Alternative routes of measles immunization: a review
Alternative routes of measles immunization: a review
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DOI：
10.1006/biol.1997.0103
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发表时间：
1997-09-01
期刊：
影响因子：
1.7
通讯作者：
Bennett, JV
中科院分区：
文献类型：
--
作者：
Cutts, FT;Clements, CJ;Bennett, JV
麻疹是发展中国家儿童死亡的主要原因之一，尽管目前通过麻疹疫苗接种方案每年预防了200多万儿童死亡。新的战略，如大规模运动，以及可能的麻疹疫苗的新制剂，可能会促进在控制疾病方面取得进一步进展，并改善其最终根除的前景。为了评估非经皮途径接种疫苗以改善控制的可能性，我们回顾了皮内、结膜、口服、气雾剂和鼻腔给药后对麻疹疫苗的血清学反应的研究。在可以进行此类比较的8例活体研究中，对皮内疫苗的反应只有1例超过经皮结果，通常产生显著较低的血清反应。此外，使用针头和注射器皮内注射比皮下接种更困难。在口服疫苗后，在三项小型研究中，只有不到50%的儿童血清转换。鼻腔给药尚未得到广泛研究，但它可能容易受到上呼吸道感染的干扰。结膜注射后的血清转换是非常不稳定的，这一途径在幼儿中是困难的。在9个月以下的婴儿中，雾化注射疫苗在9个试验中有7个导致80%或更好的血清反应，标准滴度剂量的埃德蒙斯顿-萨格勒布菌株始终产生比施瓦茨菌株更好的结果。然而，皮下注射后的血清反应在六个比较中的四个明显超过相同疫苗的气雾剂。几项试验指出，在婴幼儿中使用气雾剂存在实际困难。相比之下，无论疫苗菌株如何，较大的血清阴性儿童对气雾剂疫苗的反应通常都很好(超过90%，通常为100%)，而且估计保留剂量往往低得令人惊讶。在三项研究中的每一项中，都可以将相同的疫苗经皮注射和气雾剂注射给血清阳性的儿童进行比较，气雾剂的血清反应更好。在年龄较大的儿童中，埃德蒙斯顿-萨格勒布菌株的气雾剂也相当一致地比施瓦茨菌株的气雾剂提供更好的血清反应，在血清阳性的儿童中差异最显著。因此，除了非常年轻的婴儿可能例外，气雾剂路线是有希望的，也提供了几个理论和实践上的优势。应该进行进一步的随机试验来评估雾化疫苗、鼻腔疫苗和皮下疫苗的比较反应，特别是在那些针对大规模宣传活动的年龄段(通常是9个月到15岁)。改进的麻疹疫苗气雾剂输送技术的发展将极大地促进这一途径的广泛使用，特别是在低收入国家的大规模运动中。(C)1997年国际生物标准化协会。
Measles is one of the major causes of childhood mortality in developing countries, despite current prevention of over 2 million child deaths each year by measles vaccination programmes. New strategies, such as mass campaigns, and possibly new preparations of measles vaccines, may facilitate further progress in controlling the disease and improving the prospects for its ultimate eradication. To evaluate the potential for non-percutaneous routes of vaccine administration to improve control, we reviewed studies of serological responses to measles vaccine after intradermal, conjunctival, oral, aerosol and intranasal administration.The response to intradermal vaccination exceeded percutaneous results in only one of eight instances in live studies where such comparisons could be made, often producing substantially lower seroresponses. Further, intradermal administration using a needle and syringe is more difficult than subcutaneous vaccination. Alter oral administration of vaccine, less than 50% of children seroconverted in three small studies. Intranasal administration has not been studied extensively, but it may be susceptible to interference by upper respiratory infections. Seroconversion after conjunctival administration was very variable, and this route was difficult practically in young children.In infants below 9 months of age, aerosol administration of vaccine resulted in 80% or better seroresponse in seven of nine trials, with the Edmonston-Zagreb strain in standard titre doses consistently producing better results than the Schwarz strain. However, seroresponses after subcutaneous administration clearly exceeded those from aerosols of the same vaccine in four of six comparisons. Several trials noted practical difficulties in aerosol administration in young infants in contrast, older seronegative children generally responded well to aerosol administration of vaccine (above 90% and often 100% seroresponse), regardless of vaccine strain and often with surprisingly low estimated retained doses. In each of three studies where it was possible to compare the same vaccines given percutaneously and by aerosol to seropositive children, better seroresponses followed aerosols. In older children, aerosols of the Edmonston-Zagreb strain also rather consistently provided better seroresponses than aerosols of the Schwarz strain, with the most notable differences in seropositive children. Thus; with the possible exception of very young infants, the aerosol route is promising and offers several theoretical and practical advantages as well.Further randomized trials should be conducted to evaluate comparative responses to aerosolized, intranasal, and subcutaneous vaccine, especially in those age ranges targeted for mass campaigns (most commonly 9 months to 15 years). The development of improved technology for aerosol delivery of measles vaccine would greatly advance the potential for wide scale use of this route, especially in mass campaigns in low income countries. (C) 1997 The international Association of Biological Standardization.