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粘膜流感疫苗在老年人中是否有作用?

Is there a role for a mucosal influenza vaccine in the elderly?

作者信息

Corrigan E M, Clancy R L

机构信息

The Australian Institute of Mucosal Immunology, Royal Newcastle Hospital, New South Wales.

出版信息

Drugs Aging. 1999 Sep;15(3):169-81. doi: 10.2165/00002512-199915030-00001.

Abstract

Influenza infection is an acute respiratory disease with a high morbidity and significant mortality, particularly among the elderly and individuals with chronic diseases. The majority of countries now recommend annual influenza vaccination for all people aged 65 years or older, and for those with high risk conditions. Most commercially available influenza vaccines are administered systemically and while these are effective in children and young adults, efficacy levels in elderly individuals have been reported to be much lower. Mucosal vaccines may offer an improved vaccine strategy for protection of the elderly. As the influenza virus causes a respiratory infection, it is potentially more beneficial to administer a vaccine that will boost protection in the mucosal surfaces of the upper and lower respiratory tract. Mucosal influenza vaccines are aimed at stimulating protective immunity in the respiratory tract via oral or intranasal immunisation. This review examines our present knowledge of mucosal immunity and current strategies for mucosal vaccination. It also stresses that the use of serum antibody levels as a 'surrogate marker' for protection against influenza is potentially misleading; serum antibody, for example, may be a quite inappropriate marker to assess a mucosal vaccine. This marker does not reflect other immune responses to vaccination that are crucial for protection.

摘要

流感感染是一种发病率高且死亡率显著的急性呼吸道疾病,在老年人和患有慢性病的人群中尤为如此。现在大多数国家建议65岁及以上的所有人以及有高风险状况的人群每年接种流感疫苗。大多数市售流感疫苗通过全身给药,虽然这些疫苗对儿童和年轻人有效,但据报道在老年人中的效力水平要低得多。黏膜疫苗可能为保护老年人提供一种更好的疫苗策略。由于流感病毒会引起呼吸道感染,接种一种能增强上、下呼吸道黏膜表面保护作用的疫苗可能更有益。黏膜流感疫苗旨在通过口服或鼻内免疫刺激呼吸道的保护性免疫。本综述探讨了我们目前对黏膜免疫的认识以及黏膜疫苗接种的当前策略。它还强调,将血清抗体水平用作预防流感的“替代标志物”可能会产生误导;例如,血清抗体可能是评估黏膜疫苗的一个相当不合适的标志物。该标志物不能反映对疫苗接种的其他对保护至关重要的免疫反应。

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