婴儿脊灰母传抗体对Sabin株脊髓灰质炎灭活疫苗不同序贯免疫接种程序效果的影响

Influence of maternal antibodies on effectiveness of different sequential immunization procedures of sIPV in infants

目的探讨婴儿脊髓灰质炎(简称脊灰)母传抗体对Sabin株脊髓灰质炎灭活疫苗(Sabin inactivated poliovirus vaccine,s IPV)与不同剂型脊髓灰质炎减毒活疫苗(oral poliovirus vaccine,OPV)采用不同序贯免疫程序接种效果的影响。方法选取柳州市600名2月龄无脊髓灰质炎疫苗免疫史的常住健康婴儿,分为6个序贯免疫组,其中1剂s IPV+2剂b OPV 2组:s IPV+2b OPV(糖丸)组、s IPV+2b OPV(液体)组;2剂s IPV+1剂b OPV 2组:2s IPV+b OPV(糖丸)组、2s IPV+b OPV(液体)组;2剂s IPV+1剂t OPV 2组:2s IPV+t OPV(糖丸)组,2s IPV+t OPV(液体)组。每组100人。按照0、28、56 d程序,分别在婴儿2、3、4月龄时接种相应疫苗。检测免前、全程免后28 d血清中脊灰中和抗体滴度,计算阳转率及GMT。结果 6个序贯免疫组免前各项指标分布均匀,各型脊灰抗体阳性率、抗体水平及分布均无明显差异。共有518例免前和免后配对血清抗体检测结果的研究对象进入免疫原性分析。s IPV+2b OPV组与2s IPV+b OPV组Ⅱ型抗体、2s IPV+t OPV(糖丸)组Ⅲ型抗体免前阴性和免前阳性者接种疫苗后阳转率差异均有统计学意义;s IPV+2b OPV(糖丸)组Ⅲ型抗体,2s IPV+b OPV(糖丸)组与2s IPV+b OPV(液体)组Ⅱ型抗体,2s IPV+t OPV(糖丸)组Ⅰ、Ⅱ型抗体的免前阳性与免前阴性者接种疫苗后的GMT差异均有统计学意义;2s IPV+t OPV(糖丸)Ⅰ型抗体组与2s IPV+t OPV(液体)Ⅱ型抗体组中,免前8~<32、≥32两种滴度水平的免后GMT差异均有统计学意义。结论脊灰疫苗序贯免疫效果受脊灰母传抗体干扰。

Objective To investigate the effect of poliomyelitis associated maternal-transferred antibodies on the efficacy of Sabin inactivated poliovirus vaccine（ s IPV） and different formulations of Oral poliovirus vaccine（ OPV） in different sequential immunization procedures. Methods A total of 600 residential healthy infants of 2 month age without a history of poliomyelitis vaccination were selected from Liuzhou City. They were divided into 6 sequential immunization groups,including 2 groups of 1 dose s IPV ＋ 2 doses b OPV（ 1 s IPV ＋ 2 b OPV（ Drug Candy,DC） group,the s IPV ＋ 2 b OPV（ liquid） group）; 2 groups of 2 doses s IPV ＋ 1 dose b OPV（ the 2 s IPV ＋ 1 b OPV（ DC） group,the 2 s IPV＋1 b OPV（ liquid） group）; and 2 groups of 2 doses s IPV＋1 dose t OPV（ the 2 s IPV＋1 t OPV（ DC）group,the 2 s IPV＋1 t OPV（ liquid） group）. There were 100 infants in each group. The vaccine was inoculated at 2,3 and4 months age after birth,respectively. The titer of poliomyelitis neutralization antibody in serum was detected before immunization and 28 days after the whole process of immunization. The positive rate and GMT were calculated. Results The distribution of each indexes before immunization were uniform in the 6 sequential immunization groups,and there was no a statistical difference in the positive rate,level and the distribution of antibody among poliomyelitis types. A total of 518 subjects with paired serum antibody test results before and after immunization were enrolled in the immunogenicity analysis.Statistical difference was found in the positive conversion rate between the s IPV＋2 b OPV group and the 2 s IPV＋b OPV type II antibody group and the 2 s IPV＋t OPV（ DC） type III antibody group. There was a statistical difference in GMT between the s IPV＋2 b OPV（ DC） type III antibody group,the 2 s IPV＋b OPV（ DC） group and the 2 s IPV＋b OPV（ liquid） type II antibody group and the 2 s IPV＋t OPV（ DC） type I＋II antibody group. Moreover,statistical difference was found in the postimmunization GMT between the2 s IPV＋t OPV（ DC） type I antibody group and the 2 s IPV＋t OPV（ liquid） type II antibody group with two levels of titer before immunization（ 8- 32 and ≥32）. Conclusion The sequential immune effect of the poliomyelitis vaccination was interfered with maternal-transferred antibodies.