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乙型肝炎疫苗：修订间差异

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B型肝炎表面抗體數值落在10 mIU/ml以內表示個體對疫苗不反應，這些人在抽血檢查以排除是否過去曾感染B肝或現在正處於感染階段，並且接受額外三劑B型肝炎疫苗注射，注射完成後經一到四個月再抽血檢測B型肝炎表面抗體數值。那些在第二次疫苗注射療程後依舊對疫苗沒有反應的人<ref>{{Cite journal | doi = 10.1093/clinids/12.6.1035 | pmid = 2148433 | year = 1990 | author1 = King | first2 = E. M. | first3 = S. D. | first4 = M. C. | first5 = J. R. | first6 = M. B. | first7 = S. A. | first8 = F. B. | title = Comparison of the immunogenicity of hepatitis B vaccine administered intradermally and intramuscularly | volume = 12 | issue = 6 | pages = 1035–1043 | journal = Reviews of infectious diseases | last2 = Taylor | last3 = Crow | last4 = White | last5 = Todd | last6 = Poe | last7 = Conrad | last8 = Gelder}}</ref> ，可能會對皮內注射、高劑量疫苗<ref>{{Cite journal | pmid = 7759824 | year = 1995 | author1 = Levitz | first2 = B. | first3 = H. | title = Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination | volume = 16 | issue = 2 | pages = 88–91 | journal = Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America | last2 = Cooper | last3 = Regan | doi = 10.1086/647062}}</ref>，或是A型B型肝炎結合疫苗有反應<ref>{{Cite journal| first1 = K. | first2 = B.| first3 = M.| last1 = Cardell| first4 = A.| title = Excellent Response Rate to a Double Dose of the Combined Hepatitis a and B Vaccine in Previous Nonresponders to Hepatitis B Vaccine| journal = The Journal of Infectious Diseases| volume = 198| issue = 3| pages = 299–226| year = 2008| pmid = 18544037 | doi = 10.1086/589722| last2 = Åkerlind| last3 = Sällberg| last4 = Frydén}}</ref>，而對疫苗依舊沒有反應的人如果之後暴露到B型肝炎病毒，會需要注射B型肝炎免疫球蛋白（HBIG）<ref name="isbn0113225288" /> 。
B型肝炎表面抗體數值落在10 mIU/ml以內表示個體對疫苗不反應，這些人在抽血檢查以排除是否過去曾感染B肝或現在正處於感染階段，並且接受額外三劑B型肝炎疫苗注射，注射完成後經一到四個月再抽血檢測B型肝炎表面抗體數值。那些在第二次疫苗注射療程後依舊對疫苗沒有反應的人<ref>{{Cite journal | doi = 10.1093/clinids/12.6.1035 | pmid = 2148433 | year = 1990 | author1 = King | first2 = E. M. | first3 = S. D. | first4 = M. C. | first5 = J. R. | first6 = M. B. | first7 = S. A. | first8 = F. B. | title = Comparison of the immunogenicity of hepatitis B vaccine administered intradermally and intramuscularly | volume = 12 | issue = 6 | pages = 1035–1043 | journal = Reviews of infectious diseases | last2 = Taylor | last3 = Crow | last4 = White | last5 = Todd | last6 = Poe | last7 = Conrad | last8 = Gelder}}</ref> ，可能會對皮內注射、高劑量疫苗<ref>{{Cite journal | pmid = 7759824 | year = 1995 | author1 = Levitz | first2 = B. | first3 = H. | title = Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination | volume = 16 | issue = 2 | pages = 88–91 | journal = Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America | last2 = Cooper | last3 = Regan | doi = 10.1086/647062}}</ref>，或是A型B型肝炎結合疫苗有反應<ref>{{Cite journal| first1 = K. | first2 = B.| first3 = M.| last1 = Cardell| first4 = A.| title = Excellent Response Rate to a Double Dose of the Combined Hepatitis a and B Vaccine in Previous Nonresponders to Hepatitis B Vaccine| journal = The Journal of Infectious Diseases| volume = 198| issue = 3| pages = 299–226| year = 2008| pmid = 18544037 | doi = 10.1086/589722| last2 = Åkerlind| last3 = Sällberg| last4 = Frydén}}</ref>，而對疫苗依舊沒有反應的人如果之後暴露到B型肝炎病毒，會需要注射B型肝炎免疫球蛋白（HBIG）<ref name="isbn0113225288" /> 。

對疫苗反應不佳的人通常是因為以下因素 : 超過40歲、肥胖、抽菸或酗酒<ref name="pmid8254852">{{Cite journal| last1 = Roome | first1 = A. J.| last2 = Walsh| year = 1993 | first2 = S.| last3 = Cartter | first3 = M.| last4 = Hadler | first4 = J.| title = Hepatitis B vaccine responsiveness in Connecticut public safety personnel| journal = Journal of the American Medical Association| pmid = 8254852| volume = 270| issue = 24 | pages = 2931–2934| doi =10.1001/jama.270.24.2931 }}</ref>，尤其是有嚴重肝病患者<ref name="pmid9316554">{{Cite journal| first1 = A.| title = Efficacy of a High and Accelerated Dose of Hepatitis B Vaccine in Alcoholic Patients a Randomized Clinical Trial| last1 = Rosman, Md| journal = The American Journal of Medicine| volume = 103| pages = 217–222| year = 1997 | doi = 10.1016/S0002-9343(97)00132-0| pmid = 9316554| last2 = Basu | first2 = P.| last3 = Galvin | first3 = K.| last4 = Lieber | first4 = C.| issue = 3 }}</ref>。 免疫抑制的病人或接受腎臟透析的病人也可能對疫苗反應較差或需要更大劑量、頻率的疫苗注射<ref name="isbn0113225288" />。至少已有一個研究指出，B型肝炎的疫苗在HIV患者體內較難生效<ref>{{Cite journal| last1 = Pasricha| first1 = N.| first2 = U.| first3 = Y.| last6 = Sud| last8 = Saikia | first4 = S. | first5 = S.| first6 = A. | first7 = R.| last5 = Arora | first8 = B.| last7 = Minz | first9 = H.| last9 = Singh| journal = BMC Infectious Diseases| volume = 6| pages = 65| year = 2006| last10 = James | doi = 10.1186/1471-2334-6-65| last2 = Datta| last3 = Chawla | first10 = I.| last4 = Singh| last11 = Sehgal| pmid = 16571140 | first11 = S.| title = Immune responses in patients with HIV infection after vaccination with recombinant Hepatitis B virus vaccine| pmc = 1525180 }} Cold or Flu like symptoms can develop after receiving the vaccine, but these are short lived. As with any injection, the muscle can become tender around the injection point for some time afterwards</ref>。


==參考文獻==
==參考文獻==

2016年3月25日 (五) 13:51的版本

乙型肝炎疫苗
疫苗说明
目標乙型肝炎
种类亚基疫苗
臨床資料
商品名（英语：Drug nomenclature）Recombivax HB
AHFS/Drugs.comMonograph
MedlinePlusa607014
ATC碼
识别信息
ChemSpider

B型肝炎疫苗（Hepatitis B vaccine），常簡稱B肝疫苗。是用來預防B型肝炎的疫苗[1] 。第一劑建議於出生後的24小時內就注射，要視情況決定之後還須追加第二或第三劑。這包括免疫功能不全的患者：例如患有艾滋病的人，或是早產兒。若是身心健康且有定期接種疫苗，則保護力可高達95% [1]。

高風險族群會建議進行血液檢測以確認疫苗的效用。有免疫功能問題的病人可能有追加注射疫苗的必要，但一般民眾則大多不需要。曾受到B型肝炎病毒感染且尚未有健全免疫力的病患，之後追加施打的疫苗應增加B型肝炎免疫球蛋白（英语：Hepatitis B immune globulin），此疫苗會經由肌肉注射的方式接種[1]。

B型肝炎疫苗較少會引發嚴重的副作用，在注射的當下可能會感到些許疼痛。在懷孕或是哺乳期間依舊可以施打疫苗。並沒有證據顯示B肝疫苗和格林-巴利症候群有相關性 。現今使用的疫苗是利用DNA重組技術製成的，可以單獨使用或和其他疫苗混合施打[1]。

第一種B肝疫苗是在1981年經美國核准[2]，1986年另一種更加安全的疫苗接著問世[1]。目前此藥名列世界衛生組織基本藥物標準清單內，同時也是基礎醫療裡很重要的藥物之一[3] 。2014年單劑的量販價介於0.58至13.20美元間[4]，在美國的售價則落在50到100美元的區間內[5]。

醫療用途

若母親為B型肝炎帶原者，嬰兒會在出生24小時內[6]接種B型肝炎疫苗，並注射B型肝炎免疫球蛋白（HBIG）[7]，若出生後臨床狀況穩定則越早注射越好[8]。 現今很多國家注射疫苗以對付B型肝炎。有很多國家B型肝炎感染的機率較高，新生兒接種B型肝炎疫苗不只可以降低感染的風險，也顯著的減少了肝癌的病例。像台灣1984年實施的B型肝炎接種計劃也和其兒童肝癌發生率的下降有關[9][10]。

在英國，會提供B型肝炎疫苗給男男性接觸人群，這是性健康檢查的一部分，在愛爾蘭也有類似的措施[11]。許多地區的所有醫療護理人員及相關實驗室人員，都要接受B型肝炎疫苗接種[12]。美国疾病控制与预防中心建議糖尿病病患都接受B型肝炎疫苗接種[13]。

疫苗效用

在首次完成三劑B型肝炎疫苗注射後一到四個月會抽一次血，檢驗B型肝炎表面抗原B型肝炎病毒表面抗體（anti-hepatitis B surface antigen antibody(anti-Hbs)）的數值是否超過100 mIU/ml[14] 超過則代表個體對疫苗已經產生適當的免疫反應，通常百分之85到90的人注射完疫苗後會產生反應[12]。 B型肝炎表面抗體數值介在10 到 100 mIU/ml 之間視為對疫苗反應不佳，這些人需要在檢驗出來後再額外注射一劑疫苗，但不需要隔一段時間後再抽血評估[15]。

B型肝炎表面抗體數值落在10 mIU/ml以內表示個體對疫苗不反應，這些人在抽血檢查以排除是否過去曾感染B肝或現在正處於感染階段，並且接受額外三劑B型肝炎疫苗注射，注射完成後經一到四個月再抽血檢測B型肝炎表面抗體數值。那些在第二次疫苗注射療程後依舊對疫苗沒有反應的人[16] ，可能會對皮內注射、高劑量疫苗[17]，或是A型B型肝炎結合疫苗有反應[18]，而對疫苗依舊沒有反應的人如果之後暴露到B型肝炎病毒，會需要注射B型肝炎免疫球蛋白（HBIG）[15] 。

對疫苗反應不佳的人通常是因為以下因素 : 超過40歲、肥胖、抽菸或酗酒[19]，尤其是有嚴重肝病患者[20]。 免疫抑制的病人或接受腎臟透析的病人也可能對疫苗反應較差或需要更大劑量、頻率的疫苗注射[15]。至少已有一個研究指出，B型肝炎的疫苗在HIV患者體內較難生效[21]。

參考文獻

  1. ^ 1.0 1.1 1.2 1.3 1.4 Hepatitis B vaccines WHO position paper (PDF). Weekly epidemiological record. 2 Oct 2009, 40 (84): 405–420. 
  2. ^ Moticka, Edward. A Historical Perspective on Evidence-Based Immunology. : 336. ISBN 9780123983756. 
  3. ^ WHO Model List of EssentialMedicines (PDF). World Health Organization. October 2013 [22 April 2014]. 
  4. ^ Vaccine, Hepatitis B. International Drug Price Indicator Guide. [6 December 2015]. 
  5. ^ Hamilton, Richart. Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. 2015: 314. ISBN 9781284057560. 
  6. ^ [1]
  7. ^ Mast, E. E.; Margolis, H. S.; Fiore, A. E.; Brink, E. W.; Goldstein, S. T.; Wang, S. A.; Moyer, L. A.; Bell, B. P.; Alter, M. J.; Advisory Committee on Immunization Practices (ACIP). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents (Free full text). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 2005, 54 (RR–16): 1–31. PMID 16371945. 
  8. ^ [2]
  9. ^ Chang, M. -H.; Chen, C. -J.; Lai, M. -S.; Hsu, H. -M.; Wu, T. -C.; Kong, M. -S.; Liang, D. -C.; Shau, W. -Y.; Chen, D. -S. Universal Hepatitis B Vaccination in Taiwan and the Incidence of Hepatocellular Carcinoma in Children. New England Journal of Medicine. 1997, 336 (26): 1855–1859. PMID 9197213. doi:10.1056/NEJM199706263362602. 
  10. ^ B型肝炎疫苗接種與盛行率之下降
  11. ^ Hepatitis B vaccine. www.nhs.uk. 
  12. ^ 12.0 12.1 Joint Committee on Vaccination and Immunisation. Chapter 12 Immunisation of healthcare and laboratory staff—Hepatitis B. Immunisation Against Infectious Disease 2006 ("The Green Book") (PDF) 3rd. Edinburgh: Stationery Office. 2006: 468. ISBN 0-11-322528-8. 
  13. ^ Centers for Disease Control and Prevention (CDC). Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP).. MMWR Morb Mortal Wkly Rep. 2011, 60 (50): 1709–11. PMID 22189894. 
  14. ^ [3]
  15. ^ 15.0 15.1 15.2 Joint Committee on Vaccination and Immunisation. Chapter 12 Immunisation of healthcare and laboratory staff—Hepatitis B. Immunisation Against Infectious Disease 2006 ("The Green Book") (PDF) 3rd. Edinburgh: Stationery Office. 2006: 468. ISBN 0-11-322528-8. 
  16. ^ King; Taylor, E. M.; Crow, S. D.; White, M. C.; Todd, J. R.; Poe, M. B.; Conrad, S. A.; Gelder, F. B. Comparison of the immunogenicity of hepatitis B vaccine administered intradermally and intramuscularly. Reviews of infectious diseases. 1990, 12 (6): 1035–1043. PMID 2148433. doi:10.1093/clinids/12.6.1035. 
  17. ^ Levitz; Cooper, B.; Regan, H. Immunization with high-dose intradermal recombinant hepatitis B vaccine in healthcare workers who failed to respond to intramuscular vaccination. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 1995, 16 (2): 88–91. PMID 7759824. doi:10.1086/647062. 
  18. ^ Cardell, K.; Åkerlind, B.; Sällberg, M.; Frydén, A. Excellent Response Rate to a Double Dose of the Combined Hepatitis a and B Vaccine in Previous Nonresponders to Hepatitis B Vaccine. The Journal of Infectious Diseases. 2008, 198 (3): 299–226. PMID 18544037. doi:10.1086/589722. 
  19. ^ Roome, A. J.; Walsh, S.; Cartter, M.; Hadler, J. Hepatitis B vaccine responsiveness in Connecticut public safety personnel. Journal of the American Medical Association. 1993, 270 (24): 2931–2934. PMID 8254852. doi:10.1001/jama.270.24.2931. 
  20. ^ Rosman, Md, A.; Basu, P.; Galvin, K.; Lieber, C. Efficacy of a High and Accelerated Dose of Hepatitis B Vaccine in Alcoholic Patients a Randomized Clinical Trial. The American Journal of Medicine. 1997, 103 (3): 217–222. PMID 9316554. doi:10.1016/S0002-9343(97)00132-0. 
  21. ^ Pasricha, N.; Datta, U.; Chawla, Y.; Singh, S.; Arora, S.; Sud, A.; Minz, R.; Saikia, B.; Singh, H.; James, I.; Sehgal, S. Immune responses in patients with HIV infection after vaccination with recombinant Hepatitis B virus vaccine. BMC Infectious Diseases. 2006, 6: 65. PMC 1525180 可免费查阅. PMID 16571140. doi:10.1186/1471-2334-6-65.  Cold or Flu like symptoms can develop after receiving the vaccine, but these are short lived. As with any injection, the muscle can become tender around the injection point for some time afterwards

外部連結

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