臺北地區1984至1985年之麻疹流行臨床觀察

An Epidemic of Measles during 1984-1985 in Taipei Clinical Observations

李俊賢(Jing-Sheng Lee) ； 謝貴雄(Kue-Hsiung Hsieh) ； 李慶雲(Chin-Yun Lee)

《Acta Paediatrica Sinica》 28卷4期 (1987/08) Pp. 234-238

摘要

在以往麻疹是一種小兒常見的傳染疾病，自從麻疹疫苗普遍接種以來，其罹病率及致死率已大幅下降，然而自1984年秋天開始到1985年春天，臺灣地區發生了大規模流行。本報告收集在這段期間至台大醫院小兒科求診的114名病患，分析結果如下：⑴流行高峯在1~2 月，此與以前未接種疫苗時代發生在5月不同。⑵將近一半的病患(55/14,48.2%)年齡在5歲以下，其中有大部份(27/55)年齡在1歲以下：石5歲以上的病例占了51.8%。⑶只有約20%的病患確曾接種疫苗。⑷有二名病患死於肺炎及呼吸衰竭，其中之一是法洛氏四重症：另一位是尚在化學治療中的組織球增生症。推測本次流行的原因有⑴木接種疫苗的人口累積到某一程度而爆發流行⑵原發性接種疫苗失敗如疫苗儲存條件不當、母親經胎盤得來的抗體或濫用免疚球蛋白乾擾所造成⑶隨著時間抗體可能逐漸消失，而失去保護作用，增加了感染的機會。

並列摘要

Prior to the introduction of effective vaccination, measles had been an endemic disease in children in developing countries. Following the introduction of measles vaccines, the morbidity and mortality rates decreased dramatically all over the world. However, a big epidemic of measles occurred again in Taiwan from the autumn of 1984 to the spring of 1985. A total of 114 cases who visited the Department of Pediatrics, NTUH during that period, were collected and analysed.
The results showed that 1) the epidemic peaked in January and February which was in contrast to that seen in the preveccination era, when the epidemic peaked in May; 2) the age of measles affected was most often below 1 year (27/114, 23.7%), but another peak occurred at the age of 5-7 years (31/114, 27.2%); 3) a definite history of vaccination could be obtained in only 20% and 4) 2 cases (1.75%) died of respiratory failure after severe pneumonia. One was operated for tetralogy of Fallot, the another was a victim of histiocytosis X who was just on chemotherapy.
Several possibilities have been proposed to explain the occurrence of this epilemic.
1)The unvaccinated or susceptible population increased gradually during the past years & amounted finally to the critical level for an epidemic to develop. 2) Increase in the number of primary vaccination failure due to inappropriate storage of the vaccine, to vaccination in infancy without revaccination & to concomittant passive antibody due to the abuse of immune serum globulin.
Efforts to increase the overall vaccination rate, and to reduce unsuccessful vaccination by health authorities and pediatrician are the key to bring measles epidemics under control in future.

並列關鍵字

measles ； vaccination failure