Immunogenicity of BCG in HIV-exposed and non-exposed infants following routine birth or delayed vaccination.
Immunogenicity of BCG in HIV-exposed and non-exposed infants following routine birth or delayed vaccination.
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DOI：
10.5588/ijtld.14.0608
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
Walzl G
中科院分区：
文献类型：
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作者：
Hesseling AC;Jaspan HB;Black GF;Nene N;Walzl G
暴露于人类免疫缺陷病毒（HIV）的婴儿暴露于结核分枝杆菌的风险较高，进展为结核病（TB）的比率较高，并且存在卡介苗（BCG）诱导的不良事件的显著风险。评估HIV暴露婴儿的延迟卡介苗接种策略。一项随机试验，在HIV暴露的未感染和未暴露的婴儿中比较出生时与14周龄时常规接种BCG，以使用7天全血干扰素-γ（IFN-γ）酶联免疫吸附试验研究BCG诱导的纵向免疫应答。婴儿对M有阳性反应的比例明显较高。出生组与延迟接种组在14周时的结核纯化蛋白衍生物（PPD）和BCG（P = 0.001）。这种差异在第24周或第52周时不再明显。在出生时接种疫苗的婴儿中，14周的IFN-γ对M.结核病PPD在HIV暴露婴儿中低于非暴露婴儿（276.5 pg/ml vs. 790.2，P = 0.048）。在所有婴儿中，IFN-γ对BCG、M.结核PPD，TB 10.4和培养滤液蛋白10/早期分泌抗原靶标6。接种时间对BCG诱导的IFN-γ应答的影响有限，尽管两个接种组的初始应答都很强，但1年后IFN-γ应答显著减弱。HIV暴露的未感染婴儿的较低反应表明生命早期可能改变了分枝杆菌免疫力。
Human immunodeficiency virus (HIV) exposed infants are at high risk of Mycobacterium tuberculosis exposure, have high rates of progression to tuberculosis (TB) disease and are at significant risk of bacille Calmette-Guérin (BCG) induced adverse events. To evaluate a delayed BCG vaccination strategy in HIV-exposed infants. A randomised trial of routine BCG vaccination given at birth compared to 14 weeks of age in HIV-exposed non-infected and non-HIV-exposed infants to investigate longitudinal BCG-induced immune responses using a 7-day whole blood interferon-gamma (IFN-γ) enzyme-linked immunosorbent assay. A significantly higher proportion of infants had positive responses to M. tuberculosis purified protein derivative (PPD) and BCG at 14 weeks in the birth vs. delayed vaccination groups (P = 0.001 for both). This difference was no longer apparent at weeks 24 or 52. Among infants vaccinated at birth, the 14-week IFN-γ response to M. tuberculosis PPD was lower among HIV-exposed than non-exposed infants (276.5 pg/ml vs. 790.2, P = 0.048). Among all infants, there were significant correlations between the magnitude of IFN-γ responses to BCG, M. tuberculosis PPD, TB 10.4 and culture filtrate protein 10/early secreted antigenic target 6. The timing of vaccination had limited effect on BCG-induced IFN-γ responses, which waned considerably over 1 year despite initial vigorous responses in both vaccination groups. The lower responses in HIV-exposed non-infected infants suggest potentially altered mycobacterial immunity early in life.