卡介苗遺害 曾小妹恐終生穿鐵衣

[newshine]

卡介苗遺害 曾小妹恐終生穿鐵衣

〔自由時報記者黃邦平／新北報導〕幾乎每個新生兒都會施打卡介苗，但是仍有少數孩童會出現不良反應；曾小妹就是施打後極少數卡介苗菌株感染造成不幸的案例，三節胸椎受損，恐怕一輩子駝背，從此每天睡醒就要穿上鐵衣。

曾小妹的媽媽說，女兒打完卡介苗隔天就有血便，但當時醫生根本沒想到可能有關聯，長期誤診為感冒，斷斷續續燒了又退，到一歲兩個月時漸漸不會走路，一歲五個月時發燒十多天不退，吃什麼藥都沒用，最後醫院院長大膽採用抗結核菌藥物才退燒，經開刀切片檢查，第七、八、九節胸椎受損嚴重，此後女兒除了睡覺，幾乎隨時都穿著鐵衣，「不習慣也要習慣」，但是還有外界的異樣眼光要忍受。

未落實宣導副作用 致診治延誤

新北市議員陳明義說，政府強制新生兒施打卡介苗是要降低感染結核病的風險，卻未落實宣導副作用，很多幼兒出現症狀時，連醫師都想不到是卡介苗惹的禍，誤診又延誤救治時機。他呼籲，除了藥害救濟基金會的金錢補償，政府也應該主動說明卡介苗的安全與注意事項，更應主動追蹤，因為這些孩子都是一輩子受苦。

新北市衛生局疾病管制科長李佳琪說，疾病管制署統計「預防接種受害救濟給付案」，近年數量最多的確實是卡介苗，可能與宣導有關，卡介苗是活性減毒疫苗，基於安全，由中央統一提供疫苗，每瓶可施打卅劑，通常都採預約，開瓶後若當天沒打完也會丟棄。

藥害家屬組聯盟 尋求救濟管道

陳明義說，受害家屬成立「卡介苗藥害家屬聯盟」，部分正尋求救濟管道，也呼籲若有受害人要尋求協助，可電洽：02-23899003興望法律事務所律師涂予彣。

[timh]

http://tw.news.yahoo.com/%E5%8D%A1%E4%B ... 53835.html

小妹妹是很可憐

但事情一碼歸一碼

看到YAHOO 回文
一些腦殘的鬼島民粹仇醫分子
幹譙醫師沒診斷出來

最好都不要去打疫苗，打了出問題也怪東怪西

[hsu]

肺外結核診斷不易
尤其是小孩子
打完隔天就有症狀？

[min]

事後諸葛比較厲害？ (壓力)

[lupin]

http://tw.news.yahoo.com/%E5%8D%A1%E4%B ... 53835.html

卡介苗遺害 曾小妹恐終生穿鐵衣
自由時報自由時報 – 2013年10月10日 上午8:40

〔自由時報記者黃邦平／新北報導〕幾乎每個新生兒都會施打卡介苗，但是仍有少數孩童會出現不良反應；曾小妹就是施打後極少數卡介苗菌株感染造成不幸的案例，三節胸椎受損，恐怕一輩子駝背，從此每天睡醒就要穿上鐵衣。

曾小妹的媽媽說，女兒打完卡介苗隔天就有血便，但當時醫生根本沒想到可能有關聯，長期誤診為感冒，斷斷續續燒了又退，到一歲兩個月時漸漸不會走路，一歲五個月時發燒十多天不退，吃什麼藥都沒用，最後醫院院長大膽採用抗結核菌藥物才退燒，經開刀切片檢查，第七、八、九節胸椎受損嚴重，此後女兒除了睡覺，幾乎隨時都穿著鐵衣，「不習慣也要習慣」，但是還有外界的異樣眼光要忍受。

未落實宣導副作用 致診治延誤

新北市議員陳明義說，政府強制新生兒施打卡介苗是要降低感染結核病的風險，卻未落實宣導副作用，很多幼兒出現症狀時，連醫師都想不到是卡介苗惹的禍，誤診又延誤救治時機。他呼籲，除了藥害救濟基金會的金錢補償，政府也應該主動說明卡介苗的安全與注意事項，更應主動追蹤，因為這些孩子都是一輩子受苦。

新北市衛生局疾病管制科長李佳琪說，疾病管制署統計「預防接種受害救濟給付案」，近年數量最多的確實是卡介苗，可能與宣導有關，卡介苗是活性減毒疫苗，基於安全，由中央統一提供疫苗，每瓶可施打卅劑，通常都採預約，開瓶後若當天沒打完也會丟棄。

藥害家屬組聯盟 尋求救濟管道

陳明義說，受害家屬成立「卡介苗藥害家屬聯盟」，部分正尋求救濟管道，也呼籲若有受害人要尋求協助，可電洽：02-23899003興望法律事務所律師涂予彣。

[旺大]

我之前有聽說美國人是不打卡介苗的
這個卡介苗有多少保護效果根本就是個未知數？

BCG Vaccine

Introduction

BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity. The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert.

Recommendations

Children. BCG vaccination should only be considered for children who have a negative tuberculin skin test and who are continually exposed, and cannot be separated from, adults who
- Are untreated or ineffectively treated for TB disease (if the child cannot be given long-term treatment for infection); or
- Have TB caused by strains resistant to isoniazid and rifampin.
所以小孩其實可以不用打這個疫苗？

Health Care Workers. BCG vaccination of health care workers should be considered on an individual basis in settings in which

A high percentage of TB patients are infected with M. tuberculosis strains resistant to both isoniazid and rifampin;
There is ongoing transmission of such drug-resistant M. tuberculosis strains to health care workers and subsequent infection is likely; or
Comprehensive TB infection-control precautions have been implemented, but have not been successful.
Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of Latent TB Infection (LTBI).

Contraindications

Immunosuppression. BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV infected) or who are likely to become immunocompromised (e.g., persons who are candidates for organ transplant).

Pregnancy. BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety.

Testing for TB in BCG-Vaccinated Persons

The tuberculin skin test (TST) and blood tests to detect TB infection are not contraindicated for persons who have been vaccinated with BCG.

Tuberculin Skin Test (TST). BCG vaccination may cause a false-positive reaction to the TST, which may complicate decisions about prescribing treatment. The presence or size of a TST reaction in persons who have been vaccinated with BCG does not predict whether BCG will provide any protection against TB disease. Furthermore, the size of a TST reaction in a BCG-vaccinated person is not a factor in determining whether the reaction is caused by LTBI or the prior BCG vaccination. (See below for specific guidance on skin test results.)

TB Blood Tests. Blood tests to detect TB infection, unlike the TST, are not affected by prior BCG vaccination and are less likely to give a false-positive result.

Treatment for LTBI in BCG-Vaccinated Persons

Treatment of LTBI substantially reduces the risk that TB infection will progress to disease. Careful assessment to rule out the possibility of TB disease is necessary before treatment for LTBI is started. Evaluation of TST reactions in persons vaccinated with BCG should be interpreted using the same criteria for those not BCG-vaccinated. Persons in the following high-risk groups should be given treatment for LTBI if their reaction to the TST is at least 5 mm of induration or they have a positive result using a TB blood test:

HIV-infected persons
Recent contacts to a TB case
Persons with fibrotic changes on chest radiograph consistent with old TB
Patients with organ transplants
Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF-a antagonists)
In addition, persons in the following high-risk groups should be considered for treatment of LTBI if their reaction to the TST is at least 10 mm of induration or they have a positive result using a TB blood test:

Recent arrivals (less than 5 years) from high-prevalence countries
Injection drug users
Residents and employees of high-risk congregate settings (e.g., correctional facilities, nursing homes, homeless shelters, hospitals, and other health care facilities)
Mycobacteriology laboratory personnel
Persons with clinical conditions that place them at high-risk for developing TB disease (e.g., diabetes)
Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
Persons with no known risk factors for TB may be considered for treatment of LTBI if their reaction to the tuberculin test is at least 15 mm of induration or they have a positive result using a TB blood test. Targeted skin testing programs should only be conducted among high-risk groups. All testing activities should be accompanied by a plan for follow-up care for persons with TB infection or disease.

[newshine]

沒事

[Einstein]

BCG要看pulmonary TB的incidence,美國adult incidence低,所以

adults who
- Are untreated or ineffectively treated for TB disease (if the child cannot be given long-term treatment for infection); or
- Have TB caused by strains resistant to isoniazid and rifampin.

那些是大人有抗藥性TB or 沒治療或治療失敗的小朋友要打(容易接觸不容易seperate)

但是台灣pulmonary TB incidence 高，很多沒治療的病人隱藏在社會內，容易傳染給小朋友，若不打，pulmonary TB 會傳給小朋友，會outbreak，用防疫的觀點來看，台灣小孩要打BCG。

[kwojohn]

(怕怕)

[李誠民]

"陳明義說，受害家屬成立「卡介苗藥害家屬聯盟」，部分正尋求救濟管道，也呼籲若有受害人要尋求協助，可電洽：02-23899003興望法律事務所律師涂予彣。"

新北市議員陳明義說，政府強制新生兒施打卡介苗是要降低感染結核病的風險，卻未落實宣導副作用，很多幼兒出現症狀時，連醫師都想不到是卡介苗惹的禍，誤診又延誤救治時機。他呼籲，除了藥害救濟基金會的金錢補償，政府也應該主動說明卡介苗的安全與注意事項，更應主動追蹤，因為這些孩子都是一輩子受苦。....執政黨--國民黨議員(還不是立法委員---國會議員)........

馬上就是流感高峰期,可以贏得國人(新北市民)的 掌聲(遲早等到機會!!!).....台灣衛生主管等著被他修理,至少醫師已經被他抹黑了!!!...全聯會不出來說明,醫生, 醫院就等著挨告吧!!!.....醫療糾紛是美國最大律師訴訟(Lawsuite)的來源!!!!.........

[李誠民]

flu&Vaccine(流感與疫苗),Rabbies&Vaccine(狂犬病與疫苗),Cancer&Vaccine(HPV四價疫苗----已經有許多Lawsuite,廠商也賠償數十億美元)..............

我很想寫些發言,似乎時機是不適宜的!!!.....說出許多Big Drug Company的內幕,不是給政客資料嗎!!!

[wipten]

BCG 只對 extrapulmonary TB 有效 ... pulmonary TB 無效

[旺大]

BCG 只對 extrapulmonary TB 有效 ... pulmonary TB 無效

所以其實卡介苗到底要不要打
還是個有爭議的。

[Einstein]

J. Pediatr. (Rio J.) vol.82 no.3 suppl.0 Porto Alegre July 2006
http://dx.doi.org/10.1590/S0021-75572006000400006


REVIEW ARTICLE

BCG vaccine: efficacy and indications for vaccination and revaccination

Mauricio L. BarretoI; Susan M. PereiraII; Arlan A. FerreiraIII

IProfessor titular, Instituto de Saúde Coletiva, Universidade Federal da Bahia, (UFBA), Salvador, BA, Brasil
IIProfessora adjunta, Instituto de Saúde Coletiva, UFBA, Salvador, BA, Brasil
IIIProfessor adjunto, Departamento de Pediatria, Universidade Federal de Mato Grosso (UFMT), Cuiabá, MT, Brasil

ABSTRACT

OBJECTIVES: To review the protective efficacy of the first and second doses of BCG vaccine and to assess its major indications and contraindications.
SOURCES OF DATA: A systematic review of the literature was made by searching PubMed and selecting studies carried out in the last 50 years. The studies were grouped according to their design (clinical trials, case-control studies, and meta-analyses) and the results were presented separately for each type of study. Other relevant topics such as BCG and HIV/AIDS, use of tuberculin skin test, issues related to vaccine scars and to the development of new vaccines were also reviewed.

SUMMARY OF THE FINDINGS: BCG vaccine has been used since 1921. However, the data concerning its use are variable and inconsistent. The protective efficacy of the first dose of BCG vaccine against miliary tuberculosis or tuberculous meningitis is remarkably important. Nevertheless, results regarding pulmonary tuberculosis have been inconsistent, either showing no efficacy or a protective efficacy rate around 80%. There is some evidence that a second dose of BCG vaccine does not increase its protective efficacy. Studies have shown that BCG vaccine protects against leprosy. The development of new vaccines to replace BCG in the future has been investigated.

CONCLUSIONS: Despite the hope that a new vaccine against tuberculosis will be available in the future, BCG vaccine, in spite of its deficiencies, is today and will still be for many years to come an important tool in controlling the harmful effects of tuberculosis, especially in countries where this disease has moderate to high levels of incidence.

However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity

應該說BCG 對pulmonary TB的保護效果不確定，不同paper做出的結果分歧很大，從無效到80%的保護效果都有，所以還沒有定論(並不是對於pulmonary TB一定無效，有效無效可能跟study group 基因，族群、strains or environment有關)，但對於TB meningitis or military TB卻是肯定都有效的保護效果(不管基因,族群,strains or environment )。所以上面的文章敘述是用variable而不是ineffective。