Bordetella pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized acellular pertussis vaccine trial (APERT)
Bordetella pertussis infections in vaccinated and unvaccinated adolescents and adults, as assessed in a national prospective randomized acellular pertussis vaccine trial (APERT)
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DOI：
10.1086/504803
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发表时间：
2006-07-15
影响因子：
11.8
通讯作者：
Edelman, Robert
中科院分区：
文献类型：
--
作者：
Ward, Joel I.;Cherry, James D.;Edelman, Robert
背景。建议青少年和老年人进行无细胞百日咳 (aP) 加强免疫，以增强长期保护并可能减少感染的社区传播。方法。这是一项多中心、随机、双盲疫苗试验，其中一半受试者接种了 aP 疫苗，一半受试者接种了甲型肝炎疫苗（对照受试者）。所有受试者都接受了近两年的咳嗽疾病观察，并接受了微生物学和血清学研究以检测百日咳感染。通过酶联免疫吸附测定法，在免疫后 1 个月和 12 个月获得的血清样本中测定针对百日咳毒素、丝状血凝素、百日咳杆菌粘附素和菌毛 2/3 的免疫球蛋白 G (IgG) 和免疫球蛋白 A (IgA) 抗体。根据对照和接种疫苗受试者的各种血清学标准确定感染率。确定有和没有感染血清学证据的受试者的长期咳嗽病的发生率。结果。对照受试者的感染率特别代表未免疫成人的感染率。在对照组中，0.4% - 2.7%的人在一年内出现各种类型和程度的百日咳抗体增加，20% - 46%的人在此期间患有长期咳嗽病。百日咳毒素抗体对于检测抗体水平的增加具有最大的特异性。无症状感染的发生率比符合严格临床和微生物学病例定义的临床疾病高出 5 倍。相对于对照受试者，aP 免疫受试者的抗体水平（即感染）增加可能较少，特别是针对菌毛 2/3 的抗体（疫苗中没有的抗原）。结论。老年人的百日咳感染大多无症状。 aP 加强剂可为青少年和成人提供针对有症状百日咳的保护，并可能针对轻度和无症状感染提供保护，并且使用加强剂可减少向其他人（尤其是婴儿）的传播。
Background. Acellular pertussis ( aP) booster immunizations have been recommended for adolescents and older persons to enhance long-term protection and to possibly reduce community transmission of infections.Methods. This was a multicenter, randomized, double-blind vaccine trial in which one-half of the subjects received aP vaccine and one-half received hepatitis A vaccine ( control subjects). All subjects were observed for almost 2 years for cough illnesses, and all underwent microbiologic and serologic studies for detection of pertussis infection. Immunoglobulin G ( IgG) and immunoglobulin A ( IgA) antibodies to pertussis toxin, filamentous hemagglutinin, pertactin, and fimbriae 2/3 were measured by enzyme-linked immunosorbent assay in serum samples obtained 1 and 12 months after immunization. Infection rates were determined with a variety of serologic criteria for control and vaccinated subjects. The incidence of prolonged cough illness was ascertained for subjects with and subjects without serologic evidence of infection.Results. Infection rates among control subjects are particularly representative of those in nonimmunized adults. Among control subjects, 0.4% - 2.7% had increases in pertussis antibody of various types and degrees over 1 year, and 20% - 46% had prolonged cough illnesses during this interval. Pertussis toxin antibody had the greatest specificity for detecting increases in antibody levels. Asymptomatic infections were similar to 5 times more common than clinical illnesses that met a strict clinical and microbiologic case definition. Relative to control subjects, aP-immunized subjects may have fewer increases in the antibody level ( i.e., infections), especially for antibodies to fimbriae 2/3 ( an antigen not in the vaccine).Conclusions. Pertussis infections in older persons are largely asymptomatic. aP boosters confer protection for adolescents and adults against symptomatic pertussis and likely confer protection against mild and asymptomatic infections, and use of boosters may reduce transmission to others, especially infants.