Granoff Dan M, Pollard Andrew J
Center for Immunobiology and Vaccine Development, Children's Hospital Oakland Research Institute, Oakland, CA, USA.
Pediatr Infect Dis J. 2007 Aug;26(8):716-22. doi: 10.1097/INF.0b013e3180cc2c25.
In 2005, a quadrivalent meningococcal conjugate vaccine was licensed in the United States for persons aged 11-55 years of age. For children aged 2-10 years with underlying diseases associated with increased risk of meningococcal disease, unconjugated meningococcal polysaccharide (MPS) vaccination is still recommended. This article reviews the increasing evidence that MPS vaccination impairs serum anticapsular antibody responses to subsequent injections of MPS or meningococcal conjugate vaccines (antibody hyporesponsiveness). Administering MPS as a probe to assess conjugate vaccine-induced immunologic memory also can extinguish subsequent memory anticapsular antibody responses, whereas conjugate vaccination regenerates memory B cells. Whether induction of antibody hyporesponsiveness or loss of immunologic memory increase the risk of acquiring meningococcal disease remains speculative. However, for children at increased risk of meningococcal disease, immunization with meningococcal quadrivalent conjugate vaccine off-label instead of MPS vaccine should be considered. Requirements for licensure of new glycoconjugate vaccines that include performing comparative clinical trials to demonstrate noninferiority with MPS vaccine, or use of a MPS challenge to assess conjugate-induced immunologic memory also should be modified because there are safer approaches for obtaining the same information.
2005年，一种四价脑膜炎球菌结合疫苗在美国被批准用于11至55岁的人群。对于2至10岁患有与脑膜炎球菌病风险增加相关基础疾病的儿童，仍建议接种非结合型脑膜炎球菌多糖（MPS）疫苗。本文综述了越来越多的证据表明，MPS疫苗接种会损害血清抗荚膜抗体对后续注射MPS或脑膜炎球菌结合疫苗的反应（抗体低反应性）。将MPS作为一种探针来评估结合疫苗诱导的免疫记忆，也会消除后续的记忆抗荚膜抗体反应，而结合疫苗接种则会使记忆B细胞再生。抗体低反应性的诱导或免疫记忆的丧失是否会增加患脑膜炎球菌病的风险仍具有推测性。然而，对于脑膜炎球菌病风险增加的儿童，应考虑使用非标签的四价脑膜炎球菌结合疫苗进行免疫接种，而非MPS疫苗。新糖结合疫苗的许可要求，包括进行比较临床试验以证明与MPS疫苗的非劣效性，或使用MPS激发试验来评估结合疫苗诱导的免疫记忆，也应进行修改，因为有更安全的方法来获取相同的信息。
