百日咳確定病例與接種百日咳疫苗之關係

Association between Pertussis Cases and Pertussis Vaccination

王志銘(Chih-Ming Wang)

指導教授 ： 李蘭

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01710

摘要

目的：由台灣近年來發生的百日咳疫情可以發現，有些接種三劑以上百日咳疫苗的兒童，仍然遭受百日咳桿菌的感染，故本研究希望藉由分析衛生署疾病管制局的各項傳染病系統資料，以瞭解「百日咳確定病例」與「接種百日咳疫苗」之關聯性，並探討百日咳確定病例「住院與否」與「接種百日咳疫苗」之關聯性。
方法：在瞭解接種百日咳疫苗與百日咳疫情之關聯性方面，利用2003年1月至2012年4月底的病例資料，計算接種百日咳疫苗劑次的比例，並分析未完整接種百日咳疫苗與感染百日咳是否有關。在探討「住院」與「未完整接種百日咳疫苗」之關聯性方面，調閱2010年至2011年病例之疫情調查表，計算出現的症狀及住院的比例、重要症狀及住院的持續天數，並分析「住院」與「未完整接種百日咳疫苗」是否有關。
結果：確定病例中以「超過疫苗保護年齡」者比例最高（43.8%），其次為「未達接種年齡」者（21.3%）及「完成四劑」者（12.4%）。卡方檢定發現「未完成完整四劑之疫苗接種」與「感染百日咳」有關。另外，症狀出現比例最高者為咳嗽（97.8%），其次是陣發性咳嗽（64.5%），且有47.1%的人有住院。重要症狀之持續天數最長為咳嗽（172天），其次為類感冒症狀（148天）、陣發性咳嗽（132天）、頭痛（102天）、咳嗽後嘔吐（98天）；這些症狀持續天數的平均值，前三位依序是咳嗽（22.8天）、類感冒症狀（20.4天）、陣發性咳嗽（19.8天）。住院天數最長為20天，最短3天，平均8.4天。另卡方檢定發現「未完成四劑疫苗接種」與「住院」之間有關。
結論：本研究發現，已超過疫苗保護年齡之民眾，可能會將百日咳菌傳染給尚未接種疫苗的嬰幼兒，故應追加接種喚醒年長族群的免疫記憶，以避免傳染給周邊的嬰幼兒高危險群。另外，雖然接種疫苗仍感染的事件偶有所聞，但本研究發現接種疫苗可有效預防百日咳，即使接種疫苗後依然有感染風險，疫苗仍有助於民眾減少住院情形。

關鍵字

百日咳 ； 感染 ； 疫苗

並列摘要

Objectives: The pertussis epidemic occurred in recent years in Taiwan shows that although some children have been vaccinated more than three doses of pertussis vaccine, they still suffer from Bordetella pertussis infection. Thus, the aims of this study were to investigate the association between the pertussis cases and pertussis vaccination, and explore the relationship between the hospitalization of pertussis cases and pertussis vaccination by the data of infectious diseases from Centers for Disease Control, Taiwan.
Methods: In order to investigate the association between the pertussis vaccination and pertussis epidemic, data from January 2003 to April 2012 were used to calculate the ratio of different doses of pertussis vaccines and to analyze the association between pertussis-unvaccinated and pertussis infection. In addition, to explore the relationship between the hospitalization and pertussis-unvaccinated, data from 2010 to 2011 were used to calculate the ratio of clinical symptoms, hospitalization, the days of important symptoms and hospitalization, as well as analyze the association between hospitalization and pertussis-unvaccinated.
Results: The highest ratio of cases was the citizen whose age is beyond the vaccine protection (43.8%), followed by those below vaccination age (21.3%) and those completed four doses of pertussis vaccines (12.4%). The chi-square test demonstrates the association between "incompletely taking the four doses of pertussis vaccines" and "pertussis infection." In addition, the highest ratio of symptoms was cough (97.8%), followed by paroxysms of coughing (64.5%), and 47.1% people were hospitalized. The longest days of important symptom is cough (172 days), followed by cold-like symptoms (148 days), paroxysms of coughing (132 days), headache (102 days), and post-tussive vomiting (98 days after ). The top three number of average days were cough (22.8 days), cold-like (20.4 days), and paroxysms of coughing (19.8 days). The maximum days in the hospital were 20 days, and the minimum were 3 days, with an average of 8.4 days. The chi-square test demonstrates there is an association between " incompletely taking the four doses of pertussis vaccines" and "hospitalization."
Conclusion: This study found that the citizen whose age is beyond the vaccine protection may transmit the pertussis bacteria to the infants and young children not yet vaccinated. Therefore, the immune memory of older population should be waken up by the additional vaccination in order to avoiding transmit the pertussis bacteria to the surrounding high-risk groups of infants and young children. In addition, this study found that although the issue of infection after vaccination happen occasionally, the vaccination can still be effective in preventing pertussis. Even the infection risk still exists after vaccination; the vaccine may help people to reduce the probability of hospitalization.

並列關鍵字

Pertussis ； Whooping cough ； Infections ； Vaccine

參考文獻

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