NEJM:孕妇接种合胞病毒疫苗可以预防婴儿感染呼吸道合胞病毒

2022-05-02 MedSci原创 MedSci原创

全世界每年约有118,200名儿童死于呼吸道合胞病毒(RSV),其中约一半发生在6个月以下婴儿中,绝大多数发生在发展中国家。在美国,RSV是婴儿住院的常见原因,估计每年RSV肺炎发病率超过2000例/

全世界每年约有118,200名儿童死于呼吸道合胞病毒(Respiratory syncytial virus, RSV),其中约一半发生在6个月以下婴儿中,绝大多数发生在发展中国家。呼吸道合胞病毒属于副黏病毒科的肺病毒属(Pneumovirus),只有一种血清型 。主要引起6个月以下婴儿患细支气管炎和肺炎等下呼吸道感染,以及较大儿童和成人的鼻炎、感冒等上呼吸道感染。

在美国,RSV是婴儿住院的常见原因,估计每年RSV肺炎发病率超过2000例/10万婴儿。福尔马林灭活全病毒疫苗的免疫接种会导致婴儿自然感染RSV后疾病增强,无法平衡副作用与免疫原性。疫苗介导的RSV疾病增强只在先前未感染过RSV的人身上出现,成人普遍接触过RSV,孕妇免疫可以规避疾病加重的风险,且在6周龄左右RSV发病高峰前被动保护婴儿。母亲免疫接种对预防婴儿流感、破伤风和百日咳的效果已得到很好证实。RSV融合蛋白(F蛋白)是中和抗体的主要靶点,其融合前结构的确定推动了RSV疫苗的开发,本文报道了二价RSV融合前F蛋白疫苗(RSVpreF疫苗)在孕妇及其婴儿中的有效性、免疫原性和安全性,相关结果于2022年4月28日发表在《新英格兰医学杂志》上。

这是一项2b期临床试验,在妊娠24至36周的孕妇随机分配接受120或240 μg RSVpreF疫苗(有无氢氧化铝)或安慰剂。该试验包括安全性终点和免疫原性终点,在中期分析中,包括分娩时母亲血清和脐带血中50%滴度的RSV A、B和联合A/B中和抗体,以及母体-婴儿胎盘转移率。

中期分析包括406名妇女和403名婴儿,327名妇女(80.5%)接种了RSVpreF疫苗,多数接种后反应为轻至中度,接种含氢氧化铝的RSVpreF疫苗的妇女局部反应发生率高于接种不含氢氧化铝的RSVpreF疫苗的妇女。疫苗组和安慰剂组的妇女和婴儿不良事件发生率相似,这些事件的类型和频率与孕妇和婴儿的背景发病率一致。接种疫苗的婴儿与接种安慰剂的婴儿之间50%中和效价的几何平均比率在具有RSV A中和抗体的婴儿中为9.7 - 11.7,在具有RSV B中和抗体的婴儿中为13.6 - 16.8。中和抗体经胎盘转移率为1.41 - 2.10,且非铝制剂高于铝制剂。在评估的胎龄范围内,接种疫苗的妇女的婴儿在脐带血中有相似的滴度和相似的胎盘转移率。

分娩或出生时RSV A和RSV B 50%中和滴度和胎盘转移率

结论

RSVpreF疫苗通过有效的胎盘转移引发中和抗体反应,并且没有明显的安全问题。

梅斯医学认为,这项研究可能不仅仅针对合胞病毒疫苗,可能对于很多疫苗同样适用。对于新生儿,一般属于脆弱人群,但是,在刚刚出生时,接种的往往是乙肝疫苗等少数疫苗,不少疫苗需要到数月以后才会陆续接种。然而在婴儿体内一般会存在母亲给予的各类抗体,可能也包括疫苗产生的抗体。因此,针对婴儿的接种,可能考虑对孕妇或成人女性接种,从而让新生儿获得免疫力,从而减少新生儿期疾病的发生,这可能成为一种重要的策略。

原始出处:

Eric A.F. Simões, M.D., Kimberly J. Center, M.D., et al. Prefusion F Protein–Based Respiratory Syncytial Virus Immunization in Pregnancy. N Engl J Med.2022; 386:1615-1626 DOI: 10.1056/NEJMoa2106062.

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    2022-10-14 lifestar

    孕妇接种#呼吸道合胞病毒疫苗#可以预防婴儿感染#呼吸道合胞病毒#

    0

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    2022-09-05 小小医者

    #孕妇#接种#合胞病毒#疫苗可以预防婴儿感染呼吸道合胞病毒,主要是孕妇可以将抗体传给婴儿,但是婴儿出生6个月后,这些#抗体#基本就消失,这是为什么6个月内的婴儿生病反而少,在6个月到3岁生病最多,因为这时候,主要靠#婴儿#自己体内逐步形成#免疫系统#了。

    0

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    2022-05-04 zhmscau
  6. [GetPortalCommentsPageByObjectIdResponse(id=2083479, encodeId=994120834e95c, content=<a href='/topic/show?id=b7cce09742a' target=_blank style='color:#2F92EE;'>#病毒疫苗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70974, encryptionId=b7cce09742a, topicName=病毒疫苗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1dbc2500219, createdName=huagfeg, createdTime=Sun Jun 05 03:54:35 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2093713, encodeId=5d5f2093e139c, content=孕妇接种<a href='/topic/show?id=5f3939e14af' target=_blank style='color:#2F92EE;'>#呼吸道合胞病毒疫苗#</a>可以预防婴儿感染<a href='/topic/show?id=0daf39e120a' target=_blank style='color:#2F92EE;'>#呼吸道合胞病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39714, encryptionId=5f3939e14af, topicName=呼吸道合胞病毒疫苗), TopicDto(id=39712, encryptionId=0daf39e120a, topicName=呼吸道合胞病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Fri Oct 14 03:28:19 CST 2022, time=2022-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243229, encodeId=67c712432291c, content=<a href='/topic/show?id=8d724525ea2' target=_blank style='color:#2F92EE;'>#孕妇#</a>接种<a href='/topic/show?id=d20b388e6e0' target=_blank style='color:#2F92EE;'>#合胞病毒#</a>疫苗可以预防婴儿感染呼吸道合胞病毒,主要是孕妇可以将抗体传给婴儿,但是婴儿出生6个月后,这些<a href='/topic/show?id=813e5516eb0' target=_blank style='color:#2F92EE;'>#抗体#</a>基本就消失,这是为什么6个月内的婴儿生病反而少,在6个月到3岁生病最多,因为这时候,主要靠<a href='/topic/show?id=daa845046b2' target=_blank style='color:#2F92EE;'>#婴儿#</a>自己体内逐步形成<a href='/topic/show?id=92bb291106f' target=_blank style='color:#2F92EE;'>#免疫系统#</a>了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45257, encryptionId=8d724525ea2, topicName=孕妇), TopicDto(id=38876, encryptionId=d20b388e6e0, topicName=合胞病毒), TopicDto(id=55167, encryptionId=813e5516eb0, topicName=抗体), TopicDto(id=45046, encryptionId=daa845046b2, topicName=婴儿), TopicDto(id=29110, encryptionId=92bb291106f, topicName=免疫系统)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Mon Sep 05 02:25:17 CST 2022, time=2022-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236512, encodeId=13c7123651291, content=<a href='/topic/show?id=d20b388e6e0' target=_blank style='color:#2F92EE;'>#合胞病毒#</a><a href='/topic/show?id=7a10388e791' target=_blank style='color:#2F92EE;'>#合胞病毒疫苗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38876, encryptionId=d20b388e6e0, topicName=合胞病毒), TopicDto(id=38877, encryptionId=7a10388e791, topicName=合胞病毒疫苗)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Thu Aug 04 08:46:36 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282585, encodeId=dec81282585e4, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Wed May 04 03:54:35 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243727, encodeId=93e61243e2775, content=NEJM上果然牛,感谢梅斯更新及时, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=小元, createdTime=Mon May 02 15:54:35 CST 2022, time=2022-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216333, encodeId=d027121633302, content=很前沿的咨询,谢谢分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Mon May 02 15:29:27 CST 2022, time=2022-05-02, status=1, ipAttribution=)]
    2022-05-02 小元

    NEJM上果然牛,感谢梅斯更新及时

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2083479, encodeId=994120834e95c, content=<a href='/topic/show?id=b7cce09742a' target=_blank style='color:#2F92EE;'>#病毒疫苗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70974, encryptionId=b7cce09742a, topicName=病毒疫苗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1dbc2500219, createdName=huagfeg, createdTime=Sun Jun 05 03:54:35 CST 2022, time=2022-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2093713, encodeId=5d5f2093e139c, content=孕妇接种<a href='/topic/show?id=5f3939e14af' target=_blank style='color:#2F92EE;'>#呼吸道合胞病毒疫苗#</a>可以预防婴儿感染<a href='/topic/show?id=0daf39e120a' target=_blank style='color:#2F92EE;'>#呼吸道合胞病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39714, encryptionId=5f3939e14af, topicName=呼吸道合胞病毒疫苗), TopicDto(id=39712, encryptionId=0daf39e120a, topicName=呼吸道合胞病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Fri Oct 14 03:28:19 CST 2022, time=2022-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243229, encodeId=67c712432291c, content=<a href='/topic/show?id=8d724525ea2' target=_blank style='color:#2F92EE;'>#孕妇#</a>接种<a href='/topic/show?id=d20b388e6e0' target=_blank style='color:#2F92EE;'>#合胞病毒#</a>疫苗可以预防婴儿感染呼吸道合胞病毒,主要是孕妇可以将抗体传给婴儿,但是婴儿出生6个月后,这些<a href='/topic/show?id=813e5516eb0' target=_blank style='color:#2F92EE;'>#抗体#</a>基本就消失,这是为什么6个月内的婴儿生病反而少,在6个月到3岁生病最多,因为这时候,主要靠<a href='/topic/show?id=daa845046b2' target=_blank style='color:#2F92EE;'>#婴儿#</a>自己体内逐步形成<a href='/topic/show?id=92bb291106f' target=_blank style='color:#2F92EE;'>#免疫系统#</a>了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45257, encryptionId=8d724525ea2, topicName=孕妇), TopicDto(id=38876, encryptionId=d20b388e6e0, topicName=合胞病毒), TopicDto(id=55167, encryptionId=813e5516eb0, topicName=抗体), TopicDto(id=45046, encryptionId=daa845046b2, topicName=婴儿), TopicDto(id=29110, encryptionId=92bb291106f, topicName=免疫系统)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Mon Sep 05 02:25:17 CST 2022, time=2022-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236512, encodeId=13c7123651291, content=<a href='/topic/show?id=d20b388e6e0' target=_blank style='color:#2F92EE;'>#合胞病毒#</a><a href='/topic/show?id=7a10388e791' target=_blank style='color:#2F92EE;'>#合胞病毒疫苗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38876, encryptionId=d20b388e6e0, topicName=合胞病毒), TopicDto(id=38877, encryptionId=7a10388e791, topicName=合胞病毒疫苗)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=病毒猎手, createdTime=Thu Aug 04 08:46:36 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282585, encodeId=dec81282585e4, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Wed May 04 03:54:35 CST 2022, time=2022-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243727, encodeId=93e61243e2775, content=NEJM上果然牛,感谢梅斯更新及时, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=小元, createdTime=Mon May 02 15:54:35 CST 2022, time=2022-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1216333, encodeId=d027121633302, content=很前沿的咨询,谢谢分享!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=65aa5643711, createdName=小白努力长高高, createdTime=Mon May 02 15:29:27 CST 2022, time=2022-05-02, status=1, ipAttribution=)]
    2022-05-02 小白努力长高高

    很前沿的咨询,谢谢分享!!!

    0

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