衛生署 疾病管制局 中區傳染病防治醫療網 王任賢 指揮官 校園流感防治 衛生署 疾病管制局 中區傳染病防治醫療網 王任賢 指揮官 This presentation will address the risk factors for and the prevention of surgical site infections.
流感的分類 季節性流感 (epidemic influenza) 新型流感 (pandemic influenza) 已經多次造訪人間，大部份人都有抗體 併發症與死亡人數均很少 新型流感 (pandemic influenza) 第一次來到人間，大家都沒有抗體 併發症與死亡人數會很多
季節性流感之防治政策 最高指導原則 呼吸道衛生及咳嗽禮節 防治政策的執行可不必太緊
流感疫苗的效益 減少流感病患死亡 降低流感病毒的排放時間 減輕症狀 流感疫苗無法讓病患免於得到流感
季節性流感疫苗接種的對象 老年人 目的在防止老年人死亡 兒童 目的在減少病毒傳播 醫護同仁 福利
Estimates of the Impact of Full Utilization of the Vaccines Currently Advocated for Adults Disease Estimated annual deaths Estimated vaccine efficacy Current vaccine utilization * Additional preventable deaths/y Influenza 20,000 70% 59% 5,740 Pneumococcal infection 40,000 60% 37% 15,120 Hepatitis B 5,000 90% 10% (1-60%) 4,050 Tet/Diph <25 99% 40% ** <15 Traveller’s diseases <10 - Adult MMR <30 95% variable * Percentage of target groups who are in compliance with current recommendation ** estimated base on seroprevalance data
Onset of Influenza A in Volunteer Slide 26 Days After Inoculation -1 1 2 3 4 5 6 7 8 23 100 Temp °F 99 97 Illness Headache, Malaise, Myalgia Lecture Notes [Keywords] ###This graph illustrates findings of a case report of a volunteer inoculated by nose drops with 300 TCID50 of influenza A H3N2. The onset of illness usually begins 18 to 72 hours after incubation, depending on the concentration of transmitted virus.17 Severity of illness correlates temporally with virus shedding in experimental inoculation of influenza in volunteers. Nasal Obstruction and Discharge, Throat Pain, Cough Adapted from Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Disease. 5th ed. 2000:1831.
Shedding of Influenza A in Volunteer Slide 27 Virus Shedding log10 TCID50 per mL nasal wash Lecture Notes [Keywords] ###As shown here in findings following inoculation of a volunteer, the influenza virus may be isolated from respiratory tract specimens within 24 hours of the onset of illness. In general, viral shedding peaks at 3 to 5 days and is usually complete by 5 to 10 days. Young children tend to shed higher titers of virus for more prolonged periods.17 Day Adapted from Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Disease. 4th ed. 1995:1554.
Influenza Virus transmission Ro: average approximately 2-3 (like SARS) Serial interval: 2-4 days Virus shedding maximal at illness onset Correlated with fever and severity of symptoms Duration of shedding in seasonal epidemics: Adults 5 days; children 7-8 days, up to 21 days Data from children (no immunity) might better represent shedding in a pandemic Longer for immunocompromised persons
流感疫苗之不良反應 Nichols et al. Arch Int Med, 1996;156:1546 This slide demonstrates the rates of local (sore arm) and systemic side effects in the week after injection in the largest randomized controlled trial of influenza vaccine in healthy working adults. Just over 1 in 20 people had a fever, nearly 1 in 5 were abnormally tired, and 6% complained of muscle aches. Before you make conclusions,however, you need to see the next slide - Nichols et al. Arch Int Med, 1996;156:1546
流感疫苗注射與安慰劑注射之不良反應比較 Nichols et al. Arch Int Med, 1996;156:1546 Here you can see that the data you were looking at were the data from the placebo group – when you compare the adverse event rates in placebo and vaccine groups, you seen that vaccine is associated with sore arm in about 40% of people. Although fever occurs after vaccination, it is not CAUSED by vaccination – because we vaccinate people in October and November, when many viruses which cause viral respiratory tract infections are circulating, it is not uncommon to develop illness after vaccine is given. This is a temporal, but not a causal association. Nichols et al. Arch Int Med, 1996;156:1546
何人不能施打流感疫苗? 6個月大以下的小孩 對流感疫苗中任何成分有過敏反應者 以前就對流感疫苗過敏者 對雞蛋具有第一型過敏反應者，會表現出hives、口腔及咽喉腫脹、無法呼吸、休克. 此狀況必須由過敏科醫師詳細評估後才可確定 病人以前接受過流感疫苗並在8週內產生過Guillain-Barré syndrome者 並換以前曾因流感疫苗而產生過嚴重Oculorespiratory Syndrome (ORS)者
何人可緩打打流感疫苗? 當下有嚴重的急性發燒疾病 下列情況仍可施打流感疫苗: 病患具有輕微的急性病，可以有發燒也可沒發燒 病患剛病癒或正在服用抗生素 施打流感疫苗兩天後始可捐血
校園流感疫苗施打前之準備 外聘醫師及護理師各ㄧ名，視學生人數而增加 導師、保健室護士、醫師、護理師均必須於施打前接受流感疫苗及施打細節之訓練 發放同意書及流感疫苗施打說帖，請學童家長簽署後同意書於施打前繳回 同意書由疾病管制局發給，施打說帖由衛生局主導編撰 對於不同意施打的家長，應由保健室打電話訊問原因，排除可能的誤解
流感疫苗施打說帖之內容 流感之嚴重性 流感疫苗介紹 施打流感疫苗之好處 流感疫苗施打會衍生出哪些不良反應 哪些反應不歸屬於流感疫苗施打所造成 哪些人不能打或緩打流感疫苗 施打流感疫苗後該注意之保健工作
流感疫苗施打時之流程 班級整隊 施打前評估 疫苗施打 施打後在教室觀察30分鐘
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