甲型肝炎减毒活疫苗病毒(H_2株)人群水平传播的能力  

Study on the possibility of transmission of live hepatitis A vaccinees (H_2 strain) from vaccinees to nonvaccinees

作　　者：毛子安[1] 黄海鹰[1] 钱汶[1] 陈念良[1] 张淑雅[1] 施世锋[2] 柴少爱[1] 

机构地区：[1]浙江省医学科学院病毒研究所,杭州310013 [2]杭州市疾病控制中心

出　　处：《中华传染病杂志》2006年第3期168-171,共4页Chinese Journal of Infectious Diseases

摘　　要：目的观察甲型肝炎(甲肝)减毒活疫苗(H_2减毒株)接种后病毒在密切接触者中是否传播。方法分别于1987年5月对浙江省医学科学院职工和家属5例、1988年4月对杭州市某小学2(2)班学生15例及1989年3月对同一所小学1(1)班、1(3)班学生42例,共62例志愿者进行甲肝减毒活疫苗(H_2减毒株)接种。采用酶联免疫吸附试验(ELISA)检测接种者血清甲肝IgM抗体及总抗体,采用ELISA双夹心捕捉抗原法和细胞培养法检测5名志愿者接种后的粪便。甲肝的诊断依据临床表现、转氨酶升高和甲肝IgM抗体等标准。结果4例志愿者接种后的31份粪便用ELISA双夹心法检测甲肝抗原全部阴性。取上述其中8份标本接种人胚肺二倍体细胞(KMB17),经二次传代有3例接种者在8～21 d时检测到甲肝病毒(HAV)。与42例接种者抗体全部阳转不同,在免疫接种后的10～11个月,作为密切接触者的24名同班同学,甲肝抗体阴性。在部分接种甲肝减毒活疫苗的班级中观察了经历一次自然甲肝野毒流行后的免疫反应。50名学生中,15名接种者甲肝抗体全部阳性,未接种者中30名甲肝抗体阴性,5名甲肝IgM抗体阳性。结论甲肝减毒活疫苗(H_2减毒株)接种后,有少量HAV疫苗病毒在粪便中排出,但目前未观察到在人群中引起水平传播。Objective To determine whether He strain vaccine virus could transmit vaccinee to non-vaccinated contacts. Methods Under the present investigation subjects, were selected on voluntary bases from Zhejiang Academy of Medical Sciences a primary school in Hangzhou. The live attenuated hepatitis A （Ha strain） vaccine used in this study was provided by Zhejiang Academy of Medical Sciences. The IgM antibody and the total antibody to hepatitis A virus were determined by two kinds of ELISA diagnostic kits, respectively. Hepatitis A cases were diagnosed according to the symptoms, signs relative to hepatitis, as well as the emergence of the IgM antibody to hepatitis A virus. Hepatitis A antigen （HAAg） was determined by ELISA based on the double-sandwich principle. Results 31 stool samples from four persons collected after 8 to 30 days of inoculation were tested for the pres ence of HAAg and the results were negative. After taking 8 samples from the above sample pool and inoculating into KMB17 cultivated cells through two passages, we found live HAV in three vaccine recipients after 8～21 days. None of the 24 nonvaccinees had seroconversion of the antibody to HAV after 10～11 months of close contacts with recipients. Five months after the vaccination an epidemic of HA caused by wild type of HAV occurred in Hangzhou. The anti HAV conversion status monitoring showed that among 50 students, 15 vaccine recipients were positive of antibody to HAV. The remaining 35 non-vaccinations showed 30 negative and 5 positive in IgM antibody, which proved they had not been infected with vaccine virus before. Conclusion The inoculation of the live, attenuated HAV vaccine, although it shows shedding of very small amount of HAV （H2 strain）, it has not let to horizontal transmission of the virus. That seems to have resulted from its limited amount of the vi rus excretion and its low ability of transmitting through oral infection.

关 键 词：肝炎病毒 甲型 疾病传播 疫苗 减毒 病毒性肝炎疫苗 

分 类 号：R186[医药卫生—流行病学]