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目的观察甲型肝炎(甲肝)减毒活疫苗(H_2减毒株)接种后病毒在密切接触者中是否传播。方法分别于1987年5月对浙江省医学科学院职工和家属5例、1988年4月对杭州市某小学2(2)班学生15例及1989年3月对同一所小学1(1)班、1(3)班学生42例,共62例志愿者进行甲肝减毒活疫苗(H_2减毒株)接种。采用酶联免疫吸附试验(ELISA)检测接种者血清甲肝IgM抗体及总抗体,采用ELISA双夹心捕捉抗原法和细胞培养法检测5名志愿者接种后的粪便。甲肝的诊断依据临床表现、转氨酶升高和甲肝IgM抗体等标准。结果4例志愿者接种后的31份粪便用ELISA双夹心法检测甲肝抗原全部阴性。取上述其中8份标本接种人胚肺二倍体细胞(KMB17),经二次传代有3例接种者在8～21 d时检测到甲肝病毒(HAV)。与42例接种者抗体全部阳转不同,在免疫接种后的10～11个月,作为密切接触者的24名同班同学,甲肝抗体阴性。在部分接种甲肝减毒活疫苗的班级中观察了经历一次自然甲肝野毒流行后的免疫反应。50名学生中,15名接种者甲肝抗体全部阳性,未接种者中30名甲肝抗体阴性,5名甲肝IgM抗体阳性。结论甲肝减毒活疫苗(H_2减毒株)接种后,有少量HAV疫苗病毒在粪便中排出,但目前未观察到在人群中引起水平传播。
Objective To observe whether the virus is transmitted in close contacts after inoculation of live attenuated hepatitis A (H) attenuated vaccine (H 2 attenuated vaccine). Methods In May 1987, there were 5 cases of workers and their families in Zhejiang Academy of Medical Sciences, 15 cases of 2 (2) classes in a primary school in Hangzhou in April 1988 and 1 (1) class in the same primary school in March 1989, 42 students in 1 (3) class, a total of 62 volunteers for live attenuated hepatitis A vaccine (H 2 attenuated strain) inoculation. Serum hepatitis A and IgM antibodies and total antibodies were detected by enzyme-linked immunosorbent assay (ELISA). The faeces of 5 volunteers after inoculation were detected by double-sandwich ELISA and cell culture. Diagnosis of hepatitis A based on clinical manifestations, elevated aminotransferases and hepatitis A IgM antibodies and other criteria. Results 31 volunteers after inoculation of 31 stool ELISA double sandwich method to detect all the negative anti-hepatitis A antigen. Eight of the above samples were inoculated with human embryo lung diploid cells (KMB17), and three inoculated patients after secondary passage detected hepatitis A virus (HAV) at 8 to 21 days. In contrast to all of the 42 vaccinated individuals, all of the 24 classmates with close contacts were negative for hepatitis A antibody 10 to 11 months after immunization. The immune response after experiencing a wild hepatitis A virus epidemic was observed in classes partially vaccinated with attenuated live attenuated hepatitis A virus. Of the 50 students, all 15 vaccinated patients were all positive for anti-HBeAg antibodies. Thirty HBeAg-negative and 5 anti-HBs IgA antibodies were found in unvaccinated students. Conclusions A small amount of HAV vaccine virus is excreted in the feces of live attenuated HAV vaccine (H_ 2 attenuated strain). However, no level of HAV vaccine virus has been observed in humans.