不同剂量乙肝疫苗阻断乙型肝炎病毒母婴传播的远期效果观察

本文对出生后接种不同剂量乙肝血源疫苗的２７２名婴儿进行了３－５年的效果随访观察。结果表明,接种３、４、５年后,抗－ＨＢｓ阳性率仍分别保持在９０．５％、８２．３％和７３．２％,ＨＢｓＡｇ阳性率分别为２．８％、３．１％和４．２％。３年后抗－ＨＢｓ阳性率逐年下降,Ｐ／Ｎ值＞５０者以接种后３年为多,＜５０者以５年为多,３年后也呈下降趋势。随访结果说明,接种１０μｇ×４、５μｇ×４及２．５μｇ×４剂量的乙肝疫苗具有阻断母婴乙肝病毒传播的效果。鉴于Ｐ／Ｎ值及抗－ＨＢｓ阳性率在接种后３年开始下降,建议接种后３年应进行一次加强接种。     

含前S蛋白乙肝疫苗免疫人群效果观察

为考核含前Ｓ蛋白乙肝血源疫苗的人群免疫效果,对９６８名ＨＢＶ标志阴性的少年人群以１０μｇ×３的免疫剂量及０、１、２月免疫程序进行接种。全程免疫后一月采血检测其抗－ＨＢｓ免疫应答。结果表明抗－ＨＢｓ阳性率达９６．６％。并对另２９１名抗－ＨＢｃ及ＨＣＶ阳性的少年人群以同样的剂量、同样的免疫程序进行免疫接种,免疫后抗－ＨＢｓ阳性率为９４．１６％,且有２３．９８％的人接种后抗－ＨＢｃ由接种前的阳性转为阴性,全部观察对象无一例检出ＨＢｓＡｇ和其它异常指标     

少年人群接种乙肝疫苗后七年随访观察

对７９名ＨＢＶ标志阴性少年人群,以乙肝疫苗１０μｇ×３的免疫剂量和０、１、２月的免疫程序进行接种,对其抗－ＨＢｓ免疫应答和临床保护效果作了为期７年的定人随访。结果表明,抗－ＨＢｓ阳转率在免后三个月时为１００％,均值为３０８４ＭＩＵ／ｍｌ。至免后８４个月时疫苗接受者中仍有５５．７％的抗－ＨＢｓ水平≥１０ＭＩＵ／ｍｌ。６例检出抗－ＨＢｓ,其中５例的抗－ＨＢｓ持续处于高水平。全部观察对象无一例检出ＨＢｓＡｇ或发生临床肝炎。少年接种乙肝血源疫苗至少７年内可具有保护性抗体。故在此期内不需加强免疫。     

国产和美国产乙型肝炎血源疫苗五年效果比较

母亲ＨＢｓＡｇ和ＨＢｅＡｇ均阳性者所生之婴儿，随机接种国产和美国产乙肝疫苗，免疫后５年婴儿ＨＢｓＡｇ携带率分别为１５．４％和１８．２％；抗－ＨＢｓ阳性率各为７６．９％和７７．３％，两组均无显著性差别。     

乙肝疫苗快速阻断HBV母婴传播的研究

为获得更快速的免疫应答,用３０μｇ／ｍｌ乙肝血源疫苗以０、２、６周免疫程序对６８名ＨＢｓＡｇ阳性母亲婴儿作了阻断ＨＢＶ母婴传播免疫效果的观察,并和常规的０、１、６月接种方案的结果进行了比较。结果表明ＨＢＩＧ合并乙肝疫苗或单用疫苗组产生抗─ＨＢｓ（＞１０ｍＩＵ／ｍｌ）血清转换率于Ｔ６Ｍ、Ｔ１２Ｍ时分别为９１．８９％,和８３．８７％;８１．０８％和８３．８７％。短程和常规免疫方案婴儿所产生的保护性抗─ＨＢＳ动态比较,表明以０、２、６周免疫后的Ｔ６ｗ、Ｔ６ｍ时的抗─ＨＢｓ有效率分别为１９．３５％和８３．８７％,明显高于０、１、６月免疫者同期抗体水平（Ｐ＜０．０１）。至Ｔ１２Ｍ时两组的阳转率无显著性差异,说明０、２、６周免疫方案能早期诱导出保护性抗─ＨＢｓ免疫应答。     

P物质对GABAA和GABAB受体介导的DRG神经元膜反应的调制作用

实验在幼年大鼠ＤＲＧ标本上进行。应用细胞内记录观察了ＳＰ对ＧＡＢＡ反应的调制作用。结果证明：（１）单独滴加ＳＰ（５×１０（－６）－４×１０（－５）ｍｏｌ／Ｌ）或浴槽灌流ＳＰ（１０（－６）－５×１０（－６）ｍｏｌ／Ｌ）不引起膜电位的改变或仅有轻微的去极化,但却能使ＧＡＢＡ引起的去极化反应减小５０．８±２０．２％（±ＳＤ）（２０／３０）;（２）单独滴加ＳＰ可使多数受检细胞ＡＰＤ５０延长２８．７±９．１％（±ＳＤ）（１０／１８）;（３）在预加ＳＰ后,能使ｂａｃｌｏｆｅｎ所引起的ＡＰＤ５０缩短效应（２０．６±２．９％,±ＳＤ）完全消除（４／１２）或翻转成ＡＰＤ（５０）延长１９．３±８．９％（±ＳＤ）（８／１２）;（４）预加ＧＡＢＡＢ受体激动剂ｂａｃｌｏｆｅｎ（１０（－４）－１０（－３）ｍｏｌ／Ｌ）３０—９０ｓ后明显地抑制ｍｕｓｃｉｍｏｌ（１０－４－１０－３ｍｏｌ／Ｌ）引起的去极化反应,其抑制效应达５４．４±１８．８％（±ＳＤ）（１７／２０）。由于ＤＲＧ神经元的胞体通常可用来作为研究初级传入终末的模型,因而本文实验结果提示：介导伤害性刺激信息的Ｐ物质在背角的释放,可能作用于初级传入终末,从而产生对抗ＧＡＢＡ介导的突触     

用套多聚酶链反应技术监测乙型肝炎病毒的母婴垂直传播

用套式多聚酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）技术对１６９对ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性孕妇及其新生儿外周血清进行了ＨＢＶ－ＤＮＡ检测,１０３对ＨＢｓＡｇ阳性孕妇及其新生儿外周务中ＨＢＶ－ＤＮＡ阳性率分别为７２．８％和３３．０％;６６对ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为８６．４％和４３．９％,对５５例ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性产妇产后     

恩拉霉素抗乙型肝炎病毒的体外实验研究

以ＨｅｐＧ２．２．２．１５细胞株为模型,以其分泌的ＨＢｓＡｇ、ＨＢｅＡｇ、ＨＢＶＤＮＡ及细胞存活率为观察指标,综合评价天然多肽类抗生素恩拉霉素体外抗ＨＢＶ效果。结果表明恩拉霉素对ＨＢｓＡｇ和ＨＢｅＡｇ的５０％抑制浓度ＩＣ５０分别为２７μｇ／ｍＬ和３４μｇ／ｍＬ,治疗指数（ＴＩ）分别为５．９和４．６。Ｓｏｕｔｈｅｒｎ结果显示,５０μｇ／ｍＬ恩拉霉素对细胞内游离ＨＢＶＤＮＡ抑制率为５６．８％。     

用套式多聚酶链反应技术监测乙型肝炎病毒的母婴垂直传播

用套式多聚酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）技术对１６９对ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性孕妇及其新生儿外周血清进行了ＨＢＶ－ＤＮＡ检测。１０３对ＨＢｓＡｇ阳性孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为７２．８％和３３．０％;６６对ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清中ＨＢＶ－ＤＮＡ阳性率分别为８６．４％和４３．９％。对５５例ＨＢｓＡｇ及ＨＢｓＡｇ／ＨＢｅＡｇ阳性产妇产后的初乳进行了ＨＢＶ－ＤＮＡ检测,结果ＨＢＶ－ＤＮＡ阳性率为３６．４％。结果表明ＨＢｓＡｇ和ＨＢｅＡｇ双阳性的孕妇及其新生儿外周血清ＨＢＶ－ＤＮＡ检出率较ＨＢｓＡｇ单阳性的孕妇及其新生儿要高,其初乳中ＨＢＶ－ＤＮＡ的检出率也高。还对１０５例注射了乙肝疫苗及高价乙肝特异性免疫球蛋白的６月龄婴儿的外周血清进行了ＨＢＶ－ＤＮＡ检测,结果有２３例阳性。     

地衣芽孢杆菌碱性蛋白酶的研究：I.碱性蛋白酶高产菌的筛选及产酶条件初探

从成都佳丰食品厂等处采集的样品中平板分离初筛到１２４株碱性蛋白酶产生菌,进一步复筛出一株高产,且稳定的碱性蛋白酶产生菌株Ｂ．Ｌ．ＪＦ－ｌｄ初步鉴定为地衣芽孢杆菌（Ｂａｃｉｌｌｕｓｌｉｃｈｅｎｉｆｏｒｍｉｓ）。该菌的最适产酶条件为：培养基（％）为麦芽糖７．５,酵母膏３,ＮａＣｌ０．５,Ｋ２ＨＰＯ４·３Ｈ２Ｏ０．５３,ＮａＨ２ＰＯ４·２３Ｈ２Ｏ０．０３,Ｎａ２ＣＯ３０．０５６,ＭｎＳＯ４ｌ×１０＾－４     

Intradermal vaccination of adults with three low doses (2 micrograms) of recombinant hepatitis B vaccine. II. Persistence of immunity and induction of immunologic memory

Of the 110 dentists who had presented seroconversion 50 days after the intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine against hepatitis B (HB), administered eight years before at an interval of one month between the 1st and 2nd doses and of five months between the 2nd and 3rd doses, 51 were included for the assessment of the persistence of immunity. None of the dentists had hepatitis or had received HB vaccine during this period. All subjects were submitted to serological tests for the detection of the following markers of hepatitis B virus (HBV) infection: HBsAg, anti-HBc, HBeAg, anti-HBe, and anti-HBs, with no HBsAg, anti-HBc, HBeAg or anti-HBe being detected. A microparticle enzyme immunoassay (MEIA) revealed the presence of anti-HBs at protective titers (> or = 10 mIU/ml) in 42 dentists (82.4%), with the anti-HBs titer being higher than 100 mIU/ml in 36 of them (70.6%) (good responders), between 10 and 100 mIU/ml in 6 (11.8%) (poor responders), and lower than 10 mIU/ml in 9 (17.6%) (non-responders). According to clinical data and serological tests, none of the dentists had presented disease or latent HBV infection during the eight years following the first vaccination. A 2 micrograms booster dose was administered intradermally to eight dentists with anti-HBs titers lower than 10 mIU/ml (non-responders) and to six dentists with titers ranging from 10 to 100 mIU/ml (poor responders); the determination of anti-HBs one month later demonstrated the occurrence of seroconversion in the eight non-responders and an increase in anti-HBs titer in the six poor responders. In summary, the present results demonstrated the prolonged persistence of protection against HBV infection and the development of immunologic memory provided by vaccination against HB--with intradermal application of three 2 micrograms doses of the Belgian recombinant vaccine at 0, 1, and 6 months--carried out eight years before in 51 dentists.     

国产甲型肝炎灭活疫苗用于儿童免疫效果研究

为了探讨国产甲型肝炎灭活疫苗在儿童中应用的免疫效果,选择2～15岁抗-HAV阴性健康易感儿童91名作为接种对象,采用0、6程序接种国产甲型肝炎灭活疫苗250U／剂,观察免疫后的局部反应和全身反应,并于全程免疫后一个月检测抗-HAV阳转率和抗体GMT。结果91例观察对象在初免和加强免疫后均未见即时副反应,只在8～72小时内出现轻微的一过性局部和全身反应。全程免疫后一个月抗-HAV阳转率为100％。抗体GMT为14 407mIU／ml。国产甲肝灭活疫苗在儿童中应用具有良好的安全性和免疫原性,采用0、6个月程序可获得高滴度抗体。     

Observational Study of Vaccine Efficacy 24 Years after the Start of Hepatitis B Vaccination in Two Gambian Villages: No Need for a Booster Dose

Objectives

To determine the duration of protection from hepatitis B vaccine given in infancy and early childhood and asses risk factors for HBV infection and chronic infection.

Methods

In 1984 infant HBV vaccination was started in two Gambian villages. Cross sectional serological surveys have been undertaken every 4 years to determine vaccine efficacy. In the current survey 84.6% of 1508 eligible participants aged 1–28 years were tested. A spouse study was conducted in females (aged 14 years and above) and their male partners.

Results

Vaccine efficacy against chronic infection with hepatitis B virus was 95.1% (95% confidence interval 91.5% to 97.1%), which did not vary significantly between age groups or village. Efficacy against infection was 85.4% (82.7% to 87.7%), falling significantly with age. Concentrations of hepatitis B antibody fell exponentially with age varying according to peak response: 20 years after vaccination only 17.8% (95% CI 10.1–25.6) of persons with a low peak response (10–99 mIU/ml) had detectable HBs antibody compared to 27% (21.9% to 32.2%) of those with a high peak response (>999 mIU/ml). Time since vaccination and a low peak response were the strongest risk factors for HBV infections; males were more susceptible, marriage was not a significant risk for females. Hepatitis B DNA was not detected after infection, which tested soley core antibody positive. An undetectable peak antibody response of <10 mIU/ml and a mother who was hepatitis B e antigen positive were powerful risk factors for chronic infection.

Conclusions

Adolescents and young adults vaccinated in infancy are at increased risk of hepatitis B infection, but not chronic infection. Married women were not at increased risk. There is no compelling evidence for the use of a booster dose of HBV vaccine in The Gambia.     

Immunogenicity of hepatitis B surface antigen derived from the baculovirus expression vector system: a mouse potency study

A standard mouse potency test was performed to evaluate the immunogenicity of recombinant hepatitis B surface antigen (HBsAg) produced in the baculovirus/insect cell expression system. Groups of NIH Swiss mice were immunized with serial four-fold amounts of either baculovirus-derived HBsAg adsorbed to aluminum sulfate or a commercially available yeast-derived recombinant HBsAg vaccine preparation. Results from these experiments showed that the effective dose of baculovirus- and yeast-derived HBsAg vaccine preparations necessary to seroconvert 50% of the animals were similar. The duration of the antibody response to HBsAg was studied in mice immunized with the highest doses of the two recombinant vaccine preparations 3 and 6 months after injection. No decrease in the anti-HBs response was observed 6 months after injection. No decrease in the anti-HBs response was observed 6 months after immunization with either of the two vaccine preparations. These results indicate that the baculovirus-derived recombinant HBsAg could serve as an alternative vaccine candidate for hepatitis B virus.     

甲、乙型肝炎联合疫苗接种恒河猴的初步观察

为了探索联合接种甲乙肝疫苗、实验性甲乙肝联合疫苗免疫恒河猴的安全性及免疫原性。实验中挑选了甲肝抗体阴性,乙肝两对半阴性,肝功能指标正常的健康恒河猴24只,随机分为10组。混合或分别接种,进行不同毒株的甲肝灭活疫苗与不同厂家的乙肝疫苗的配对效果比较。并接种了实验性甲乙肝联合疫苗;史克甲乙肝联合疫苗试验组。设甲肝单价灭活疫苗L8株、深圳乙肝单价疫苗作为对照。免疫方案0、4、24w。每只恒河猴接种lml。接种3d内,每天观察动物有无不良反应。接种1针和2针后4w内,每2w采集空腹静脉血,以后每4w采血1次检测抗HAV、抗HBs、ALT、AST直至40w。接种疫苗后4、8、24、28w穿刺肝组织做病理学检查。结果显示接种疫苗后3d内,所有恒河猴均无不良反应。ALT、AST无异常升高。4、8、24、28w肝组织无特殊病理改变。注射2针后4w,除3组外,其余各组抗HAV及抗HBs均阳转。3组抗HAV阳转时间迟至12w。全程免疫后12w(即40w),抗HAVGMT为258.75～37489.50mIU/ml;抗HBsGMT为8263.68～60008.064mIU/ml。甲乙肝疫苗联合免疫及实验性的甲乙肝联合疫苗接种恒河猴安全性及免疫原性均良好。     

Experience with vaccine prophylaxis of hepatitis B among different groups of children

The immunological activity of different vaccines against hepatitis B was evaluated in the Hepatological Center organized on the basis of the Infectious Hospital in Tula. Newborn infants were immunized with the use of the following vaccines: Engerix B (Belgium), Combiotech (Russia), Euvax B (Aventis Pastèur, South Korea). Altogether, after the full course of immunization anti-HBs were detected in 76 children out of 81 (in 93.8%). Vaccine Engerix B, when introduced according to the schedule 0-1-2-12 months, exhibited high immunogenic properties in a group of infants born of women with persistent HBs-antigenemia. Anti-HBs at a concentration exceeding 1000 I.U./I could be detected in 84.6%. In another group of children immunized according to the schedule 0-1-6 months first with vaccine Combiotech at the age of 0 and 1 month, then (at the age of 6 months) with vaccine Euvax, the presence of postvaccinal anti HBs at protective concentration was registered in all children. After immunization against hepatitis B with the use of all above-mentioned vaccines introduced according to both schedules high immunological activity and safety of immunization were noted.     

低出生体重儿乙肝疫苗免疫持久性与安全性分析

目的:研究低出生体重儿乙肝疫苗免疫持久性与安全性。方法:选择86例低出生体重儿作为研究组,另选取86例正常出生体重儿作为对照组,分别对两组接种全程酵母乙肝疫苗后的抗-HBs阳性率、抗体平均滴度进行检测,并观察不良反应的发生情况。结果:研究组与对照组接种全程乙肝疫苗后3年内的抗-HBs的有效阳性率分别是74%和72.1%(P0.05),抗体平均滴度分别是214.2 mIU/mL与210.8 mIU/mL(P0.05);6年内的抗-HBs的有效阳性率分别是82.6%和81.4%(P0.05),抗体平均滴度分别是178.6 mIU/mL与170.4 mIU/mL(P0.05)。研究组与对照组接种第1针、第2针乙肝疫苗后均未发现发热、体温波动与败血症等不良反应。结论:免疫后数年内,低出生体质量对乙肝疫苗抗体的持久性没有影响,也不影响乙肝疫苗抗体的安全性。     

沪191麻疹疫苗免疫持久性和影响因素的评价

１９９１～１９９８年,我们对荆州区川店镇５０３名６～１５月龄儿童进行了现行沪１９１麻疹疫苗血清流行病学效果观察,结果表明,初次免疫后１个月麻疹ＩｇＧ抗体阳转率为９１６５％,ＧＭＴ为１∶２６６７４,达保护滴度者比例为４６５％。随着时间的推移,第４年上述指标迅速下降到４６８６％、１∶１２７４和１８５％,第６年时低至２９４３％、１∶４８９和１３６％。０２ｍｌ、０３ｍｌ和０５ｍｌ麻疹疫苗组的近期和远期效果是类似的,初免后１个月时ＩｇＧ滴度越高,其免疫持久性越好;初免月龄是影响麻苗免疫效果的主要原因,６月龄初免组的免疫效果明显低于≥８月龄组。结果提示麻苗８月龄初免是可行的。     

抗—HBs国际单位RIA一点法定量测定与计算方法的探讨

在Radio-immuno Assay(RIA)试验测抗－HBs国际单位的简易定量与计算中,采用RIA一点法测定,以分析表达式mIU/ml＝SC（mIU/ml)[exp(0.69315S-NC/SC-NC-1]进行结果计算。此式可以常用对数式表示为mIU/ml=SC(mIU/ml)[lg^-1(0.30103S-NC/SC-NC-1],当（S－NC）在0．3－1．1界线内时,其计算结果的相对误差小于6％,是目前误差最小的简易计算方法。同时还推算求出Holliger公式的阳性对照的最适含量为124．26mIU／ml,Richardson公式的阳性对照为125mIU/ml,中国药品生物制品检定所公式的阳性对照为92．5mIU/ml。     

Immunogenicity of a DNA-recombinant hepatitis B vaccine (Engerix B) given at 3, 5 and 11 months of age with a new schedule suitable for mass vaccination programmes

Following the demonstration of a fully satisfactory immunogenic activity of a hepatitis B vaccination protocol consisting of three doses given at the 3rd and 5th months of age with a booster at 11, it was possible to administer this vaccine at the same times as the vaccinations for diphtheria, tetanus and polio which are mandatory in Italy at those ages. A field trial of this protocol in a hyperendemic area near Naples (prevalence of HBsAg about 14%) started on January 1987. The French vaccine, Hevac B, Pasteur, was used. At this time compliance is 99%, and fully satisfactory results both in terms of seroconversion rate (96.3%) and of mean anti-HBs titre (4,352 mIU/ml) two months after the booster dose have been obtained. In this paper we demonstrate that even for a new hepatitis B vaccine prepared by a DNA-recombinant technique (Engerix B, SK & F) recently introduced in Italy, the same schedule can be used. In fact two doses of this vaccine, the first given at three months of age and the second two months later, resulted in a 100% seroconversion rate and a mean anti-HBs titre of 560 mIU/ml. Two months after the booster given at 11 months of age the mean anti-HBs titre was 12,100.