Marmion B P, Ormsbee R A, Kyrkou M, Wright J, Worswick D A, Izzo A A, Esterman A, Feery B, Shapiro R A
Division of Medical Virology, University of Adelaide, South Australia.
Epidemiol Infect. 1990 Apr;104(2):275-87. doi: 10.1017/s0950268800059458.
During the period 1981-8 a clinical trial of a Q fever vaccine (Q-vax; Commonwealth Serum Laboratories, Melbourne) has been conducted in abattoir workers and other at-risk groups in South Australia. Volunteers in four abattoirs and visitors to the abattoirs were given one subcutaneous dose of 30 micrograms of a formalin-inactivated, highly-purified Coxiella burnetii cells, Henzerling strain, Phase 1 antigenic state, in a volume of 0.5 ml. During the period, over 4000 subjects have been vaccinated and the programme continues in the abattoirs and related groups. 'Common' reactions to the vaccine comprised tenderness and erythema, rarely oedema at the inoculation site and sometimes transient headache. Two more serious 'uncommon' reactions, immune abscess at the inoculation site, were observed in two subjects, and two others developed small subcutaneous lumps which gradually dispersed without intervention. Protective efficacy of the vaccine appeared to be absolute and to last for 5 years at least. Eight Q fever cases were observed in vaccinees, but all were in persons vaccinated during the incubation period of a natural attack of Q fever before vaccine-induced immunity had had time (greater than or equal to 13 days after vaccination) to develop. On the other hand, 97 Q fever cases were detected in persons working in, or visiting the same abattoir environments. Assays for antibody and cellular immunity showed an 80-82% seroconversion after vaccination, mostly IgM antibody to Phase 2 antigen, in the 3 months after vaccination. This fell to about 60%, mostly IgG antibody to Phase 1 antigen, after 20 months. On the other hand, 85-95% of vaccinees developed markers of cell mediated immunity as judged by lymphoproliferative responses with C. burnetii antigens; these rates remained elevated for at least 5 years. The Q fever vaccine, unlike other killed rickettsial vaccines, has the property of stimulating long-lasting T lymphocyte memory and this may account for its unusual protective efficacy as a killed vaccine.
1981年至1988年期间，在南澳大利亚州的屠宰场工人和其他高危人群中开展了一项Q热疫苗（Q-vax；联邦血清实验室，墨尔本）的临床试验。来自四个屠宰场的志愿者以及屠宰场访客皮下注射了一剂30微克福尔马林灭活的、高度纯化的贝氏柯克斯体亨泽林菌株第1相抗原状态的细胞，体积为0.5毫升。在此期间，超过4000名受试者接种了疫苗，该项目在屠宰场及相关群体中仍在继续。疫苗的“常见”反应包括接种部位压痛和红斑，很少出现水肿，有时会出现短暂头痛。两名受试者出现了另外两种更严重的“不常见”反应，即接种部位免疫脓肿，另外两名受试者出现了小的皮下肿块，未经干预逐渐消散。疫苗的保护效力似乎是绝对的，至少持续5年。在接种疫苗者中观察到8例Q热病例，但所有病例均发生在疫苗诱导的免疫力尚未产生（接种疫苗后大于或等于13天）之前，处于Q热自然发作潜伏期时接种疫苗的人群中。另一方面，在同一屠宰场环境中工作或到访的人员中检测到97例Q热病例。抗体和细胞免疫检测显示，接种疫苗后3个月内血清转化率为80%至82%，主要是针对第2相抗原的IgM抗体。20个月后，这一比例降至约60%，主要是针对第1相抗原IgG抗体。另一方面，通过针对贝氏柯克斯体抗原的淋巴细胞增殖反应判断，85%至95%的接种疫苗者出现了细胞介导免疫标志物；这些比率至少5年保持升高。与其他灭活立克次体疫苗不同，Q热疫苗具有刺激持久T淋巴细胞记忆的特性，这可能解释了其作为一种灭活疫苗具有异常保护效力的原因。
