A comparison of clinical and immunologic features in children and older patients hospitalized with severe cholera in Bangladesh.
A comparison of clinical and immunologic features in children and older patients hospitalized with severe cholera in Bangladesh.
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DOI：
10.1097/inf.0b013e3181783adf
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发表时间：
2008-11
期刊：
影响因子：
--
通讯作者：
Qadri F
中科院分区：
文献类型：
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作者：
Chowdhury F;Khan AI;Harris JB;LaRocque RC;Chowdhury MI;Ryan ET;Faruque AS;Calderwood SB;Qadri F
霍乱弧菌感染可诱导对随后严重疾病的保护，这表明有效的疫苗可能是一种重要的预防策略。现有疫苗对霍乱的保护作用低于自然感染，特别是对儿童。我们对孟加拉国达卡121名儿童（2岁-12岁）和276名老年患者（>12岁）的队列进行了为期4年的研究，以比较老年患者和儿童的临床特征以及对关键抗原的免疫反应。老年患者病情较重。霍乱儿童更常见的是视黄醇缺乏，而锌缺乏在两组中同样普遍。儿童对霍乱毒素B亚单位（CT B）产生了较高的杀弧菌和血清免疫应答。相比之下，老年患者对另外2种关键的霍乱弧菌抗原，脂多糖（LPS）和毒素共调节菌毛抗原（TcpA）产生了更高的免疫应答。我们比较了感染后的免疫反应与接受活的口服疫苗后发生的免疫反应，孟加拉国的儿童和老年患者在类似的时间段内。杀弧菌抗体和LPS抗体的应答率在感染后高于接种后。接种疫苗的老年患者和儿童对CTB和TcpA的反应都很差。虽然儿童在感染后产生了强烈的杀弧菌和CTB特异性反应，但与老年患者相比，他们对LPS和TcpA的反应减少，对疫苗接种的反应也减少。需要进行更多的研究，以确定各种因素，包括可改善儿童对自然感染和疫苗接种的反应的微量营养素干预措施。
Infection with Vibrio cholerae induces protection from subsequent severe disease, suggesting that an effective vaccine could be an important preventive strategy. Available vaccines provide less protection against cholera than natural infection, particularly in children. We examined a cohort of 121 children (2 years-12 years of age) and 276 older patients (>12 years of age) hospitalized with cholera in Dhaka, Bangladesh over a 4-year period, to compare clinical features in older patients and children and immune responses to key antigens. Older patients had more severe disease. Children with cholera were more commonly retinol deficient, while zinc deficiency was equally prevalent in both groups. Children developed higher vibriocidal and serum immune responses to the B subunit of cholera toxin (CTB). In contrast, older patients mounted higher immune responses to 2 other key V. cholerae antigens, the lipopolysaccharide (LPS) and toxin coregulated pilus antigens (TcpA). We compared immune responses following infection with those occurring after receipt of a live, oral vaccine in both children and older patients in Bangladesh, during a similar time period. The response rates for vibriocidal and LPS antibodies were higher after infection than after vaccination. Both vaccinated older patients and children responded poorly to CTB and TcpA. Although children developed vigorous vibriocidal and CTB-specific responses following infection, they had lessened responses to LPS and TcpA compared with older patients, as well as lessened responses to vaccination. More studies need to be carried out to determine factors, including micronutrient interventions that can improve responses in children to both natural infection and vaccination.