龄～5岁婴幼儿中的安全性和免疫原性.方法 采用随机、盲态、同类制品平行对照设计,对1～5岁、7～12月龄和3～6月龄组婴幼儿分别接种b型流感嗜血杆菌结合疫苗,观察局部及全身反应,并检测血清抗体滴度.结果 3个年龄组接种Hib结合疫苗后不良反应总发生率为24.9％,1～5岁、7 ～12月龄和3～6月龄组不良反应总发生率分别为19.8％、24.9％和30.0％,其中3～6月龄试验组和对照组间不良反应总发生率差异有统计学意义(P=0.029 1),试验组高于对照组,其余2个年龄组试验组和对照组间不良反应总发生率差异无统计学意义(P =0.737 8和P=0.757 8).Hib结合疫苗免后阳转率达98.5％.达保护性水平的比例为95.6％,免后抗-Hib平均水平(GMT)为8.77 μg/ml.结论 b型流感嗜血杆菌结合疫苗接种3月龄～5周岁受试者达到良好的免疫效果,接种后具有良好的安全性及耐受性.     

Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review

Background

Cardiovascular diseases (CVDs) constitute major comorbidities in type 2 diabetes mellitus (T2DM), contributing substantially to treatment costs for T2DM. An updated overview of the economic burden of CVD in T2DM has not been presented to date.

桃源居社区儿童b型流感嗜血杆菌结合疫苗副反应观察

本实验旨在观察深圳市桃源居社区儿童接种b型流感嗜血杆菌(Hib)结合疫苗后副反应情况。通过系统跟进观察398名儿童接种后情况,设置梯度进行分类,与其他参考文献及厂商资料进行比较后得出,Hib疫苗在现场接种中副反应发生率和强度低,局部反应轻微,是一种安全有效的疫苗,可以在社区儿童中广泛推广使用。     

Alzheimer's Disease: A Healthcare Burden of Epidemic Proportion

Alzheimer''s disease is the most common cause of dementia and increases in prevalence exponentially with age, with trends in the United States likely to worsen in ensuing decades. The pathology in Alzheimer''s disease is characterized by an increase in extracellular amyloid plaques and intraneural neurofibrillary tangles, with neuronal destruction in several areas of the brain, and biochemically by a deficiency in acetylcholine; clinical manifestations include progressive loss of memory, change in personality, and behavioral disturbances. Pharmacotherapy includes the T.S. Dharmarajan Srinivas G. Gunturu use of cholinesterase inhibitors and memantine; addressing the many behavioral manifestations of the disease, especially in advanced stages, imposes tremendous burden to caregivers and healthcare resources.Alzheimer''s disease (AD), the most common cause of dementia, increases in prevalence exponentially with age, and the trend of growing incidence of the disease is likely to continue in the United States. Alzheimer''s dementia is a common, acquired disorder that is manifested as slowly progressive memory loss with at least 1 cognitive dysfunction (ie, aphasia, apraxia, agnosia, or executive dysfunction) and resulting in impaired occupational and social performance. The deterioration in cognition from earlier levels must occur in the absence of delirium or other causes of dementia (eg, Parkinson''s disease or vascular dementia).1,2The National Institute of Neurologic and Communicative Disorders and Stroke-Alzheimer''s Disease and Related Disorders Association classifies AD as3,4:

• Definite—clinical diagnosis and histology confirmed
• Probable—clinical syndrome, no histology
• Possible—atypical presentation, no alternative diagnosis or histologic proof.

It is important to distinguish AD, which refers to the pathologic changes in the brain, from Alzheimer''s dementia, which refers to the clinical manifestations. AD is more common than Alzheimer''s with dementia; not everyone with AD, even AD that is proved at autopsy, necessarily manifests the clinical features of dementia.There are currently more than 5 million Americans with AD, and the prevalence increases with age. The prevalence of AD is 4% among people younger than 65 years, which increases to more than 13% in the older than 65-year age-group, and up to 50% in the older than 85-year age-group.5 But these US trends are not universal. In Japan, vascular dementia is more common than Alzheimer''s dementia.6 The US Alzheimer''s Association predicts a surge in the incidence of AD in the baby boom era (Figure 1). AD is the fifth leading cause of death in people older than 65 years in the United States.7Open in a separate windowFigure 1Projected Annual Incidence of Alzheimer''s Disease in the United StatesSource: Alzheimer''s Association. Alzheimer''s disease facts and figures. 2008. www.alz.org/national/documents/report_alzfactsfigures2008.pdf.     

Use of the Pre-Post Method to Measure Cost Savings in Disease Management

The US disease management (DM) industry continues to endorse the use of the methodologically flawed pre-post design to evaluate financial outcomes, which regularly reports returns on investment of up to 8:1. This is in sharp contrast to the peer-reviewed literature and large Medicare demonstration projects that generally report little, if any, cost savings from DM. The industry defends the practice of using the pre-post evaluation design by suggesting that measuring total healthcare costs at the diseased-population level eliminates regression to the mean and accounts for indirect changes in physician behavior. The industry further argues that equivalent and concurrent control groups are not available and that instead, a cost trend of the non-diseased population should be used to provide equivalence. This article illustrates the fallacies of these arguments and demonstrates how the pre-post technique elicits financial results generally favoring the DM program. Given that the continued use and support of this methodology serves only to propagate the concerns over the financial value of DM, it is time that a collective decision be made as to whether maximizing short-term profits is worth jeopardizing the long-term viability of the entire industry. Additionally as important, other healthcare systems around the world are looking to the US DM industry for guidance as they ponder the introduction of DM in their own countries. The inability of DM to accurately measure and achieve financial savings may be inhibiting the widespread initiation of future DM programs.     

Glycogen Storage Disease Type Ia: Current Management Options,Burden and Unmet Needs

Glycogen storage disease type Ia (GSDIa) is caused by defective glucose-6-phosphatase, a key enzyme in carbohydrate metabolism. Affected individuals cannot release glucose during fasting and accumulate excess glycogen and fat in the liver and kidney, putting them at risk of severe hypoglycaemia and secondary metabolic perturbations. Good glycaemic/metabolic control through strict dietary treatment and regular doses of uncooked cornstarch (UCCS) is essential for preventing hypoglycaemia and long-term complications. Dietary treatment has improved the prognosis for patients with GSDIa; however, the disease itself, its management and monitoring have significant physical, psychological and psychosocial burden on individuals and parents/caregivers. Hypoglycaemia risk persists if a single dose of UCCS is delayed/missed or in cases of gastrointestinal intolerance. UCCS therapy is imprecise, does not treat the cause of disease, may trigger secondary metabolic manifestations and may not prevent long-term complications. We review the importance of and challenges associated with achieving good glycaemic/metabolic control in individuals with GSDIa and how this should be balanced with age-specific psychosocial development towards independence, management of anxiety and preservation of quality of life (QoL). The unmet need for treatment strategies that address the cause of disease, restore glucose homeostasis, reduce the risk of hypoglycaemia/secondary metabolic perturbations and improve QoL is also discussed.     

The Burden of Influenza B: A Structured Literature Review

We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010.Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B–specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant.The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.THERE ARE 3 TYPES OF INFLUenza, A and B being most common in humans, each with unique characteristics. Influenza C is less common and produces milder disease.1,2 Influenza A virus subtypes are based on 2 surface proteins: hemagglutinin (H) and neuraminidase (N). Current influenza A subtypes found in people are H1N1 and H3N2. Influenza B is not divided into subtypes; however, 2 antigenically and genetically distinct lineages, B/Victoria/2/87–like (Victoria lineage) and B/Yamagata/16/88–like (Yamagata lineage), have circulated worldwide since 1983.3 Two influenza A subtypes and 1 influenza B lineage are included in current trivalent seasonal influenza vaccines.The first influenza virus—A (H1N1)—was recovered in 1933; influenza B was first identified in 1940 by Francis.4 In early years, influenza B epidemics were noted to occur at intervals of 2 to 4 years and were generally well-defined and discrete; medically attended illnesses, including clinic visits and hospitalizations, were common in all age groups.5 The emergence of a second lineage of influenza B in 1983,3 along with changing demographics and rapid movement of human populations, has changed the epidemiology of influenza B.1,6 New variants of influenza B arise less frequently than for influenza A2; therefore, in some years, adults with previous exposure to influenza B may have less severe illness than similarly exposed children who invariably have higher attack rates. Since 2001, both influenza B lineages have been cocirculating each influenza season, in contrast to the pattern of multiyear dominance by a single lineage that occurred between 1985 and 20007–32 Although both influenza A and B have an impact on human health, multiple differences exist between them, including molecular differences.33Although just 2 subtypes of influenza A have cocirculated in recent years, a total of 16 subtypes are found in animal species, especially birds and pigs, providing an opportunity for pandemics through mutation or reassortment.33 By contrast, with no natural animal host (other than seals) and a slower rate of mutation, influenza B has little potential for such impact.3,33 Given these differences, it is reasonable to hypothesize that there are also differences in the presentation, symptoms, risk factors, and total burden of influenza A and B viruses which may, in turn, inform vaccination and prevention efforts.To date, more research has focused on influenza A than on influenza B.33 Current opinion of influenza B remains influenced by early studies that concluded that influenza B posed less of a disease burden than influenza A.1,2 Furthermore, because of the ability of influenza A to cause severe pandemics, it is more frequently a topic of press coverage than influenza B, reinforcing the perception that influenza B does not pose a serious threat to public health. In contrast to the popular view that influenza B has minimal impact, there are indications that the impact of influenza B is substantial.Before initiating a formal review of the literature, we examined recent surveillance data. Among US pediatric influenza deaths between 2004 and 2011, excluding the 2009–2010 pandemic, 22% to 44% of deaths each season were confirmed to be influenza B–related; the remainder were related to influenza A.34 Similar multiseason mortality data are not available in the European Union; however, in the United Kingdom, influenza B dominated the 2010–2011 season with both influenza B lineages cocirculating.35,36 Of 607 UK fatalities associated with influenza during that season, 40 were associated with influenza B (through June 30, 2011).35,36 Surveillance data from the United States and Europe suggest a potentially increasing burden of influenza B in recent years (Figure 1). This high variability in influenza B circulation may be attributable to variable population immunity and competition between the 2 cocirculating lineages of influenza B. Furthermore, behavioral trends, such as increasing urbanization and travel, facilitate the spread of influenza viruses.37 In 2002, 52 million persons embarked on international flights demonstrating how respiratory viruses can be spread rapidly.38,39 It is notable that the B lineage selected for the seasonal influenza vaccine and the dominant circulating B strain have matched only 5 times in the 10 seasons between 2001–2002 and 2010–2011.40Open in a separate windowFIGURE 1—Influenza B activity, as indicated by proportion of samples testing positive for influenza B in Europe and the United States, 1994–2011.Note. Data on influenza B activity in Europe from the European Influenza Surveillance Network are unavailable before 2000.Source. Data were obtained from the Centers for Disease Control and Prevention and the European Influenza Surveillance Network.7–32As evidence of influenza B burden accumulates and vaccine technology advances, it is increasingly important to understand and quantify the impact of influenza B on the worldwide population. We designed this review to comprehensively examine the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the recent peer-reviewed literature.     

三种B型流行性感冒嗜血杆菌结合疫苗的安全性观察

近年来B型流行性感冒嗜血杆菌结合疫苗"简称HIB疫苗"在全国各地逐步开始推广应用.国内外还没有对三种不同厂家的HIB疫苗同时进行安全性观察的文章.为更好地推广HIB疫苗在我市的应用.特选定上城、下城、拱墅3区180名2～6月龄儿童分别接种史克必成公司、巴斯德公司、默克公司生产的3种HIB疫苗,观察其安全性.