脊髓灰质炎疫苗的免疫规划程序,接种?口服?

创作:张玲 审核:Epi汪 01月11日
纳入152例婴儿,总体上分为接种三价灭活脊髓灰质炎疫苗后口服二价脊灰疫苗(IPV-bOPV),以及单纯IPV免疫组;
IPV-bOPV组和单纯IPV组分别有37%和26%的婴儿在初免后粪便中检出针对2型脊灰病毒的特异性抗体;
口服脊灰疫苗后,二组均可快速诱导出肠道免疫应答,2周后抗体滴度及免疫球蛋白A浓度明显升高;
母乳喂养的时间与婴儿脊灰疫苗免疫情况相关;
脊灰病毒的粘膜和全身免疫是独立的,不同的免疫规划方案对脊灰的作用值得进一步研究。
延伸阅读

Intestinal Immunity to Poliovirus Following Sequential Trivalent Inactivated Polio Vaccine/Bivalent Oral Polio Vaccine and Trivalent Inactivated Polio Vaccine-only Immunization Schedules: Analysis of an Open-label, Randomized, Controlled Trial in Chilean Infants

接种三价灭活脊髓灰质炎疫苗后序贯口服二价脊髓灰质炎疫苗 vs. 仅接种三价灭活脊髓灰质炎疫苗,对脊髓灰质炎病毒肠道免疫的影响:在智利婴儿中开展的一项非盲、随机、对照临床试验的分析

2018-10-30, Article, 10.1093/cid/ciy603more

Abstract:
Background: Identifying polio vaccine regimens that can elicit robust intestinal mucosal immunity and interrupt viral transmission is a key priority of the polio endgame.
Methods: In a 2013 Chilean clinical trial (NCT01841671) of trivalent inactivated polio vaccine (IPV) and bivalent oral polio vaccine (bOPV; targeting types 1 and 3), infants were randomized to receive IPV-bOPV-bOPV, IPV-IPV-bOPV, or IPV-IPV-IPV at 8, 16, and 24 weeks of age and challenged with monovalent oral polio vaccine type 2 (mOPV2) at 28 weeks. Using fecal samples collected from 152 participants, we investigated the extent to which IPV-bOPV and IPV-only immunization schedules induced intestinal neutralizing activity and immunoglobulin A against polio types 1 and 2.
Results: Overall, 37% of infants in the IPV-bOPV groups and 26% in the IPV-only arm had detectable type 2-specific stool neutralization after the primary vaccine series. In contrast, 1 challenge dose of mOPV2 induced brisk intestinal immune responses in all vaccine groups, and significant rises in type 2-specific stool neutralization titers (P < .0001) and immunoglobulin A concentrations (P < 0.0001) were measured 2 weeks after the challenge. In subsidiary analyses, duration of breastfeeding also appeared to be associated with the magnitude of polio-specific mucosal immune parameters measured in infant fecal samples.
Conclusions: Taken together, these results underscore the concept that mucosal and systemic immune responses to polio are separate in their induction, functionality, and potential impacts on transmission and, specifically, provide evidence that primary vaccine regimens lacking homologous live vaccine components are likely to induce only modest, type-specific intestinal immunity.

First Authors:
Elizabeth B Brickley

Correspondence Authors:
Peter F Wright

All Authors:
Elizabeth B Brickley,Wendy Wieland-Alter,Ruth I Connor,Margaret E Ackerman,Austin W Boesch,Minetaro Arita,William C Weldon,Miguel G O'Ryan,Ananda S Bandyopadhyay,Peter F Wright