百日咳
维基百科，自由的百科全书
| ICD-10 | A37. |
|---|---|
| ICD-9 | 033 |
| DiseasesDB | 1523 |
| MedlinePlus | 001561 |
| eMedicine | emerg/394 ped/1778 |
百日咳 (pertussis)，意思是指強烈的咳嗽，所以又名 whooping cough。
目录 |
[编辑] 傳染途徑
人為百日咳桿菌的唯一宿主，其主要侵犯的對象是孩童，有一半的個案是一歲以下的嬰兒，且此病較常發生在女孩身上。傳染途徑主要是由空氣傳染(間接)或飛沫傳染(直接)，病菌經由患者呼吸道之飛沫散播後，進入易感宿主之呼吸道而傳染，並不需要經由媒介物傳染。感染性病菌經常是經由兄弟姊妹或父母帶回家散播。早期陣發性咳嗽未出現之前疾病具有高度傳染性，之後傳染力逐漸降低，約三週之後，縱使病人仍有持續痙攣性咳嗽或哮喘亦不具傳染性。
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維基百科的內容不可視作醫療意見。任何健康問題應諮詢專業的醫護人員。 |
[编辑] 臨床症狀
平均潛伏期約七至十天，很少超過14天。百日咳的臨床症狀初期的卡它期，會出現流鼻水、輕微咳嗽及發燒等類似上呼吸道感染的感冒症狀，持續約1至2週。接著為發作的陣咳期，此時呼吸道分泌物愈多愈黏稠，而咳嗽也更嚴重，其為突然的陣痙性的咳嗽，可以持續2至4週；這個時期也是最容易被診斷出來的時期。但嬰兒的症狀通常較不明顯，常有的症狀是呼吸暫停、哽塞窒息、嘔吐、臉部通紅、發紺或眼睛凸起等。成人則較容易形成長期性的咳嗽，但一般成人的症狀較輕微且不十分典型。在恢復期則症狀逐漸消失而至痊癒，但若併發肺炎則可能死亡。其他嚴重的合併症包括肺泡或橫膈破裂、腦部缺氧或鹼中毒引發的痙欒、嘔吐及結膜下出血。
[编辑] 疫苗
[编辑] 疫苗研究历史
Efforts to develop an inactivated whole-cell pertussis vaccine began soon after B. pertussis was grown in pure culture in 1906. In 1925, the Danish physician Thorvald Madsen was the first to test a whole-cell pertussis vaccine on a wide scale.[1] He used the vaccine to control outbreaks in the Faroe Islands in the North Sea. In 1942, the American scientist Pearl Kendrick combined the whole-cell pertussis vaccine with diphtheria and tetanus toxoids to generate the first DTP combination vaccine. To minimize the frequent side effects caused by the pertussis component of the vaccine, the Japanese scientist Yugi Sato developed an acellular pertussis vaccine consisting of filamentous hemagglutinin (FHA) and pertussis toxin (PT), which are secreted by B. pertussis into the culture medium. Sato's acellular pertussis vaccine was used in Japan beginning in 1981.[2] Later versions of the acellular pertussis vaccine used in other countries consisted of additional defined components of B. pertussis and were often part of the DTaP combination vaccine.
[编辑] 当前情况
Pertussis vaccines are highly effective. However, they offer protection for only a few years, and are given so that immunity lasts through childhood, the time of greatest exposure and greatest risk.[3] The immunizations are given in combination with tetanus and diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years. The short term effectiveness of the vaccines and the presence of B. pertussis infection in adults and adolescents who may transmit the bacteria to infants have caused many in the medical field to call for booster immunizations at later ages. Canada, France, and Germany now have booster shots available for adolescents.
Traditionally, pertussis vaccines are not given after age seven, as the frequency of side effects associated with the immunization tends to increase with age.[來源請求] The most serious side-effects of immunization are neurological: they include seizures and hypotonic episodes. However, some countries now give adolescents a booster shot to maintain their immunity.[來源請求] The acellular vaccine, known as DTaP, has greatly reduced the incidence of adverse effects. An acellular vaccine preparation for older individuals is available in Canada, Europe, and the United States. The Food and Drug Administration has approved the use of the vaccines Boostrix (GlaxoSmithKline) for 10-18 year olds on May 2005 and Adacel (Sanofi Pasteur) for 11-64 year olds in August 2005.[4] However, they are not recommended for those who had an adverse reaction to the older vaccines.
[编辑] Whole-cell pertussis vaccine controversy
Much of the controversy surrounding the DTP vaccine in the 1970s and 1980s related to the question of whether the whole-cell pertussis component caused permanent brain injury in rare cases. Although it was well-established that the pertussis component of the DTP vaccine accounted for most of the minor local and systemic side effects in many vaccinated infants, several published studies failed to show a causal relationship between administration of the DTP vaccine and permanent brain injury.[5] However, criticism of these studies and well-publicized anecdotal reports of DTP-induced permanent disability and death gave rise to anti-DTP movements.[6]
By the late 1970s, publicity about adverse reactions and deaths following pertussis vaccination caused the immunization rate to fall in several countries, including Great Britain, Sweden, and Japan. In many cases, a dramatic increase in the incidence of pertussis followed.[7] These developments led Yugi Sato to introduce a safer acellular version of the pertussis vaccine for Japan in 1981. Nevertheless, other countries continued to use the whole-cell DTP formulation.
In the United States, low profit margins and an increase in vaccine-related lawsuits led many manufacturers to stop producing the DTP vaccine by the early 1980s.[來源請求] In 1982, the television documentary "DTP: Vaccine Roulette" depicted the lives of children whose severe disabilities were blamed on the DTP vaccine. The negative publicity generated by the documentary led to a tremendous increase in the number of lawsuits filed against vaccine manufacturers.[8] By 1985, manufacturers of vaccines had difficulty obtaining liability insurance. The price of the DTP vaccine skyrocketed, leading to shortages around the country. Only one manufacturer of the DPT vaccine remained in the U.S. by the end of 1985. To avert a vaccine crisis, Congress in 1986 passed the National Childhood Vaccine Injury Act (NCVIA), which established a federal no-fault system to compensate victims of injury caused by mandated vaccines.[9] Since then, the prices of vaccines have stabilized, and the number of lawsuits filed against DTP manufacturers have dwindled. The majority of claims that have been filed through the NCVIA have been related to injuries allegedly caused by the whole-cell DTP vaccine. The acellular pertussis vaccine was approved in the United States in 1992 for use in the combination DTaP vaccine. Research has shown the acellular vaccine to be safe, with few reports of adverse effects.[1] Although the whole-cell DTP vaccine is no longer used in the United States, it is still purchased by the World Health Organization and distributed to developing nations because of its much reduced cost compared to the acellular DTaP vaccine.
[编辑] 参考文献
引用错误 5; 无效请求；需求为空
