The Yin and Yang of the Non-Specific Effects of Vaccines.
The Yin and Yang of the Non-Specific Effects of Vaccines.
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DOI：
10.1016/j.ebiom.2017.08.008
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发表时间：
2017-09
期刊：
影响因子：
11.1
通讯作者：
Cose S
中科院分区：
文献类型：
--
作者：
Cose S
疫苗的非特异性效应（NSE）是指特定疫苗的任何其他效应，而不是特定疫苗接种减少疾病的预期效应。近年来，这一公共卫生领域受到了大量关注，双方的论点都表明疫苗对NSE有利或有害。那么，这一切是从哪里开始的，这一切意味着什么，以及目前的研究如何有助于我们理解这个复杂而情绪化的问题？疫苗NSE的一些第一批证据来自几内亚比绍的一个研究小组，该小组研究将高滴度麻疹病毒引入WHO的扩大免疫规划（EPI）疫苗计划（Aaby et al.，1993 a; Aaby等人，1993年c）。作者进行了一项随机对照试验，以确定在4-6个月时给予高滴度麻疹病毒（MV）是否与9个月时常规给予的标准MV剂量一样有效。确实如此，但随后的研究指出，给予高滴度MV疫苗的婴儿的死亡率高出两倍，并且这种效果仅在女孩中观察到，而在男孩中没有观察到（Aaby等人，1993年b）。值得注意的是，这两种MV疫苗都是减毒活疫苗。随后的分析（Aaby等人，2003）表明，与高滴度MV相关的性别特异性死亡率不是由于MV疫苗本身，而是由于后来接种了非活疫苗，如白喉/百日咳/破伤风（DPT）联合疫苗。最近，同一小组重新分析了最近开发的非活疫苗，抗疟疾疫苗RTS，S的存活数据（Klein et al.，2016年）。本分析中提供的数据还表明，如果您接种的最后一种疫苗是非活疫苗（例如DPT或RTS，S），那么接种这些疫苗的女性的死亡率高于接种活疫苗作为最后一种疫苗的女性。在男性中，任何疫苗似乎都没有有害的NSE。但事情并不像看起来那么糟糕。来自几内亚比绍的同一小组已经表明，如果在出生时给予体重不足的婴儿另一种活疫苗BCG，则在生命的前四周内全因死亡率显著降低（Aaby等人，2011年）。其他人已经表明BCG在给予流感疫苗接种的成人中赋予非特异性益处（Leentjens等人，2015），可能在被称为“训练的先天免疫”的过程中（Saeed et al.，2014年）。目前尚不清楚非活疫苗的有害作用如何干扰活疫苗的有益作用，但需要更清楚地了解这些现象。
The Non-Specific Effects (NSE) of vaccines refers to any other effect of a given vaccine, other than the intended effect of reducing disease from the specific vaccination. This area of public health has received a large amount of attention in recent years, with arguments on both sides suggesting that vaccines have either beneficial or detrimental NSE. So, where did it all start, what does it all mean and how does the present study contribute to our understanding of this complex and emotive issue?Some of the first evidence of the NSE of vaccines came from a group in Guinea-Bissau studying the introduction of a high titer measles virus into the WHO's Expanded Programme on Immunization (EPI) vaccine schedule (Aaby et al., 1993a; Aaby et al., 1993c). The authors conducted a randomised controlled trial to determine if high titer measles virus (MV), given at 4–6 months, was as effective as the standard MV dose that was being routinely given at 9 months of age. It was, but subsequent studies noted that there was a twofold higher mortality rate in infants given the high titer MV vaccine, and that this effect was seen only in girls, and not boys (Aaby et al., 1993b). It is important to note that both of the MV vaccines are live, attenuated vaccines. Subsequent analysis (Aaby et al., 2003) suggested that the sex-specific mortality associated with high titer MV was due, not to the MV vaccine itself, but the later administration of non-live vaccines, such as the combination vaccine Diphtheria/Pertussis/Tetanus (DPT). Recently, the same group has reanalysed survival data from a more recently developed non-live vaccine, the anti-malarial vaccine, RTS, S (Klein et al., 2016). The data presented in this analysis would also suggest that if the last vaccine you are given is a non-live vaccine (DPT or RTS, S for example), then there is a higher mortality rate in females receiving these vaccines than if you were given a live vaccine as the last vaccine. There appears to be no deleterious NSE for any vaccine in males. But things are not as bad as they seem. The same group from Guinea-Bissau has shown that if another live vaccine, BCG, is given at the time of birth to underweight babies, there is a significant decrease in all-cause mortality in the first four weeks of life (Aaby et al., 2011). Others have shown that BCG confers a non-specific benefit in adults given influenza vaccination (Leentjens et al., 2015), likely in a process known as “trained innate immunity”(Saeed et al., 2014). It is not currently clear how the deleterious effects of non-live vaccines interrupt the beneficial effects of live vaccines, but more clearly needs to be done to understand these phenomena.
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影响因子：
6.4
作者：
Leentjens, Jenneke;Kox, Matthijs;Netea, Mihai G.
通讯作者：
Netea, Mihai G.
DOI：
10.1126/science.1251086
发表时间：
2014-09-26
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Saeed S;Quintin J;Kerstens HH;Rao NA;Aghajanirefah A;Matarese F;Cheng SC;Ratter J;Berentsen K;van der Ent MA;Sharifi N;Janssen-Megens EM;Ter Huurne M;Mandoli A;van Schaik T;Ng A;Burden F;Downes K;Frontini M;Kumar V;Giamarellos-Bourboulis EJ;Ouwehand WH;van der Meer JW;Joosten LA;Wijmenga C;Martens JH;Xavier RJ;Logie C;Netea MG;Stunnenberg HG
通讯作者：
Stunnenberg HG
影响因子：
5.1
作者：
AABY, P;KNUDSEN, K;DASILVA, MC
通讯作者：
DASILVA, MC
影响因子：
5
作者：
AABY, P;SAMB, B;WHITTLE, H
通讯作者：
WHITTLE, H
影响因子：
--
作者：
AABY, P;ANDERSEN, M;FERNANDES, M
通讯作者：
FERNANDES, M