Wilde H, Thipkong P, Sitprija V, Chaiyabutr N
Queen Saovabha Memorial Institute (World Health Organization Collaborating Center for Research in Rabies), Thai Red Cross Society, Bangkok, Thailand.
Ann Intern Med. 1996 Aug 1;125(3):233-6. doi: 10.7326/0003-4819-125-3-199608010-00012.
Active immunization against infectious disease is important. However, much of our world faces poverty, social injustice, and warfare, all of which cause universal immunization to remain a distant dream. Agents that provide passive immunity thus remain essential biologicals. The most important of these are human or equine antisera against rabies, tetanus, diphtheria, and snake antivenins. Homologous products are either unavailable or unaffordable in places where they are needed the most. Less expensive heterologous (equine) antisera can be purified and are safe to use, but these antisera are also in short supply. Monoclonal antibodies have been developed but are even less likely to be affordable in poor countries. Several traditional sources of equine antisera are becoming depleted as a result of economic disincentives; a poor reputation based on the high adverse reaction rates of the old, unpurified products; and the activities of animal rights activists who object to the use of horses as blood donors. Purified, pepsin-digested equine antisera are preferred; but developing countries sometimes are forced to make crude products that are less safe or have no specific therapy available at all.
针对传染病的主动免疫很重要。然而，世界上许多地方面临贫困、社会不公和战争，所有这些都使得普遍免疫仍然是一个遥远的梦想。因此，提供被动免疫的制剂仍然是必不可少的生物制品。其中最重要的是抗狂犬病、破伤风、白喉的人源或马源抗血清以及蛇毒抗毒素。在最需要这些同源产品的地方，要么无法获得，要么价格昂贵。价格较低的异源（马源）抗血清可以提纯且使用安全，但这些抗血清也供应短缺。单克隆抗体已经研制出来，但在贫穷国家更不太可能买得起。由于经济激励不足、基于旧的未提纯产品的高不良反应率而导致的声誉不佳以及动物权利活动家反对将马用作供血者的活动，几种传统的马源抗血清来源正逐渐枯竭。提纯的、经胃蛋白酶消化的马源抗血清是首选；但发展中国家有时被迫生产安全性较低的粗制品，或者根本没有特效疗法可用。
