臺北市兒童卡介苗接種之需求評估

Assessment of the Need for Universal BCG Vaccination in Children in Taipei City

王培東(Pair-Dong Wang)

《北市醫學雜誌》 2卷6期 (2005/06) Pp. 526-534

https://doi.org/10.6200/TCMJ.2005.2.6.04

摘要

目的：本研究主要目的是探討臺北市兒童結核病的流行現況並評估全面性兒童卡介苗接種的必要性。方法：以回朔性研究蒐集1998～2002年間，完成中心登記之0-14歲兒童結核病個案，以瞭解台北市兒童結核病發生之狀況及趨勢；另收集1996-2000年間台北市國小二年級學童接受結核菌素皮膚測試之結果，用以推估7歲兒童結核病感染盛行率及年結核感染率，最後據此分析是否可以中止卡介苗接種。結果：台北市兒童結核病在1998-2002年的平均年發生率為每10萬人口4.10人，0-4歲兒童結核性腦膜炎的平均年發生率為每10^7全人口0.76人，在連續五年中只有2002年出現1個病例，其餘1998-2001年均為0病例；在結核菌素皮膚測試方面，結核菌自然感染的盛行率由1996年6.27%下降至2000年1.40%，結核年感染率亦從0.92%降至0.20%。結論：整體而言臺北市兒童結核病的流行現況雖已符合國際抗癆抗肺疾聯盟所建議可以中止卡介苗接種的三項條件中的一個，然而台北市結核病的整體發生率仍然偏高，而且兒童患者的結核病75%是被傳染而非再活動性，以致兒童被傳染的危險性也增高，故目前並不適宜貿然中止全面性卡介苗接種計畫。建議臺北市結核病防治宜將重點放在治療成人的痰陽可傳染性病患管理上，臺北市的兒童才有中止卡介苗接種的環境。

關鍵字

卡介苗 ； 兒童結核病 ； 臺北市 ； 疫苗

並列摘要

Background and Purpose: This retrospective study evaluated epidemiological trends in tuberculosis among childhood and whether or not universal vaccination should be retained in Taipei City. Methods: Data of all recorded tuberculosis cases among childhood from 1998 through 2002 obtained from the Tuberculosis Registry Center was analyzed for the trend of incidence. Tuberculin skin tests were also performed to estimate the prevalence and annual risk of tuberculosis infection in second-grade school children during the period 1996-2000. Results: The results show that average annual incidence of tuberculosis among childhood was 4.1 per 100,000 populations during 1998-2002 in Taipei. The average annual incidence of tuberculosis meningitis in children 0-4 years old was 0.76 per 10 million general population over the previous 5 years (1998-2002). In second-grade school children, the annual risk of tuberculosis infection was 0.2% in 2000 with a decreasing trend over the study period. Conclusions: Our findings indicate that one of the criteria established by International Union Against Tuberculosis and Lung Disease to discontinue universal BCG vaccination have already been met in Taipei. Despite these favorable effectiveness, considering the incidence of TB were as high as 70.14 per 100,000 populations in Taipei, mass BCG vaccination should be retained till the risk of exposure decreased.

並列關鍵字

Bacillus Calmette-Guérin (BCG) ； tuberculosis among childhood ； Taipei City ； vaccine