Cox R J, Brokstad K A, Ogra P
Influenza Research Centre; Broegelmann Research Laboratory, The Gade Institute, University of Bergen, Bergen, Norway.
Scand J Immunol. 2004 Jan;59(1):1-15. doi: 10.1111/j.0300-9475.2004.01382.x.
Influenza virus is a globally important respiratory pathogen which causes a high degree of morbidity and mortality annually. The virus is continuously undergoing antigenic change and thus bypasses the host's acquired immunity to influenza. Despite the improvement in antiviral therapy during the last decade, vaccination is still the most effective method of prophylaxis. Vaccination induces a good degree of protection (60-90% efficacy) and is well tolerated by the recipient. For those at risk of complications from influenza, annual vaccination is recommended due to the antigenic changes in circulating strains. However, there is still room for improvement in vaccine efficacy, long-lasting effect, ease of administration and compliance rates. The mucosal tissues of the respiratory tract are the main portal entry of influenza, and the mucosal immune system provides the first line of defence against infection. Secretory immunoglobulin A (SIgA) and IgM are the major neutralizing antibodies directed against mucosal pathogens. These antibodies work to prevent pathogen entry and can function intracellularly to inhibit replication of virus. This review describes influenza virus infection, epidemiology, clinical presentation and immune system response, particularly as it pertains to mucosal immunity and vaccine use. Specifically, this review provides an update of the current status on influenza vaccination and concentrates on the two main types of influenza vaccines currently in use, namely the cold-adapted vaccine (CAV) given intranasally/orally, and the inactivated vaccine (IV) delivered subcutanously or intramuscularly. The commercially available trivalent IV (TIV) elicits good serum antibody responses but induces poorly mucosal IgA antibody and cell-mediated immunity. In contrast, the CAV may elicit a long-lasting, broader immune (humoral and cellular) response, which more closely resembles natural immunity. The immune response induced by these two vaccines will be compared in this review.
流感病毒是一种全球重要的呼吸道病原体，每年都会导致高度的发病率和死亡率。该病毒不断发生抗原变化，从而绕过宿主对流感的获得性免疫。尽管在过去十年中抗病毒治疗有所改善，但疫苗接种仍然是最有效的预防方法。疫苗接种可诱导良好程度的保护（60 - 90%的效力），并且受种者耐受性良好。对于有流感并发症风险的人群，由于流行毒株的抗原变化，建议每年接种疫苗。然而，在疫苗效力、长效性、给药便利性和依从率方面仍有改进空间。呼吸道的黏膜组织是流感的主要入侵门户，黏膜免疫系统提供了抵御感染的第一道防线。分泌型免疫球蛋白A（SIgA）和IgM是针对黏膜病原体的主要中和抗体。这些抗体可防止病原体进入，并能在细胞内发挥作用以抑制病毒复制。本综述描述了流感病毒感染、流行病学、临床表现和免疫系统反应，特别是与黏膜免疫和疫苗使用相关的内容。具体而言，本综述提供了流感疫苗接种现状的最新信息，并重点介绍了目前使用的两种主要流感疫苗，即经鼻/口服的冷适应疫苗（CAV）和皮下或肌肉注射的灭活疫苗（IV）。市售的三价灭活疫苗（TIV）可引发良好的血清抗体反应，但诱导的黏膜IgA抗体和细胞介导免疫较差。相比之下，CAV可能引发持久、更广泛的免疫（体液和细胞）反应，更类似于自然免疫。本综述将比较这两种疫苗诱导的免疫反应。
