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題名 | 臺灣幼兒接種卡介苗政策之評估及展望=Assessment and Perspective of BCG -Vaccination Policy in Taiwan |
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作 者 | 邱美玉; 許建邦; 黃彥芳; 陳昶勳; | 書刊名 | 疫情報導 |
卷期 | 31:5 2015.03.10[民104.03.10] |
頁次 | 頁104-114 |
分類號 | 412.452 |
關鍵詞 | 卡介苗; 結核病; 疫苗; 結核性腦膜炎; |
語文 | 中文(Chinese) |
中文摘要 | 卡介苗接種策略是一項具有實證根據的結核病防治政策,深受世界衛生組織及世界各國所推崇,在結核病負擔較高的國家中,仍是一項極為重要的策略。接種卡介苗可減少嚴重結核病造成終生殘疾或死亡,然而也造成少數幼童有不同程度的不良反應,使其成為結核病防治政策中頗具思辯的議題。 本文針對我國現行卡介苗接種政策之選定及主動監測機制進行評析,其中我國歷來採用日本 Tokyo 172菌株,在相同保護力的情形下該菌株為毒性較弱,引起不良反應機率較小的菌株。每次接種之活菌數為 7.5x10 5,較鄰近國家日本每次接種之活菌數為少,但以 5歲以下結核病發生率觀之,我國卡介苗確實發揮其保護力。接種時程及接種方式之訂定則參照世界衛生組織之建議,為出生後 24小時後及早接種,選擇每次注射劑量較穩定的皮內注射。並持續對卡介苗接種業務人員進行相關教育訓練,以維護皮內注射之接種品質。此外,自 2007年起推行卡介苗之主動監測機制,就完整追蹤之 2008~2009出生世代資料顯示,我國嚴重不良反應案件(骨炎/骨髓炎)發生率約為每百萬人口 55例,尚在世界衛生組織估計的範圍內。 國際抗癆聯盟曾訂定停止全面接種卡介苗的條件/標準,經評估後,我國之疫情條件尚未符其訂定之標準,故結核病防治專家會議決議,即使有少數嚴重不良反應發生,權衡結核病在幼童有致死或導致失能的嚴重後果,仍應依照世界衛生組織之建議,繼續按原時程接種。為減少接種卡介苗可能帶來的傷害,已建置不良反應主動監測機制、強化提供家長完整的接種資訊及後續關懷追蹤。未來將持續進行疫苗安全性評估及教育訓練等作業,使卡介苗接種衍生的不良反應案件儘速釐清,並作為調整未來卡介苗接種政策之參考。 |
英文摘要 | BCG-vaccination is an evidence-based, tuberculosis (TB) control policy endorsed by many countries and World Health Organization (WHO). Especially in high TB-burden countries, it protects unspecified population. BCG-vaccination reduces disability and death caused by TB and accompany with low risk and different types of adverse reaction. There is a history of controversial concern over its efficacy and impact. This article describes Taiwan`s current policy of BCG-vaccination and active surveillance mechanism. Since 1977, Taiwan`s BCG vaccine was manufactured from Japanese Tokyo 172 strain. This strain was less virulent and caused less adverse events as revealed by published literature. The number of bacilli in single injection dose was 7.5x105, which was less than the dose in Japan. Follow recommendation of WHO, we complete BCG-vaccination in the infancy and choose intradermal injection. As a routine vaccination program, the TB incidence rate in the population younger than 5 years old was in accordance with other low-TB burden countries without routine BCG-vaccination. Moreover, continuous training of BCG-vaccination skill was provided to maintain good quality of inoculation. In accordance, a BCG-vaccination active surveillance was established since 2007. The birth cohort of 2008-9 reveals the incidence of severe BCG-related adverse events was 55 cases per million population which was under the estimated range by WHO. The current TB status in Taiwan did not fit to the criteria to terminate BCG-vaccination as recommended by the International Union against Tuberculosis and Lung Disease (IUATLD). After weighing the mortality and long-term side effects caused by TB meningitis, the TB experts’ panel suggested to adopt recommendation of WHO and keep current BCG-vaccination policy as usual. In order to reduce the possible BCG-related harm, active surveillance mechanism was set up, strengthened providing comprehensive information and, follow up and personal care; furthermore, vaccine safety evaluation, health education and training, and to fast clarify the cause of adverse reaction. These would be the references for adjusting the policy of BCG-vaccination in the future. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。