Is susceptibility to severe infection in low-income countries inherited or acquired?
Is susceptibility to severe infection in low-income countries inherited or acquired?
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DOI：
10.1111/j.1365-2796.2006.01742.x
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发表时间：
2007-02-01
影响因子：
11.1
通讯作者：
Aaby, P.
中科院分区：
文献类型：
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作者：
Aaby, P.
从低收入国家的角度来看，我们需要强调影响对严重感染的后天易感性的因素。这些因素可以通过公共卫生干预措施加以改变。本文件回顾了几内亚比绍28年来了解严重麻疹感染原因和卫生干预措施影响的经验。在1970年代，营养不良导致的后天易感性被认为是高死亡率的主要原因。然而，我们发现营养状况与随后死于麻疹的风险之间没有联系。相反，拥挤和暴露强度是严重麻疹的主要决定因素。麻疹、水痘、百日咳和小儿麻痹症的传播因素已得到证实。我们发现麻疹疫苗接种与死亡率的大幅下降有关，特别是对女孩而言。提示麻疹疫苗具有良好的非靶向免疫刺激作用。当世界卫生组织引进一种新的高滴度麻疹疫苗（HTMV）时，非靶向效应的重要性得到了明确的证明。HTMV是完全保护，但与女孩的死亡率高一倍。卡介苗（BCG）、白喉-破伤风-百日咳（DTP）和口服脊髓灰质炎疫苗（OPV）也显示出非靶向效应，该效应对BCG和OPV有益，但对DTP呈阴性。对女孩来说，有利和不利的影响都最强烈。有许多后天因素影响感染的易感性，其方式尚未被医学科学探索。它们可能对低收入国家的儿童生存产生重大影响。
From a low-income country perspective, we need to emphasize factors which affect acquired susceptibility to severe infection. Such factors may lend themselves to modification by public health interventions. The present paper reviews the experience with understanding the causes of severe measles infection and the impact of health interventions in Guinea-Bissau over a 28-year period. In the 1970s, acquired susceptibility because of malnutrition was considered to be the main cause of high mortality. However, we found no association between nutritional status and subsequent risk of dying of measles. Instead, crowding and intensity of exposure were the main determinants of severe measles. Factors related to transmission have been substantiated for measles, chickenpox, whooping cough and polio. We found measles vaccination to be associated with a major reduction in mortality, particularly for girls. This suggested that measles vaccine has a beneficial nontargeted immune stimulatory effect. The importance of nontargeted effects was clearly documented when World Health Organization introduced a new high-titre measles vaccine (HTMV). HTMV was fully protective but associated with twofold higher mortality for girls. Bacille Calmette Guerin (BCG), diphtheria-tetanus-pertussis (DTP) and oral polio vaccine (OPV) have also shown nontargeted effects, the effect being beneficial for BCG and OPV but negative for DTP. Both beneficial and negative effects are strongest for girls. There are many acquired factors, which affect susceptibility to infection in ways which have not been explored by medical science. They may have a major impact on child survival in low-income countries.