Wassermann
Wassermann
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瓦瑟曼
DOI：
10.1136/bmj.1.5485.436
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发表时间：
1966
影响因子：
--
通讯作者：
Marie
中科院分区：
文献类型：
--
作者：
Julien Rouzot;Julien Ferry;Marie
在英国，在决定最合适的麻疹免疫接种方法时，应考虑两个主要因素。首先，任何反应的严重程度必须在可接受的低水平。在这个国家，麻疹一般是一种轻微的疾病，虽然经常发生并发症，但其中许多可以通过抗生素治疗来解决。这种疾病不能被认为是严重到足以证明疫苗接种程序是合理的，因为疫苗接种程序会在很大比例的儿童中引起不良反应。其次，接种疫苗应产生足够的长期免疫力。用几年后就会消失的免疫力来取代麻疹自然发作后的终身免疫力是没有意义的。这可能只会导致疾病转移到以后的生活中，当它往往更严重。有人可能会说，即使没有建立起长期的免疫力，对易感年龄组的大部分儿童进行大规模疫苗接种，这种疾病也可以得到充分的控制，而且，如果病毒已经从社区中消除，以后的生活也会得到保护。但是依靠这种方式控制麻疹是冒着相当大的风险的。麻疹是一种传染性很强的疾病，如果麻疹传入一个社区，而该社区的成员已经有一段时间没有麻疹，尽管以前已经免疫，但可能已经失去了免疫力，则可能导致大规模爆发。目前医学研究理事会试验中使用的免疫程序如何满足这些需求？该试验包括两种不同的疫苗-单独的施瓦茨减毒活疫苗，以及一个月后接种活疫苗的单剂量灭活疫苗。在10个月至2岁的高度易感年龄组的儿童参加了研究，并在1964- 1965年麻疹流行期间进行了为期6个月的随访。大约10 000名儿童被分配到每个计划中，大约16 000名儿童仍然没有接种疫苗，作为对照。结果发现，在接种后三周内，单独接种活疫苗比接种灭活疫苗导致更多的疾病，但总的来说，大多数儿童仍然很好，或者只有轻微的抱怨。但是，在接种疫苗的两组儿童和未接种疫苗的儿童中，都有少数热性惊厥病例，从发病时起，似乎活疫苗单独接种时是其中一些病例的原因，而不是在接种一剂灭活疫苗后接种。然而，报告认为，这种热性惊厥在这个年龄的儿童中并不严重，并指出麻疹发作引起惊厥的危险要大得多。一般而言，从结果来看，就接种反应而言，两种方案都是可接受的，尽管灭活疫苗后接种活疫苗比单独接种活疫苗略具优势。至于免疫活性，试验表明，在6个月的随访期间，两种方案都实现了实质性保护（约85%）。还有证据表明，接种疫苗的儿童患麻疹的症状平均比未接种疫苗的儿童轻。这些结果令人鼓舞，但只有85%的儿童受到保护的事实必须引起一些疑虑。此外，麻疹发作后会留下终身免疫力，除非这种程度的免疫力，或接近这种程度的免疫力，可以通过人工手段复制，否则接种麻疹疫苗可能只会将疾病推迟到成年，弊大于利。当本试验中的儿童通过一次或两次进一步的流行病进行随访时，无疑将获得更多的信息。但是，在我们知道疫苗的潜力之前，在我们通过进一步的实地试验了解如何最好地在实践中应用疫苗以获得高的个体和高的群体免疫力之前，似乎有充分的理由推迟英国全国范围内的儿童常规免疫接种。
In deciding on the most suitable method to use in immunizing against measles in Britain two main factors should be considered. First, any reactions must be of an acceptably low degree of severity. Measles in this country is in general a mild disease, and though complications often occur19 many of them can be dealt with by antibiotic treatment. The disease cannot be regarded as serious enough to justify a vaccination procedure which causes untoward reactions in a high proportion of children. Secondly, vaccination should produce an adequate immunity of long duration. There is little point in replacing the life-long immunity which follows a natural attack of measles by an immunity which fades away after a few years. This might merely result in shifting the disease to later in life, when it is often more serious. It may be argued that, even though an immunity of long duration was not established, the disease could be adequately controlled by mass vaccination of a high proportion of children in the susceptible age groups, and that protection in later life would result from the virus having been eliminated from the community. But to depend on controlling measles in this way is taking a considerable risk. Measles is a highly infectious disease, and its introduction into a community whose members have been free of it for some time, and, though previously immunized, may have lost their immunity, could result in a large outbreak. How do the immunization procedures used in the present Medical Research Council trial stand up to these needs ? The trial has included two different schedules-the Schwarz attenuated live vaccine alone, and a single dose of killed vaccine followed one month later by live vaccine. Children in the highly susceptible age group of 10 months to 2 years took part and were followed up for six months through the measles epidemic of 1964-5. About 10,000 children were allocated to each schedule and about 16,000 remained unvaccinated, serving as controls. It was found that the live vaccine alone resulted in more illness during the three weeks after vaccination than when it was preceded by killed vaccine, but that on the whole the majority of children remained well or had only trivial complaints. But there were a few cases of febrile convulsions in both groups of vaccinated children and also in the unvaccinated group, and it appeared, from the time of their onset, that live vaccine was responsible for some of them when given alone but not when given after a dose of killed vaccine. However, the report considers that such febrile convulsions are not serious in children of this age and also points out that there is a much greater risk of convulsions from an attack of measles. In general it would appear from the results that both schedules are acceptable so far as vaccination reactions are concerned, though killed vaccine followed by live vaccine had a slight advantage over live vaccine given alone. As to immunizing activity, the trial showed that substantial protection (about 85%) was achieved by both schedules during the six months' follow-up. There was also evidence that measles when it occurred in vaccinated children was on the average of a milder form than in those who had not been vaccinated. These results are encouraging, but the fact that only 85% of the children were protected must arouse some misgiving. Moreover, an attack of measles leaves behind it immunity for life, and unless this degree of immunity, or something closely approaching it, can be reproduced by artificial means vaccination against measles may merely have the effect of postponing the disease to adult life and doing more harm than good. More information will doubtless be available when the children in the present trial have been followed up through one or two further epidemics. But until we know what the potentialities of the vaccines are, and until we learn by further field trials how best to apply the vaccines in practice so as to obtain both a high individual and a high herd immunity, there seems every reason to postpone routine immunization of children in Britain on a national scale.