Davidson M, Bulkow L R, Grabman J, Parkinson A J, Chamblee C, Williams W W, Lanier A P, Schiffman G
Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, Alaska.
Arch Intern Med. 1994 Oct 10;154(19):2209-14.
To prevent serious pneumococcal infections, 23-valent pneumococcal polysaccharide vaccine is recommended for individuals over 24 months of age with chronic predisposing diseases and for healthy older adults. This nonrandomized controlled study in rural Alaska assessed the immunogenicity of revaccination in adults.
Twenty-six adults, 33 to 88 years of age, vaccinated a mean of 7.4 years before this study, were matched to 26 previously unvaccinated subjects by age, number of chronic diseases, sex, and ethnicity. One or more chronic diseases were validated in 62% of subjects (32 of 52). All received a first or second intramuscular dose of pneumococcal vaccine. Antibody levels were determined by radioimmunoassay for 12 pneumococcal capsular serotypes immediately before and 20 to 84 days after vaccination.
Six to 9 years after primary vaccination, over one third of serotype-specific antibody levels were below 500 ng of antibody nitrogen per milliliter, equal to the percentage in unvaccinated subjects of similar age. Antibody levels against all pneumococcal serotypes rose to similar levels after primary vaccination and revaccination, and 54% and 55%, respectively, of subjects who received primary vaccination and revaccination had at least a 1.4-fold increase in antibody levels. Only the antibody level for serotype 4 remained low. Neither gender nor age affected peak response. For those with chronic diseases, there was a trend toward fewer low antibody levels against three or more serotypes after revaccination (two subjects [13%]) than after primary vaccination (five subjects [31%]).
Following the initial immunization of high-risk and elderly patients with pneumococcal polysaccharide, pneumococcal antibody levels appear to wane with time. Primary vaccination and revaccination 6 or more years after a first dose of pneumococcal vaccine stimulate comparable mean antibody levels.
为预防严重的肺炎球菌感染，推荐23价肺炎球菌多糖疫苗用于24个月以上患有慢性易患疾病的个体以及健康的老年人。这项在阿拉斯加农村地区进行的非随机对照研究评估了成人再次接种疫苗的免疫原性。
26名年龄在33至88岁之间、在本研究前平均7.4年接种过疫苗的成年人，按照年龄、慢性病数量、性别和种族与26名未接种过疫苗的受试者进行匹配。62%的受试者（52名中的32名）确诊有一种或多种慢性病。所有受试者均接受了第一剂或第二剂肺炎球菌疫苗的肌肉注射。在接种疫苗前即刻以及接种后20至84天，通过放射免疫测定法测定12种肺炎球菌荚膜血清型的抗体水平。
初次接种疫苗6至9年后，超过三分之一的血清型特异性抗体水平低于每毫升500纳克抗体氮，这一比例与未接种疫苗的同龄受试者相当。初次接种疫苗和再次接种疫苗后，针对所有肺炎球菌血清型的抗体水平均上升至相似水平，初次接种疫苗和再次接种疫苗的受试者中分别有54%和55%的人抗体水平至少提高了1.4倍。只有血清型4的抗体水平仍然较低。性别和年龄均不影响峰值反应。对于患有慢性病的人来说，再次接种疫苗后针对三种或更多血清型的低抗体水平的受试者数量（2名受试者[13%]）比初次接种疫苗后（5名受试者[31%]）有所减少，呈现出一种趋势。
高危和老年患者初次接种肺炎球菌多糖疫苗后，肺炎球菌抗体水平似乎会随时间下降。在接种第一剂肺炎球菌疫苗6年或更久后进行初次接种和再次接种，可刺激产生相当的平均抗体水平。
