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作者:台大醫院小兒部李秉穎醫師

建立:2005.11.02

修改:2005.11.02

慢性神經肌肉疾病兒童應該每年接種流感疫苗

最近美國醫學會雜誌刊出一篇費城兒童醫院的報告,該研究由2000年6月到2004年5月之間,針對745名培養出流感病毒的21歲以下住院兒童進行分析。根據多變數分析的結果,患有神經病變或神經肌肉疾病的兒童,一旦感染流感之後併發呼吸衰竭的比率達12%,稍高於慢性肺病的9%與心臟病的8%,可見這些神經肌肉系統異常的病人特別需要接受流感疫苗注射。美國預防接種諮詢委員會於2005年開始增加一項流感疫苗建議接種對象:「患有呼吸功能異常、呼吸道分泌物需特別照護、容易吸入外物之疾病,包括認知障礙、脊髓受傷、癲癇與其他神經肌肉病變」,此研究結果支持新加的疫苗接種建議。

2005年美國預防接種委員會的建議接種對象包括:1. 50歲以上老人;2. 居住於慢性醫療問題病患的照護場所;3. 慢性心肺疾病,包括氣喘,但不包括高血壓;4. 前年因為慢性疾病需要規律追蹤者,慢性代謝性疾病(包括糖尿病)、腎功能異常、血色素異常、免疫功能不全(包括治療藥物或人類免疫不全病毒引起者);5. 患有呼吸功能異常、呼吸道分泌物需特別照護、容易吸入外物之疾病,包括認知障礙、脊髓受傷、癲癇與其他神經肌肉病變;6. 長期服用阿斯匹靈的6月至18歲兒童;7. 於流感流行季節懷孕;8. 6-23月兒童;9. 容易傳染流感給高危險者:醫護人員與其他僱員、居家照護人員、親密接觸者。

 

研究論文摘要

文章出處:Keren R, et al. JAMA. 2005;294:2188-2194.

Context The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for children with certain chronic medical conditions to prevent serious complications of influenza infection. Little is known about the relative contribution of each of these chronic medical conditions to the development of serious influenza-associated complications.

Objective To identify chronic medical conditions that are associated with respiratory failure in children hospitalized with community-acquired laboratory-confirmed influenza.

Design, Setting, and Patients A retrospective cohort study of patients aged 21 years or younger hospitalized at The Children’s Hospital of Philadelphia with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (June 2000 through May 2004). We examined 9 ACIP-designated high-risk chronic medical conditions and 3 additional chronic medical conditions (neurological and neuromuscular disease [NNMD], gastroesophageal reflux disease [GERD], and history of prematurity) that in recent studies have been associated with influenza hospitalization and severe influenza-related complications.

Main Outcome Measures Rate and odds ratio (OR) of respiratory failure, defined as need for mechanical ventilation.

Results Of 745 children hospitalized with community-acquired laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated high-risk chronic medical conditions. Neurological and neuromuscular disease, GERD, and history of prematurity were present in 12%, 14%, and 3%, of children, respectively. Thirty-two children (4.3%) developed respiratory failure. In multivariate logistic regression analyses, conditions associated with respiratory failure included NNMD (OR, 6.0; 95% confidence interval [CI], 2.7-13.5), chronic pulmonary disease other than asthma (OR, 4.8; 95% CI, 1.5-15.1), and cardiac disease (OR, 4.0; 95% CI, 1.6-10.2). The predicted probabilities of respiratory failure derived from the multivariate model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and 8% (95% CI, 4%-18%) for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively.

Conclusions These results support the ACIP’s recent decision to add NNMD to the list of conditions for which annual influenza vaccine is recommended in children. Neurologists and primary care pediatricians should be alerted to the increased risk of respiratory failure and the importance of influenza vaccination in children with NNMD.

 

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