Baral Stefan, Sherman Susan G, Millson Peggy, Beyrer Chris
Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
Lancet Infect Dis. 2007 Oct;7(10):667-74. doi: 10.1016/S1473-3099(07)70237-2.
Injection drug use is a prevalent global phenomenon; one not bound by a country's level of development or geographical location. Injection drug users (IDUs) are at high risk for a variety of parenterally acquired and transmitted infections. Licensed vaccines are available for some of these infectious diseases, such as tetanus, influenza, and hepatitis A and B viruses; however, there have been conflicting reports as to their immunogenicity in IDUs. We summarise the lessons learned from studies evaluating the immunogenicity of vaccination strategies in IDUs. A common theme across these diseases is that although there is a tendency towards decreased antibody responses after immunisation, there is no conclusive evidence linking these observations to a decrease in clinical protection from infection. There is a clear need for definitive studies of vaccination strategies in IDUs; however, a synthesis of the available published evidence suggests that immunisation does result in effective clinical protection from disease in this population. The inclusion of IDUs as a high-risk study population in future trials evaluating HIV and hepatitis C virus vaccines will help to assess the immunogenicity of candidate vaccines against parenteral exposure, and also to evaluate the efficacy of candidates as promising antigens become available.
注射吸毒是一种普遍的全球现象，不受一个国家的发展水平或地理位置限制。注射吸毒者（IDU）面临多种经注射感染和传播的感染的高风险。针对其中一些传染病，如破伤风、流感以及甲型和乙型肝炎病毒，有获得许可的疫苗；然而，关于这些疫苗在注射吸毒者中的免疫原性，报告结果相互矛盾。我们总结了评估注射吸毒者疫苗接种策略免疫原性的研究中所吸取的经验教训。这些疾病的一个共同主题是，尽管免疫后抗体反应有下降趋势，但没有确凿证据将这些观察结果与感染临床防护能力的下降联系起来。显然需要对注射吸毒者的疫苗接种策略进行确定性研究；然而，对现有已发表证据的综合分析表明，免疫接种确实能为该人群提供有效的疾病临床防护。在未来评估艾滋病毒和丙型肝炎病毒疫苗的试验中，将注射吸毒者纳入高危研究人群，将有助于评估候选疫苗针对经注射暴露的免疫原性，并且在有前景的抗原可用时，还能评估候选疫苗的效力。
