Pichichero Michael E
Rochester General Research Institute, Rochester General Hospital, Rochester, New York 14621, USA.
Pediatrics. 2009 Dec;124(6):1633-41. doi: 10.1542/peds.2008-3645. Epub 2009 Nov 23.
Almost all current vaccines work by the induction of antibodies in serum or on the mucosa to block adherence of pathogens to epithelial cells or interfere with microbial invasion of the bloodstream. However, antibody levels usually decline after vaccination to undetectable amounts if further vaccination does not occur. Persistence of vaccine-induced antibodies usually goes well beyond the time when they should have decayed to undetectable levels because of ongoing "natural" boosting or other immunologic mechanisms. The production of memory B and T cells is of clear importance, but the likelihood that a memory response will be fast enough in the absence of a protective circulating antibody level likely depends on the pace of pathogenesis of a specific organism. This concept is discussed with regard to Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis; hepatitis A and B; diphtheria, tetanus, and pertussis; polio, measles, mumps, rubella, and varicella; rotavirus; and human papilloma virus. With infectious diseases for which the pace of pathogenesis is less rapid, some individuals will contract infection before the memory response is fully activated and implemented. With infectious diseases for which the pace of pathogenesis is slow, immune memory should be sufficient to prevent disease.
几乎所有现有的疫苗都是通过诱导血清或黏膜中的抗体来发挥作用，以阻止病原体黏附上皮细胞或干扰微生物侵入血液循环。然而，如果不进行进一步接种，抗体水平通常会在接种疫苗后下降到检测不到的水平。由于持续的“自然”增强或其他免疫机制，疫苗诱导的抗体持续存在的时间通常远远超过它们本应衰减到检测不到水平的时间。记忆B细胞和T细胞的产生显然很重要，但在没有保护性循环抗体水平的情况下，记忆反应足够迅速的可能性可能取决于特定病原体的发病进程。本文针对b型流感嗜血杆菌、肺炎链球菌和脑膜炎奈瑟菌；甲型和乙型肝炎；白喉、破伤风和百日咳；脊髓灰质炎、麻疹、腮腺炎、风疹和水痘；轮状病毒；以及人乳头瘤病毒讨论了这一概念。对于发病进程不那么迅速的传染病，一些个体在记忆反应完全激活并发挥作用之前就会感染。对于发病进程缓慢的传染病，免疫记忆应该足以预防疾病。
