人用疫苗佐剂的安全性

从铝佐剂诞生至今,佐剂发挥着免疫调节、抗原递送的作用。新型人用疫苗佐剂陆续批准上市,以弥补疫苗免疫原性较弱的缺点。然而,人体免疫系统、病原体、佐剂之间的作用机制尚未完全清楚,佐剂诱导的自身免疫/炎性综合征(autoimmune/inflammatory syndrome induced by adjuvants,ASIA)及相关不良反应,限制了人用疫苗佐剂的大量使用,这些均引起了人们对佐剂安全性的高度关注。现就7种已上市人用疫苗佐剂(铝佐剂、MF59、AS03、ISA51、病毒体佐剂、AS01及AS04)的作用机理、应用情况及其安全性问题作一阐述,为新型人用疫苗佐剂合理、可靠的分析与评价提供思路。     

药物基因组学在新药临床试验及个体化用药中的应用

药物安全性和有效性评价是药物临床试验和个体化用药的核心,也是药物基因组学研究的主要内容。药物基因组学研究贯穿于药物 研发、上市评价和临床应用整个过程, 根据药物代谢酶、转运体、受体相关基因多态性对用药者进行分层分析,评价与药物体内的处置过程、 安全性、有效性个体差异的相关性。综述药物基因组学在新药临床试验、个体化用药中的应用研究新进展。     

温州地区人群对甲型H1N1流感认知情况及其疫苗不良反应的调查

目的了解温州地区居民对甲型H1N1流感(以下简称甲流)的认知情况及其疫苗的不良反应,分析相关调查数据为医务人员加强疾病防控提供依据。方法采用自行设计问卷,随机抽取2010年3月-4月温州地区居民888人为调查对象,对其进行问卷调查。结果温州地区人群对甲流及其疫苗的认知程度平均得分为15.69分,处于中低水平,各年龄段、各职业人群在认知度上差异存在统计学意义(P<0.05),走访的113名70岁以上的老人在甲型H1N1信息上欠缺认识。调查对象中50.5%人群对甲流疫苗的安全性持质疑观望态度。调查对象中共115人已接种疫苗,13人出现不良反应,占11.3%。结论甲流疫苗具有较高的安全性,但温州地区人群对甲型H1N1流感相关知识了解欠缺,而且群众的信任度不高,因此仍应加大宣传力度,尤其加强对老年人的预防宣教。JP     

2008—2012年麻疹减毒活疫苗的质量分析

目的对中国2008—2012年连续5年麻疹减毒活疫苗(简称麻疹疫苗)的批签发情况进行总结,评价其麻疹疫苗的总体质量。方法通过对送检样品的资料审查和关键项目的实验室检定,采用趋势分析法对病毒滴度等进行分析和比较,回顾麻疹疫苗质量的整体情况。结果中国麻疹疫苗整体质量较好,批签发通过率为98.6%。疫苗关键指标数据稳定,病毒滴度100%符合国家标准,其中8批疫苗病毒滴度由于超过警戒线企业主动撤检。结论中国麻疹减毒活疫苗的质量稳中有升。国家疫苗批签发程序对确保上市疫苗的质量发挥重要作用,趋势分析在批签发中的应用更加严格保证了上市疫苗的安全性和有效性。     

疫苗的稳定性研究进展

疫苗的稳定性始终贯穿在产品的研发阶段以及疫苗上市、疫苗运输和上市后继续追踪其免疫效果的全过程。疫苗稳定性试验所得数据是评价该疫苗质量和免疫效果的重要依据,更是制定产品储存条件、有效期等重要参数的主要依据。现就疫苗的稳定性相关法规、研究方案、有效期制定、联合疫苗稳定性研究及成品中有效成分的累计时间等方面作一综述。     

2011—2016年河南省b型流感嗜血杆菌结合疫苗预防接种不良反应监测分析

目的分析2011—2016年河南省b型流感嗜血杆菌结合疫苗(简称Hib疫苗)预防接种不良反应的发生特征,评价Hib疫苗预防接种的安全性。方法通过中国免疫规划信息管理系统,收集2011—2016年河南省报告的Hib疫苗不良反应个案数据和Hib疫苗接种数据,采用描述流行病学方法对其进行分析。结果 2011—2016河南省共报告Hib疫苗接种不良反应960例,年平均报告发生率为10.55/10万剂次;以一般反应为主,占93.23%;4—8月为高峰;主要集中在郑州市、洛阳市、濮阳市和周口市;男性多于女性;<1岁儿童为主要报告人群;不良反应主要发生在首剂次接种后及接种后2 d内。一般反应的主要症状为发热、红肿、硬结,异常反应主要为过敏反应性疾病,治愈或好转达99.79%。结论 Hib疫苗不良反应报告发生率较低,具有良好的安全性。     

百日咳菌培养过程中通气量的变化对百日咳毒素（PT）产量的影响

目的:自20世纪80~90年代以来,各种不同类型的无细胞百日咳疫苗已在各国批准上市[1]。其免疫效果已被证实,不良反应比菌体疫苗明显较低,但成本比菌体疫苗高很多,而百日咳菌的免疫性抗原成分复杂,目前尚未能以分子生物等手段将这些抗原克隆到成本较低的细菌中。因此,改进培养技术     

HBsAg分子生物学与HBV疫苗研究进展

通过对ＨＢｓＡｇ的免疫原性、肝细胞嗜性及其与ＨＢＶ免疫病理的关系等研究,阐述了ｐｒｅＳ多肽对ＨＢＶ感染免疫应答的作用及其与肝细胞膜的相互作用。基于ｐｒｅＳ多肽在乙肝免疫中的重要性,使得乙肝疫苗的研究随着重组ＤＮＡ技术的发展从第一代血源乙肝疫苗到第二代基因工程疫苗特别是多肽或亚单位疫苗在产量、质量、免疫原性、安全性等方面的研究取得了长足的进展。     

我国免疫规划疫苗现状及安全问题探讨

疫苗的接种在预防以及控制传染病中发挥了至关重要的作用。本文重点介绍了我国的免疫规划疫苗(一类疫苗)、非免疫规划疫苗(二类疫苗)以及疫苗接种可能产生的不良反应。此外,还讨论了疫苗相关的安全事件及其教训。     

埃博拉病毒疫苗和药物的研发进展及启示

2014年空前的西非埃博拉疫情,使得埃博拉病毒受到了全世界的广泛关注。针对埃博拉病毒病,目前还没有获批上市的疫苗和药物,但有几种疫苗和药物已在非人灵长类动物中证实了保护效果,其中少数品种已进入临床试验阶段。本文集中介绍几种最具前景的疫苗和药物,并对其发展前景进行了分析和预测。     

Ontology-Based Combinatorial Comparative Analysis of Adverse Events Associated with Killed and Live Influenza Vaccines

Vaccine adverse events (VAEs) are adverse bodily changes occurring after vaccination. Understanding the adverse event (AE) profiles is a crucial step to identify serious AEs. Two different types of seasonal influenza vaccines have been used on the market: trivalent (killed) inactivated influenza vaccine (TIV) and trivalent live attenuated influenza vaccine (LAIV). Different adverse event profiles induced by these two groups of seasonal influenza vaccines were studied based on the data drawn from the CDC Vaccine Adverse Event Report System (VAERS). Extracted from VAERS were 37,621 AE reports for four TIVs (Afluria, Fluarix, Fluvirin, and Fluzone) and 3,707 AE reports for the only LAIV (FluMist). The AE report data were analyzed by a novel combinatorial, ontology-based detection of AE method (CODAE). CODAE detects AEs using Proportional Reporting Ratio (PRR), Chi-square significance test, and base level filtration, and groups identified AEs by ontology-based hierarchical classification. In total, 48 TIV-enriched and 68 LAIV-enriched AEs were identified (PRR>2, Chi-square score >4, and the number of cases >0.2% of total reports). These AE terms were classified using the Ontology of Adverse Events (OAE), MedDRA, and SNOMED-CT. The OAE method provided better classification results than the two other methods. Thirteen out of 48 TIV-enriched AEs were related to neurological and muscular processing such as paralysis, movement disorders, and muscular weakness. In contrast, 15 out of 68 LAIV-enriched AEs were associated with inflammatory response and respiratory system disorders. There were evidences of two severe adverse events (Guillain-Barre Syndrome and paralysis) present in TIV. Although these severe adverse events were at low incidence rate, they were found to be more significantly enriched in TIV-vaccinated patients than LAIV-vaccinated patients. Therefore, our novel combinatorial bioinformatics analysis discovered that LAIV had lower chance of inducing these two severe adverse events than TIV. In addition, our meta-analysis found that all previously reported positive correlation between GBS and influenza vaccine immunization were based on trivalent influenza vaccines instead of monovalent influenza vaccines.     

东莞市预防接种不良反应监测和处理控制系统的建立及评价

为了解东莞市各种疫苗预防接种不良反应的发生情况,建立预防接种不良反应(AEFI)监测和处理控制系统,评价其运行状况,提高预防接种工作质量。根据WHO对AEFI的定义和分类方法,确定了东莞市AEFI报告范围,报告人、报告程序、报告制度以及调查内容和方法,并对该系统2005年收集的AEFI病例进行描述性分析。全市共登记预防接种不良反应560例,其中疫苗反应占了95.36%。男性多于女性。在所使用的26种疫苗中有18种出现不良反应,以Hib和百白破(DPT)的发生率最高,且百白破的报告数最多,占57.5%。在报告的预防接种不良反应中,发热、局部红肿疼痛以及皮疹等过敏性反应占了94.1%。结果认为该系统在评价疫苗的安全性,发现不良反应发生的危险因素,改善预防接种服务质量起着重要作用。     

Will Dengue Vaccines Be Used in the Public Sector and if so,How? Findings from an 8-country Survey of Policymakers and Opinion Leaders

Background

A face-to-face survey of 158 policymakers and other influential professionals was conducted in eight dengue-endemic countries in Asia (India, Sri Lanka, Thailand, Vietnam) and Latin America (Brazil, Colombia, Mexico, Nicaragua) to provide an indication of the potential demand for dengue vaccination in endemic countries, and to anticipate their research and other requirements in order to make decisions about the introduction of dengue vaccines. The study took place in anticipation of the licensure of the first dengue vaccine in the next several years.

Methods/Principal Findings

Semi-structured interviews were conducted on an individual or small group basis with government health officials, research scientists, medical association officers, vaccine producers, local-level health authorities, and others considered to have a role in influencing decisions about dengue control and vaccines. Most informants across countries considered dengue a priority disease and expressed interest in the public sector use of dengue vaccines, with a major driver being the political pressure from the public and the medical community to control the disease. There was interest in a vaccine that protects children as young as possible and that can fit into existing childhood immunization schedules. Dengue vaccination in most countries surveyed will likely be targeted to high-risk areas and begin with routine immunization of infants and young children, followed by catch-up campaigns for older age groups, as funding permits. Key data requirements for decision-making were additional local dengue surveillance data, vaccine cost-effectiveness estimates, post-marketing safety surveillance data and, in some countries vaccine safety and immunogenicity data in the local population.

Conclusions/Significance

The lookout for the public sector use of dengue vaccines in the eight countries appears quite favorable. Major determinants of whether and when countries will introduce dengue vaccines include whether WHO recommends the vaccines, their price, the availability of external financing for lower income countries, and whether they can be incorporated into countries'' routine immunization schedules.     

简述疫苗安全性管理

疫苗接种是保护公众健康最有效的措施之一,疫苗可有效降低传染病的发病率和死亡率。与疫苗的有效性评估不同,疫苗的安全性不能直接测定,只能通过有限的疫苗不良事件的相关情况来推断。对疫苗安全性监测的科学理论,全球关注的个案研究,以及注册前有关疫苗的临床试验安全性的相关事宜进行了简介。     

Composition of acellular pertussis and combination vaccines: a general review.

Since the development and introduction of the acellular pertussis vaccine in Japan in the early eighties, we have come a long way in using this component in combination with other vaccines. However, the basic problem in development of an effective and safe pertussis vaccine is that the antigens to induce complete protection against clinical pertussis and the precise mechanism by which pertussis vaccine confers immunity is yet unknown. Hence, the composition of future acellular pertussis vaccine remains an open issue. Recently, acellular pertussis vaccine has been licensed for the booster doses in the U.S.A. and for primary immunization of infants in Italy and Germany. A multicentric trial has been carried out to compare the serological response and adverse reactions of 13 acellular pertussis vaccines. These vaccines contained one or more of the four components, i.e. FHA, PT, 69 kDa OMP and fimbriae. All vaccines were associated with substantially fewer and less adverse reactions and were more immunogenic with respect to antibodies against the added antigens. DTP vaccines in the near future will have combinations of other components and the key antigen for combination will be acellular pertussis component which is going to replace whole cell pertussis component in DTP vaccines. In view of this, manufacturers like ourselves from the developing countries are still groping in the dark, uncertain whether we should have a single component acellular pertussis vaccine or multicomponent one. This will have a major impact on the cost of production, the final cost of the combination vaccines and the regulatory issues that we will have to tackle in view of the recent thinking on harmonization in the pharmaceutical industry.     

Post-licensure evaluation of vaccine safety: current status and future directions. Symposium organised by the International Alliance for Biological Standardization (IABS) in Barcelona, Spain, 27-28 April 2011

Adverse events following immunization, while rare, unfortunately do occur. And when they do, the public's faith in vaccines waves. It's a known fact, for example, that vaccine safety concerns are among the most important factors contributing to parents refusing vaccination for their children. How best, then, to tackle these concerns and increase public confidence in the vaccine safety system? In an effort to contribute to identifying the right mechanisms, the International Alliance for Biological Standardization organized an international symposium on "Post-Licensure Evaluation of Vaccine Safety" in Barcelona in early Spring. Delegates from 24 countries took a close look at the current status of this challenging problem and identified several practical measures which could help address the situation. They suggested an integrated vaccine safety program to be in place in all countries and standardized so that information and data can be exchanged on a routine basis. Another proposal was to put in place simple measures such as the use of bar codes on vaccine vials.     

联合疫苗应用现状及评价*

联合疫苗含有两种或多种免疫原（活的、灭活的病原体或者提纯的抗原）,用于预防多种疾病或由同一病原体的不同亚型或血清型引起的疾病,可以避免常规免疫多次注射的问题。然而和单价疫苗相比,联合疫苗研发的复杂性大大增加,将多种免疫原混合到一起进行免疫时不同免疫原间可能因为物理、化学和免疫学机制而干扰其他免疫原的免疫反应,此外佐剂和防腐剂等非活性成分也可能对联合后的活性成分产生影响,这就对联合疫苗的评价提出了特别的要求。本文对联合疫苗的研究应用现状、临床评价和发展前景等方面做一综述。     

轮状病毒VP4亚单位疫苗研究进展

轮状病毒是全球范围内导致5岁以下婴幼儿严重腹泻的主要病原体,造成了巨大的经济负担和社会负担。疫苗预防接种是控制轮状病毒感染最为有效的手段,但在轮状病毒导致的死亡率较高的非洲和亚洲部分低收入国家,目前已经上市的轮状病毒疫苗的有效性较低,且会增加肠套叠的风险。更加安全、有效的轮状病毒疫苗对于降低轮状病毒感染导致的发病率和死亡率具有重要意义。目前,各国科研人员试图从多个方面提高轮状病毒疫苗的有效性,非复制型基因工程亚单位疫苗是目前轮状病毒疫苗研究的主要方向。文中就目前轮状病毒亚单位疫苗,特别是基于VP4蛋白的亚单位疫苗的研究进展进行了综述,以期对轮状病毒疫苗的发展提供借鉴意义。     

Safety of the malaria vaccine candidate, RTS,S/AS01E in 5 to 17 month old Kenyan and Tanzanian Children

The malaria vaccine candidate, RTS,S/AS01(E), showed promising protective efficacy in a trial of Kenyan and Tanzanian children aged 5 to 17 months. Here we report on the vaccine's safety and tolerability. The experimental design was a Phase 2b, two-centre, double-blind (observer- and participant-blind), randomised (1∶1 ratio) controlled trial. Three doses of study or control (rabies) vaccines were administered intramuscularly at 1 month intervals. Solicited adverse events (AEs) were collected for 7 days after each vaccination. There was surveillance and reporting for unsolicited adverse events for 30 days after each vaccination. Serious adverse events (SAEs) were recorded throughout the study period which lasted for 14 months after dose 1 in Korogwe, Tanzania and an average of 18 months post-dose 1 in Kilifi, Kenya. Blood samples for safety monitoring of haematological, renal and hepatic functions were taken at baseline, 3, 10 and 14 months after dose 1. A total of 894 children received RTS,S/AS01(E) or rabies vaccine between March and August 2007. Overall, children vaccinated with RTS,S/AS01(E) had fewer SAEs (51/447) than children in the control group (88/447). One SAE episode in a RTS,S/AS01(E) recipient and nine episodes among eight rabies vaccine recipients met the criteria for severe malaria. Unsolicited AEs were reported in 78% of subjects in the RTS,S/AS01(E) group and 74% of subjects in the rabies vaccine group. In both vaccine groups, gastroenteritis and pneumonia were the most frequently reported unsolicited AE. Fever was the most frequently observed solicited AE and was recorded after 11% of RTS,S/AS01(E) doses compared to 31% of doses of rabies vaccine. The candidate vaccine RTS,S/AS01(E) showed an acceptable safety profile in children living in a malaria-endemic area in East Africa. More data on the safety of RTS,S/AS01(E) will become available from the Phase 3 programme.     

Evaluation of vaccines against enteric infections: a clinical and public health research agenda for developing countries

Enteric infections are a major cause of morbidity and mortality in developing countries. To date, vaccines have played a limited role in public health efforts to control enteric infections. Licensed vaccines exist for cholera and typhoid, but these vaccines are used primarily for travellers; and there are two internationally licensed vaccines for rotavirus, but they are mainly used in affluent countries. The reasons that enteric vaccines are little used in developing countries are multiple, and certainly include financial and political constraints. Also important is the need for more cogent evidence on the performance of enteric vaccines in developing country populations. A partial inventory of research questions would include: (i) does the vaccine perform well in the most relevant settings? (ii) does the vaccine perform well in all epidemiologically relevant age groups? (iii) is there adequate evidence of vaccine safety once the vaccines have been deployed in developing countries? (iv) how effective is the vaccine when given in conjunction with non-vaccine cointerventions? (v) what is the level of vaccine protection against all relevant outcomes? and (vi) what is the expected population level of vaccine protection, including both direct and herd vaccine protective effects? Provision of evidence addressing these questions will help expand the use of enteric vaccines in developing countries.