季節性流感疫苗

季節性流感疫苗，簡稱流感疫苗（influenza vaccine，flu shot），為針對流行性感冒（季节性流感）的疫苗。因為流感病毒變化的速度很快，一年會發展新的流感疫苗兩次。大部分狀況下，疫苗有中度到高度的保護力；然而每年情況略有不同。[1][2]對65歲以上的長者，目前證據較缺乏。[3][4]平均來說，他們可以減少半日因病而上班必須請假的狀況。[5]有打疫苗的孩童，可以保護他們周遭的人。[1]

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
季節性流感疫苗
美国海军人员接种疫苗
臨床資料
商品名Fluarix、Fluzone、others
AHFS/Drugs.comMonograph
给药途径IM、鼻内
ATC碼
法律規範狀態
法律規範
  • 美：处方药（℞-only）
识别
CAS号1704512-59-3
流行性感冒
H1N1 virus
類型
疫苗
治療
大流行
爆發疫情
  • 2008年西孟加拉邦H5N1流感
  • 2007年伯纳德·马修斯H5N1流感
  • 2007年澳大利亚马流感
  • 2006年印度H5N1流感
  • 1976年豬流感
參見
  • 流感季
  • 流感的演变
  • 流感研究
  • 类流感疾病
  • 流感疫苗年表

世界衛生組織和美國疾病控制與預防中心都建議幾乎任何大於六個月的人，每年應該施打流感疫苗。[1][6]尤其是孕婦、六個月大至五歲的孩童、有慢性疾病者、美洲原住民、以及醫療相關人員。[1][7]

分類

流感疫苗多分为：（裂解）灭活疫苗（IIV）及裂解亚单位疫苗[8]、减毒活疫苗（LAIV）、重组亚单位疫苗（RIV）[9]。灭活疫苗（含灭活全病毒、灭活裂解、裂解亚单位三个子类[8]）最为常用，又分为三价与四价剂型。

其中，对于流感的灭活疫苗是用灭活剂来处理在鸡蛋或细胞培养物中制备的野生型病毒。如果季节性疫苗所包含的病毒在抗原上与最终流行的病毒非常匹配，灭活疫苗通常可以预防一半以上的严重流感相关的疾病[10]。然而，这些人群应禁止接种该疫苗[10]

  1. 接种流感疫苗后出现过危及生命的过敏反应
  2. 对疫苗中的任何成分（其中一些含有少量鸡蛋蛋白）严重过敏的人
  3. 有格林-巴利综合征病史的人

疫苗通常每年接种一剂，但 6 个月至 8 岁的儿童在一个流感季节可能需要接种两剂。

第二种主要流感疫苗是通过鼻腔喷雾局部注射的三价或四价减毒活疫苗。每年都会制备新的疫苗，以解决抗原漂移问题[10]。该疫苗在美国许可用于 2 至 49 岁的人群[10]。

有效性

过去灭活疫苗及减毒疫苗曾产生抗体依赖增强作用使2009年接种季节性甲型H1N1（针对类似A/Brisbane/59/2007的一株）疫苗的人更容易得甲型H1N1pdm09（A/California/7/2009病毒）新型流感。[11]2010年起H1N1株被改为“pandemic系”，2022年为人6B.1a.5a.2系。[12]2011年起开始推广亚单位疫苗。

年度更新

在每年的季节性流行期间，编码血凝素和神经氨酸酶蛋白的基因都会发生点突变，而这两种蛋白是保护性抗体的主要靶标。流行性流感病毒株的这种抗原漂移导致监管官员和生产商每年都要调整流感疫苗中的病毒抗原。偶尔，人类和禽类共同感染的情况下，分割的病毒基因组会重新出现，产生一种新的病毒，也就是抗原转变，从而导致大流行。1918 年（H1N1）、1957 年（H2N2）、1968 年（H3N2）和 2009 年（新型 H1N1）都发生过全球性的大流行。在这种情况下，必须对疫苗进行重大调整[10]。

以下为北半球每年流感疫苗针对的毒株列表。Starting in the 2012–2013 season, the recommendation shifted from a trivalent influenza vaccine (TIV) containing three strains to a quadrivalent influenza vaccine (QIV) that contains both influenza B lineages.

年度H1N1甲流 演化支 类似猪H1支[note 1]H3N2甲流 演化支乙流Victoria株 演化支乙流山形株
November 1998–April 1999[13]A/Beijing/262/95 (H1N1)-like virus 未谱系 A/Sydney/5/97 (H3N2)-like virus N/A B/Beijing/184/93-like virus
November 1999–April 2000[14] B/Shangdong/7/97-like virus[note 2] B/Beijing/184/93-like virus[note 2]
2000–2001[15]A/New Caledonia/20/99 (H1N1)-like virus A/Moscow/10/99 (H3N2)-like virus N/A B/Beijing/184/93-like virus
2001–2002[16] N/A B/Sichuan/379/99-like virus
2002–2003[17] B/Hong Kong/330/2001-like virus N/A
2003–2004[18] B/Hong Kong/330/2001-like virus N/A
2004–2005[19]A/Fujian/411/2002 (H3N2)-like virus N/A B/Shanghai/361/2002-like virus
2005–2006[20]A/California/7/2004 (H3N2)-like virus N/A B/Shanghai/361/2002-like virus
2006–2007[21]A/Wisconsin/67/2005 (H3N2)-like virus B/Malaysia/2506/2004-like virus N/A
2007–2008[22]A/Solomon Islands/3/2006 (H1N1)-like virus B/Malaysia/2506/2004-like virus N/A
2008–2009[23]A/Brisbane/59/2007 (H1N1)-like virus 1B.2.1[12]A/Brisbane/10/2007 (H3N2)-like virus N/A B/Florida/4/2006-like virus
2009–2010[24]B/Brisbane/60/2008-like virus N/A
2010–2011[25]A/California/7/2009 (H1N1)-like virus (0)[26] 1A.3.3.2[12]A/Perth/16/2009 (H3N2)-like virus N/A
2011–2012[27]A/California/7/2009 (H1N1)-like virus N/A
2012–2013[28]A/California/7/2009 (H1N1)pdm09[note 3]-like virus[29]A/Victoria/361/2011 (H3N2)-like virus B/Wisconsin/1/2010-like virus
2013–2014[30]A/California/7/2009 (H1N1)pdm09[note 3]-like virusA(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011[note 4] B/Massachusetts/2/2012-like virus
2014–2015[31]A/California/7/2009 (H1N1)pdm09[note 3]-like virusA/Texas/50/2012 (H3N2)-like virus[note 5]
2015–2016[32]A/California/7/2009 (H1N1)pdm09[note 3]-like virusA/Switzerland/9715293/2013 (H3N2)-like virus B/Phuket/3073/2013-like virus
2016–2017[33][34]A/California/7/2009 (H1N1)pdm09[note 3]-like virusA/Hong Kong/4801/2014 (H3N2)-like virus 3C.2a
2017–2018[35][36]A/Michigan/45/2015 (H1N1)pdm09[note 3]-like virus[37] 6B.1 不再使用
2018–2019[38][39]A/Michigan/45/2015 (H1N1)pdm09[note 3]-like virusA/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus 3C.2a1B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
2019–2020[40][41][42]A/Brisbane/02/2018 (H1N1)pdm09[note 3]-like virus 6B.1A.1A/Kansas/14/2017 (H3N2)-like virus 3C.3a
2020–2021 egg-based vaccines[43]A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus[note 3] 6B.1A.5a.1A/Hong Kong/2671/2019 (H3N2)-like virus 3C.2a1b.1bB/Washington/02/2019 (B/Victoria lineage)-like virus V1A.3
2020–2021 cell- or recombinant-based vaccines[43]A/Hawaii/70/2019 (H1N1)pdm09-like virus[note 3]A/Hong Kong/45/2019 (H3N2)-like virus
2021–2022 egg-based vaccines[44]A/Victoria/2570/2019 (H1N1)pdm09-like virus[note 3] 6B.1A.5a.2A/Cambodia/e0826360/2020 (H3N2)-like virus 3C.2a1b.2a.1
2021–2022 cell- or recombinant-based vaccines[44]A/Wisconsin/588/2019 (H1N1)pdm09-like virus[note 3]
2022–2023 egg-based vaccines[45]A/Victoria/2570/2019 (H1N1)pdm09-like virusA/Darwin/9/2021 (H3N2)-like virus 3C.2a1b.2a.2aB/Austria/1359417/2021 (B/Victoria lineage)-like virus V1A.3a.2
2022–2023 cell- or recombinant-based vaccines[45]A/Wisconsin/588/2019 (H1N1)pdm09-like virusA/Darwin/6/2021 (H3N2)-like virus
2023–2024 egg-based vaccines[46]A/Victoria/4897/2022 (H1N1)pdm09-like virus 6B.1A.5a.2a.1A/Darwin/9/2021 (H3N2)-like virus
2023–2024 cell- or recombinant-based vaccines[46]A/Wisconsin/67/2022 (H1N1)pdm09-like virusA/Darwin/6/2021 (H3N2)-like virus
  1. 早期针对人类流感病毒进行详细谱系，仅存在最接近的猪H1流感病毒的HA蛋白谱系，一些最接近人H1N1流感病毒的猪H1流感病毒甚至属于H1N2型。
  2. The recommendation was for either the B Victoria or the B Yamagata strain.
  3. (H1N1)pdm09 is newer nomenclature for the 2009 pandemic H1N1 virus, not a different strain.
  4. It is recommended that A/Texas/50/2012 is used as the A(H3N2) vaccine component because of antigenic changes in earlier A/Victoria/361/2011-like vaccine viruses (such as IVR-165) resulting from adaptation to propagation in eggs.
  5. A/Texas/50/2012 is an A(H3N2) virus that following adaptation to growth in eggs has maintained antigenic properties similar to the majority of recently circulating cell-propagated A(H3N2) viruses including A/Victoria/361/2011

副作用

疫苗大致上是安全的。在兒童，有5-10%會有發燒的反應，也有可能有肌肉痛、疲倦等症狀。在某些年份，疫苗可能在年長者引起格林－巴利综合征，機率約百萬分之一。疫苗不應該施打於對蛋嚴重過敏者、或有流感疫苗過敏史者。疫苗有不活化疫苗及減毒疫苗兩種。孕婦應該使用不活化疫苗。在施打類型方面，有肌肉內注射、鼻噴劑、皮內注射等形式。[1]

歷史

對抗流感的疫苗在1930年代開始，一直到1945年開始在美國廣為使用。[47][48]它被列在世界衛生組織基本藥物標準清單，即其建議之對基礎健康照護系統最重要的藥物。[49]在2014年，其批發價約5.25美元。[50]在美國，則是少於25美元。[51]

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