Patriarca P A, Wright P F, John T J
Division of Immunization, Centers for Disease Control, Atlanta, Georgia 30333.
Rev Infect Dis. 1991 Sep-Oct;13(5):926-39. doi: 10.1093/clinids/13.5.926.
Although rates of seroconversion following administration of trivalent oral poliovirus vaccine (TOPV) approach 100% in industrialized countries, only 73% (range, 36%-99%) and 70% (range, 40%-99%) of children in developing countries have detectable antibody to poliovirus types 1 and 3, respectively, after three doses. While factors accounting for these differences have not been fully elucidated, available data suggest that type 2 vaccine virus and enteric pathogens often interfere with responses to types 1 and 3 vaccine viruses but that this interference may be overcome by modifying the absolute and relative dosage of the three Sabin types. Increasing the interval between doses beyond 30 days may also be important, in view of the prolonged excretion of vaccine virus and the potential for interference with responses to subsequent doses. Although advances in molecular biology may ultimately lead to the development of more-immunogenic vaccine candidates, approaches such as increasing the number of doses of TOPV, mass vaccination campaigns, and combined use of oral and inactivated vaccines should also be considered.
尽管在工业化国家，接种三价口服脊髓灰质炎疫苗（TOPV）后的血清转化率接近100%，但在发展中国家，分别只有73%（范围为36%-99%）和70%（范围为40%-99%）的儿童在接种三剂疫苗后可检测到针对脊髓灰质炎病毒1型和3型的抗体。虽然造成这些差异的因素尚未完全阐明，但现有数据表明，2型疫苗病毒和肠道病原体常常干扰对1型和3型疫苗病毒的反应，但这种干扰可通过调整三种萨宾病毒株的绝对剂量和相对剂量来克服。鉴于疫苗病毒的排泄时间延长以及可能干扰对后续剂量的反应，将接种剂量之间的间隔延长至30天以上可能也很重要。尽管分子生物学的进展最终可能会促使开发出免疫原性更强的候选疫苗，但也应考虑增加TOPV接种剂量、开展大规模疫苗接种运动以及联合使用口服疫苗和灭活疫苗等方法。
