Wutzler Peter, Hardt Roland, Knuf Markus, Wahle Klaus
Institute of Virology and Antiviral Therapy - University Hospital Jena, Catholic Clinic Mainz, St. Hildegardis Hospital, Department of Child and Adolescent Medicine, Dr. Horst Schmidt Clinic GmbH, Wiesbaden, German Association of General Practitioners, Münster.
Dtsch Arztebl Int. 2013 Nov 22;110(47):793-8. doi: 10.3238/arztebl.2013.0793.
The main target groups for influenza vaccination are the elderly, the chronically ill, infants, and toddlers. Influenza vaccines are needed that suit the immunological particularities of each of these age and risk groups. Recent years have seen the approval of influenza vaccines that are more immunogenic than before, but whose use in Germany is limited by the restriction of reimbursement to a small number of vaccines.
The Medline database was selectively searched for pertinent literature.
The suboptimal immunogenicity of conventional influenza vaccines that contain inactivated viral cleavage products and subunits can be markedly improved by the use of squalene-based adjuvant systems, by the integration of viral antigens in virosomal particles, or by intradermal administration. The vaccination of elderly persons with a vaccine containing the adjuvant MF59 was found to lower the risk of hospitalization for influenza or pneumonia by 25% compared to vaccination with a trivalent inactivated vaccine (TIV). On the other hand, the adjuvant ASO3 was found to be associated with an up to 17-fold increase in the frequency of narcolepsy among 4- to 18-year-olds. In a prospective study, a virosomal vaccine lowered the frequency of laboratory-confirmed influenza in vaccinated children by 88% compared to unvaccinated children (2 versus 18 cases per 1000 individuals). A live, attenuated influenza vaccine lowered the rate of disease in children up to age 7 by 48% compared to a TIV (4.2% versus 8.1%).
The newer vaccines possess improved efficacy when used for primary and booster immunization in certain age and risk groups, and they are superior in this respect to conventional vaccines based on viral cleavage products and subunits. The risk/benefit profiles of all currently available vaccines vary depending on the age group or risk group in which they are used.
流感疫苗接种的主要目标群体是老年人、慢性病患者、婴幼儿。需要适合这些年龄和风险群体免疫特性的流感疫苗。近年来已批准了比以往免疫原性更强的流感疫苗，但在德国其使用受到报销限制，仅少数疫苗可报销。
对Medline数据库进行选择性检索以查找相关文献。
含有灭活病毒裂解产物和亚单位的传统流感疫苗免疫原性欠佳，通过使用基于角鲨烯的佐剂系统、将病毒抗原整合到病毒体颗粒中或采用皮内给药，可显著提高其免疫原性。研究发现，与接种三价灭活疫苗（TIV）相比，给老年人接种含佐剂MF59的疫苗可使流感或肺炎住院风险降低25%。另一方面，发现佐剂ASO3与4至18岁人群发作性睡病的发生率高达17倍的增加有关。在一项前瞻性研究中，与未接种疫苗的儿童相比，一种病毒体疫苗可使接种疫苗儿童中实验室确诊流感的发生率降低88%（每1000人中有2例与18例）。与TIV相比，一种减毒活流感疫苗可使7岁及以下儿童的发病率降低48%（4.2%对8.1%）。
新型疫苗在某些年龄和风险群体用于初次和加强免疫时具有更高的效力，在这方面优于基于病毒裂解产物和亚单位的传统疫苗。所有现有疫苗的风险/收益情况因使用的年龄组或风险组而异。
