Vaccination of cystic fibrosis patients against Pseudomonas aeruginosa reduces the proportion of patients infected and delays time to infection
Vaccination of cystic fibrosis patients against Pseudomonas aeruginosa reduces the proportion of patients infected and delays time to infection
复制标题
DOI：
10.1097/01.inf.0000129688.50588.ac
复制
发表时间：
2004-06-01
影响因子：
3.6
通讯作者：
Schaad, UB
中科院分区：
文献类型：
--
作者：
Lang, AB;Rüdeberg, A;Schaad, UB
简介：囊性纤维化（CF）几乎总是导致铜绿假单胞菌的慢性气道感染。尽管抗生素治疗取得了进展，但慢性感染后肺功能迅速恶化，发病率和死亡率增加。通过接种疫苗预防感染是可取的，但早期的试验结果令人失望。新的铜绿假单胞菌疫苗的有希望的短期免疫原性和安全性促使我们评估其长期有效性。我们进行了10年的回顾性分析的结果在一组接种patients.Materials和方法：在1989年至1990年，30岁的儿童CF，平均年龄7岁，以前没有感染铜绿假单胞菌的历史，接种铜绿假单胞菌与多价结合疫苗。我们报告了1989年至2001年随访的26例患者。这些病人每年都接受疫苗加强剂。与CF患者对照组进行了性别，年龄和（如果可能的话）基因突变的比较。接种疫苗的患者和对照组在同一个CIF诊所就诊，并在整个研究期间接受相同的临床管理。结果：接种组感染铜绿假单胞菌的时间比对照组长，接种组慢性感染的患者比对照组少（32%比72%; P < 0.001）。对照组（44%）中粘液感染的比例高于接种组（25%）。病人！研究结束时，18岁的受试者的1秒用力呼气容积（FEV 1）平均值低于13-17岁的受试者，但与对照组（48.0% vs 78.7%）相比，接种组（73.6% vs 83.7%）的差异较小。在18岁年龄组中，10岁时的平均FEV1%为73.6%（接种疫苗组）和48.0%（对照组）（P < 0.05）。在接种疫苗组中，25名患者中只有11名（44%）在10年随访时体重不足，而研究开始时25名患者中有18名（72%）体重不足。在对照组中，17（68%）的25例患者体重不足，在10年的随访相比，16（64%）的25在开始的study.Conclusion：定期接种的年轻CF患者的一段时间为10年的多价结合疫苗减少了慢性感染铜绿假单胞菌的频率。这与更好地保护肺功能有关。在研究期间，接种疫苗的患者体重增加更多，这可能表明整体健康状况有所改善。
Introduction: Cystic fibrosis (CF) almost always leads to chronic airway infection with Pseudomonas aeruginosa. Despite advances in antibiotic therapy, after chronic infection rapid deterioration in lung function occurs, increasing morbidity and mortality. Prevention of infection by vaccination is desirable, but earlier trials produced disappointing results. The promising short term immunogenicity and safety of a new P. aeruginosa vaccine prompted us to evaluate its long term efficacy. We conducted a 10-year retrospective analysis of outcomes in a group of vaccinated patients.Materials and Methods: In 1989-1990, 30 young children with CF, mean age 7 years, with no prior history of infection with P. aeruginosa, were vaccinated against P. aeruginosa with a polyvalent conjugate vaccine. We report the follow-up of 26 of these patients from 1989 to 2001. The patients were given yearly vaccine boosters. Comparisons were made with a CF patient control group matched for gender, age and, where possible, genetic mutation. Vaccinated patients and controls were attending a single CIF clinic and received the same clinical management throughout the study period. Main outcomes were time to infection, proportion of patients infected, development of P. aeruginosa mucoid phenotype, lung function and body weight.Results: The time to infection with P. aeruginosa was longer in the vaccination group than in the control group, and fewer vaccinated patients than controls became chronically infected (32% versus 72%; P < 0.001). The proportion of mucoid infections was higher in the control group (44%) than in the vaccinated group (25%). Patients ! 18 years of age at the end of the study had a lower mean forced expiratory volume at 1 s (FEV1) than did those 13-17 years of age, but this difference was small in the vaccinated group (73.6% versus 83.7%) compared with the controls (48.0% versus 78.7%). In the : 18 year age category the mean FEV1% at 10 years was 73.6% (vaccinated) and 48.0% (controls) (P < 0.05). In the vaccinated group only 11 (44%) of 25 patients were underweight at the 10-year follow-up compared with 18 (72%) of 25 at the beginning of the study. In the control group 17 (68%) of 25 patients were underweight at 10-year follow-up compared with 16 (64%) of 25 at the beginning of the study.Conclusion: Regular vaccination of young CF patients for a period of 10 years with a polyvalent conjugate vaccine reduced the frequency of chronic infection with P. aeruginosa. This was associated with better preservation of lung function. Vaccinated patients gained more weight during the study period, a possible indication of an improved overall health status.