由“不活性傷寒疫苗之副作用”談軍中傷寒防治策略

本研究以海軍某艦艇單位施打不活性傷寒疫苗(TAB)來評估疫苗副作用，並針對軍中傷寒防治提出建議。1994年六月，海軍某艦艇男性士官兵共92人，其中有84人(82.4%)接種TAB疫苗，年齡在20到28歲(21.9±0.7)，一般身體狀況良好，無發燒或特殊病史。採皮下注射0.5cc，並發給問卷，記錄接種後48小時內之各項症狀。問春回覆者共73人(86.9%),其中33人(45.2%)記錄至少一種副作用。所記錄的副作用人數和比例為：打針部位疼痛29人(39.7%)；打針的手臂疼痛無力15人(20.6%)；發熱全身倦怠8人(11.0%)；打針部位發紅腫脹6人(8.2%)；頭暈4人(5.5%)：腹瀉3人(4.1%)；頭痛2人(2.7%)；頸部淋巴結腫大1人(1.4%)。這位淋巴結腫大者後來診斷確定是「急性淋巴球白血病」(acute lymphoblastic leukemia)，洽由此次疫苗接種提早發現。本文依據文獻資料比較TAB疫苗與活性。服傷寒疫苗(Ty21a)在疫笛效力、方便性及副作用等的差異，並建議軍中停止每年全面性施打此副作用大但保護效果卻有限的不活性傷寒疫苗(TAB)；若有任務需要可採用免疫效果更好且副作用極少的活性。服傷寒疫苗(Ty21a)。其他相關建議包括：（一）「食勤人員」的體檢項目，應增加糞便之傷寒細菌培養檢查，以發現潛伏的無症狀傷寒帶原者，減少引爆流行之可能：（二）定時做拱水系統的傷寒菌偵測，以確保飲水安全；（三）對醫院檢驗科工作同仁，給予活性口服傷寒疫笛Ty21a，以增加免疫力。

關鍵字

傷寒；預防接種；副作用

並列摘要

Two specific aims of this study are :(1) to evaluate the adverse reactions of killed parenteral typhoid vaccine (TAB), and (2) to give recommendations for military typhoid control strategies in Taiwan, R.O.C. Eighty four (82.4%) male soldiers (mean age 21.9±0.7) in one naval ship (total 92 persons, age 20-28y/o) received the TAB vaccine with a dosage of 0.5cc through subcutaneous injection in June, 1994. Seventy three (86.9%) persons answered a structured questionnaire about adverse reactions. Among them, 33 cases (45.2%) had at least one of the following adverse reactions: local tenderness at the injection site, pain and soreness of arm, fever and general malaise, local swelling at injection site, dizziness, diarrhea, and headache. One case with neck lymphadenopathy was finally diagnosed as acute lymphoblastic leukemia which was detected earlier through this immunization. According to adverse reactions and vaccine delivery practices between TAB and Ty21a vaccines, we recommend to stop using TAB vaccine but immunize soldiers with Ty21a vaccine for its better protection and less side effects. Other recommendations include: (1) to screen ”stool culture” of typhoid bacilli routinely among food handlers, (2) to set up a periodic bacterial surveillance of water supply, and (3) to immunize hospital diagnostic laboratory personnel with Ty2la vaccine.

並列關鍵字

Typhoid fever ； Immunization ； Adverse reaction

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由“不活性傷寒疫苗之副作用”談軍中傷寒防治策略

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