2013-01-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/648944摘要:關鍵詞:血清流行病學、A型肝炎、水痘、麻疹、百日咳 台灣兒童感染團隊(TPIDA)自2010年開始建構,由台大醫院黃立民教授主持。從起初六家醫學中心增加至目前七家參加研究的醫院(包括台大醫院、林口長庚兒童醫院、花蓮慈濟醫院、台北馬偕醫院、中國醫藥學院附設醫院、成大醫院及高雄長庚醫院),近一年來已合作完成與兒童下呼吸道感染相關的多項整合型研究,明年開始將繼續合作研究各種兒童疫苗接種的效果。 常規的疫苗施打已經改變過去常見感染性疾病的流行病學,但由於疫苗的保護效果不一定是終生有效,而且有些族群,並沒有全面接受疫苗。了解並追蹤重要傳染病的血清流行病學,有助於政府疫苗政策制定。本計畫目標為建立台灣國小學童重要傳染病在各年級之血清抗體盛行率資料,並作為國民免疫力長期追蹤調查計畫之先驅計畫,完成國民免疫力長期追蹤調查,以提供新疫苗政策訂定或原有疫苗政策修訂之的重要依據。原則上依衛生署傳染病諮詢委員會預防接種組(ACIP)決議之優先順序進行,本次調查之疫苗可預防疾病依序為:A型肝炎、水痘、麻疹、百日咳。A型肝炎是世界各地都會發生的流行性疾病,在己開發國家偶爾可以見到它的局部流行。現在所用的A型肝炎疫苗由於它的價格目前仍相當昂貴,尚未引入政府全面免費施打疫苗的項目。根據過去的研究發現大多數年輕人百分之九十五未曾接觸過此病毒,表示目前A型肝炎在台灣甚少見其蹤跡。如此一來,有許多人未曾在兒童期感染感染,一旦流行,往往在成人造成較嚴重的症狀,而且會使流行的規模大得不可收拾,了解A型肝炎血清抗體流行病學絕對有其必要性。水痘疫苗自2004年起,列入常規疫苗,水痘的最高發生率已從2000年到2003年,四到五歲兒童的每千人有六十六例顯著下降到2008年,六歲兒童的每千人有二十三例。但水痘抗體的持續性或疫苗接種後感染病例的研究,仍值得持續進行,是否應如美國一樣施打第二劑,仍有待進一步地觀察及追蹤。麻疹是一種急性、高傳染性的病毒性疾病。民國81年衛生署實施「根除三麻一風計畫」後,麻疹的報告病例明顯減少。但近年來仍有些許麻疹群聚感染的現象發生,主要因為與鄰近我國之中國或東南亞地區交流頻繁,另外最近台灣本土的研究也指出國人麻疹抗體的盛行率正在下降。研究國人麻疹抗體的盛行率與免疫力,有助於我們朝向根除麻疹目標邁進。百日咳是一種高度傳染性的呼吸道疾病,雖然有有效的藥物與廣泛的疫苗接種,但是至今世界上仍沒有任何一個國家根除百日咳,主因在於百日咳疫苗保護力僅維持6到12年,無法持續到青少年或成年人。以前認為青少年或成年人不需要追加接種疫苗,因為成人得到百日咳通常以長期咳嗽來表現,少有嚴重的疾病或併發症。但近年的研究發現,在嬰幼兒疫苗接種率高的國家,青少年與成人感染百日咳的比例漸漸提高,成為嬰幼兒百日咳主要的傳染來源。自民國98年度,政府開始推動國小一年級學童接受新三合一疫苗(破傷風、減量白喉、減量非細胞性百日咳混合疫苗,Tdap)接種,目的在於增加了非細胞性百日咳疫苗,來補強學童免疫力,並避免學童將百日咳傳染給嬰幼兒,引發重症。台灣百日咳疫苗接種政策是否需要修訂需持續的血清與流病監測。本計畫第一年(102年度)預定抽出樣本約為1500位國小學童,以及1000位國中學童,並採多段分層抽樣,將全國各鄉鎮市區依人口密度等特性分層,每一層內的小學、國中為第一層抽取單位,被抽的機率和該層小學生及國中生人數多少成正比,被抽到之學校國小1-6年級、國中1-3年級均抽樣,每1年級抽1班。第二年(103年度)預定抽出樣本約為3000位0~5歲學齡前兒童,先分北中南東(每區抽出樣本數與6歲以下人口數成正比), 各區再依健兒門診量將衛生所醫療院所分層(約4層)屆時抽出一定之醫療單位,每一醫療單位抽出約2-10名幼兒。完成抽樣、有效樣本數之個案檢體採集(每位受試者抽血5-10 cc )後、進行抗體檢測及分析等。<br> Abstract: keywords:seroepidemiology、hepatitis A、varicella、measlesTPIDA is now composed of 20 core members, including infectious diseases specialists, virologists, molecular biologists, and more than 30 technicians and assistants working together. The clinical research network will be organized into a clinical database center, a respiratory virus bank, 2 central labs including one HAE lab, all be supervised by the Research Committee. Investigators from 8 major medical centers that cover northern, central, eastern, and southern parts of Taiwan will join in this consortium. These centers include: National Taiwan University Hospital, National Cheng Kung University Hospital, Mackay Memorial Hospital (Taipei), Chang Gung Memorial Hospitals (Linkou Branch and Kaohsiung branch), Hualien Tzu Chi Hospital, China Medical University Hospital, and Veterans General Hospital (Taichung).Routine immunization has changed the epidemiology of vaccine-preventable diseases. However, the immunity provided by vaccine may be not life-long. Surveillance of seroepidemiology on vaccine-preventable diseases would provide a strong evidence-informed foundation from which to successfully advocate for improvements in vaccine policy and methods of surveillance. The aim of this study is to evaluate the seroprevalence for diseases of hepatitis A, varicella, pertussis and measles. According to previous studies in Taiwan, most young adults did not have antibody response to hepatitis A virus (HAV), which indicated hepatitis A was not endemic in Taiwan for years. Once HAV was introduced, a large outbreak can be predicted. Therefore, seroepidemiology survey for hepatitis A virus is important. Varicella is the primary disease caused by varicella-zoster virus (VZV). It is a common and highly contagious disease and has a significant health impact on children. In Taiwan, since 2004, routine varicella immunization provided by the government has been administered to all one-year-old children. A significant post-vaccination decrease in incidence among preschool children, especially for 3 to 6 year-old children had been identified. The peak incidence was reduced from 66 per thousand for 4 and 5 year-old children before the nationwide immunization (from year 2000 to 2003), to 23 per thousand for 6 year-old children in 2008 (p < 0.001). Currently, the varicella vaccine program consists of a single-dose vaccination in Taiwan. However, both varicella outbreaks and breakthrough infections have occurred after the single-dose varicella vaccine program was initiated. These might be related to a loss of immunity or to primary vaccine failure. In the United States, varicella immunization policy has been changed by stipulating that 2 doses be administered, once at 1 year of age and another administered between the ages of 4 and 6 years old since 2006. In Taiwan, boosters in 4-6 year-old children to reduce the breakthrough infection or amend the primary vaccine failure may be considered if further epidemiology reveals frequent outbreaks or breakthrough infections in kindergarteners. The Taiwanese government has been making great efforts to eliminate measles, mumps, and rubella by sustaining high vaccination-coverage levels (>95%), implementing a second dose of MMR at primary school entry, and maintaining an effective surveillance system. Due to the alteration of political policy, Taiwan had seen an increased volume of travel from and to China and other Asian countries in recent years. During November 2008 to February 2009, a resurgence of measles caused by imported index cases occurred in Taiwan. Increased reports of measles outbreaks were reported globally, even in areas with high vaccination coverage. According to a study conducted by Chang-Gung Memorial Hospital, a decreased seropositivity of measles to a level of 50–60% in adolescents and young adults up to 25 years old was found. Among 53 patients with confirmed measles during November 2008 and May 2009 in Taiwan, 12 (23%) patients have received at least one dose of measles-containing vaccine. The waning vaccine-induced immunity against measles may have impact on the control of measles, especially when the vaccinated population becomes older. It is worth to evaluate the immunity against measles in the population in Taiwan to eliminate measles.Pertussis, an acute, infectious cough illness, remains endemic in many areas despite routine childhood pertussis vaccination for more than half a century and high coverage levels in children for more than a decade. A primary reason for the continued circulation of Bordetella pertussis is that immunity to pertussis wanes approximately 5--10 years after completion of childhood pertussis vaccination, leaving adolescents and adults susceptible to pertussis. Pertussis vaccine has been routinely given in infants at age 2, 4, 6, 15-18 months in infants. Since 2006, Taiwan Centers for Disease Control has included the combined tetanus, diphtheria and acellular pertussis (Tdap) vaccine into the routine childhood immunization program. The implementation of the new vaccine policy aims to improve schoolchildren’s overall immunity against pertussis.In the project, we attempt to recruit 1500 junior high students and 1000 elementary school students from island wide to evaluate seroprevalence for diseases of hepatitis A, varicella, measles and pertussis. These data would provide estimates of vaccine coverage and immunity against vaccine-preventable diseases by population.血清流行病學水痘麻疹百日咳A型肝炎seroepidemiologyhepatitis Avaricellameasles學童血清流行病學調查計畫