台灣某監獄爆發流行性感冒事件之流行病學及Oseltamivir使用之經驗

The Experience of Using Oseltamivir for Influenza Outbreak in a Prison in Taiwan

張雍敏(Yung-Ming Chang) ； 蘇秋霞(Chiu-Hsia Su) ； 鄭玉新(Yu-Hsin Cheng) ； 姜淑莉(Shu-Li Chiang) ； 盧進德(Chin-Te Lu) ； 陳豪勇(Haur-Yeong Chen) ； 楊世仰(Shih-Yan Yang) ； 陳昶勳(Chang-Hsun Chen) ； 張上淳(Shan-Chwen Chang)

《感染控制雜誌》 16卷5期 (2006/10) Pp. 265-275

https://doi.org/10.6526/ICJ.200610_16(5).0001

摘要

流行性感冒（流感）是一種急性傳染病，就人口密集機構的高危險群病人而言，一旦發生流行，感染率可能高達40-50%。民國93年8月20日起台灣某監獄受刑人陸續出現突然發燒、咳嗽、肌肉酸痛、喉嚨痛等症狀。經通報後，部分病例迅速檢驗證實爲A型流感，衛生單位除展開調查外，並介入防疫措施，以期控制疫情。自民國93年8月20日至民國93年9月30日止，該監獄共有186位受刑人符合流感之病例定義，侵襲率爲9.1%。在使用抗病毒藥物控制疫情時，除對病例給予治療性投藥及病例之同寢室接觸者預防性投藥外，尚針對疫情較嚴重的房舍受刑人進行全面預防性投藥。本調查共計186人及953人分別服用治療性及預防性用藥，研究結果顯示，在抗病毒藥物全面性投予之房舍，呈現顯著終止傳播及控制疫情效果。自最後1名病例之發病日起，續追蹤28日後，該監獄並無新個案發生；且原本有症狀之患者服藥後，其症狀皆迅速緩解，也無服藥後導致副作用的情形發生。然而，於爆發疫情之初，該單位並未及時上網通報，致衛生單位介入時，已出現次級感染，可能是導致本次疫情無法在局部投予預防性抗病毒藥物後，在短時間內迅速控制疫情之主因。

關鍵字

流行性感冒 ； 監獄 ； 抗病毒藥物

並列摘要

Influenza is an acute respiratory infectious disease with high transmissibility. The attack rate may be up to 40-50% in high-density-population institutions. Since August 20th of 2004, some inmates from one prison experienced sudden onset of fever, cough, myalgia and sore throat. After being reported to the health authorities some cases were proved to be influenza A. The health authorities initiated an investigation, as well as implementation of preventive measures in order to confine the spread of disease. From August 20th of 2004 till September 30th of the same year, a total of 186 inmates from the prison fulfilled the case definition of influenza. The attack rate was 9.1%. Antiviral drug-ose1t-tmvir was administered to the symptomatic cases. In addition, oseltamivir was used as prophylaxis for those inmates who stayed in the same room with the syriptomatic cases. Later, oseltamivir was prescribed more aggressively for those inmates who stayed in buildings with a higher number of cases. Therapeutic and prophylactic oseltamivir were given to 186 and 953 inmates respectively, and the study results indicated that the spread of outbreak was terminated and the epidemic was confined more effectively in buildings with comprehensive antiviral drug administration. A follow-up survey 28 days after the onset of the last patient showed no more new cases in that prison. Moreover, the drug relieved the patient's influenza symptoms rapidly without my adverse reaction. In retrospect, the prison failed to report to the health authorities at the beginning of the outbreak and secondary infection had occurred when the agency started to intervene. That was the most likely reason why the outbreak could not be controlled sooner, even after giving the antiviral drug treatment for the patients and prophylaxis for the close contacts.

並列關鍵字

influenza ； prison ； antiviral drug ； oseltamivir