EFFICACY OF AN INFLUENZA HEMAGGLUTININ DIPHTHERIA TOXOID CONJUGATE VACCINE IN ELDERLY NURSING-HOME SUBJECTS DURING AN INFLUENZA OUTBREAK
EFFICACY OF AN INFLUENZA HEMAGGLUTININ DIPHTHERIA TOXOID CONJUGATE VACCINE IN ELDERLY NURSING-HOME SUBJECTS DURING AN INFLUENZA OUTBREAK
复制标题
DOI：
10.1111/j.1532-5415.1994.tb01746.x
复制
发表时间：
1994-03-01
影响因子：
6.3
通讯作者：
ERSHLER, WB
中科院分区：
文献类型：
--
作者：
GRAVENSTEIN, S;DRINKA, P;ERSHLER, WB
目的：比较流感血凝素-白喉圆环结合疫苗与市售流感血凝素亚单位疫苗预防居住在养老院的老年人流感的有效性。设计：一项前瞻性、随机、双盲疫苗试验，接种后随访5个月。设置：14个威斯康星州养老院。参与者：养老院居民至少65岁，能够提供知情同意书，没有恶性肿瘤，没有接受免疫抑制治疗。干预措施：参与者通过肌肉注射接受0.5公吨三价流感疫苗，每种疫苗含有15 μ g A/Leningrad/360/86（H3 N2），A/Taiwan/1/86（H1N1）和B/安阿伯/1/86（HA）或0.5 mt含有与白喉环偶联的相同抗原的流感疫苗（HA-D）。对呼吸道疾病进行临床监测，每周两次，持续5个月。新的呼吸道疾病的所有体征和症状的记录，和病毒培养和急性和恢复期血清obtained.Results：204名参与者接受HA和204收到HA-D。两组对所有流感抗原的基线抗体水平相似。基于血清中和活性，HA-D受体的血清转化率更高（P < 0.05），几何平均滴度（GMT）增加更大，抗体滴度持续增加的时间长于HA受体。淋巴细胞增殖试验表明，HA-D受体的疫苗血凝素回忆率较高（P < 0.05）。在甲型流感爆发期间（H3 N2 A/Shanghai/11/87-like和A/维多利亚/7/87-like），HA-D（29/195）比HA（43/204）接受者更少有实验室确认的感染（P = 0.053），其中，HA-D治疗受试者较少发生下呼吸道受累结论：HA-D在机构老年受者中具有更强的免疫原性，对流感感染具有更强的保护作用。上级保护可能是由于HA-D刺激和募集抗原呈递细胞的能力，从而使受体能够实现和维持功能性抗体滴度。
Objective: To compare the efficacy of an influenza hemagglutinin-diphtheria toroid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home.Design: A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination.Setting: Fourteen Wisconsin nursing homes.Participants: Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy.Interventions: Participants received, by intramuscular injection, 0.5 mt of a trivalent influenza vaccine containing 15 mu g each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mt of an influenza vaccine containing the same antigens conjugated to diphtheria toroid (HA-D).Measurements: Blood was obtained pre- and 1 month postvaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained.Results: 204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022).Conclusions: HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.