流行性感冒疫苗接種的免疫反應之先驅研究

A Pilot Study of Immune Response after Influenza Vaccination

免疫力較差者如老年人或慢性病病患者，如果罹患流行性感冒，比較容易發生肺炎、急性支氣管炎、腦炎等併發症，並增加其住院率及致死率。根據國外過去研究指出，老年人接種流行性感冒疫苗可以降低併發肺炎之機率，並且可減少其死亡率，因此對於民眾、家庭及社會而言，是符合預防醫學的目的及經濟效益。臺灣則從民國87年10月開始，對於65歲以上高危險群之老年人，由衛生署補助接種流行性感冒疫苗，同時也建議其他高危 險群民眾接受注射。因此，本研究主要目的為評估流行性感冒疫苗接種後之血清免疫反應與副作用。本研究自民國 87年10月起至88年3月止共收集自願接受本調查的成人共 114 位，經3週後有 74 人(64.9%)完成前後兩次問卷調查及血液檢查， 結果發現：(1)接種流行性感冒疫苗後之副作用包括疲倦（佔 6.1% ）、發燒（佔 1.8% ）及局部不適（佔 1.8%）等；(2)接受流行性感冒疫苗注射前具有效抗體的情況為H3N2佔40.5%，H1N1 佔 56.8%，B佔63.5%；而其中 l9人（佔 25.7%）血清中同時有此三種有效抗體，15 人（佔 20.3% ）血清中並無此三種有效抗體；(3) 接受流行性感冒疫苗注射後具有效抗 體的情況為 H3N2 佔 87.8%，H1N1佔95.9%，B佔91.9%，即大部份的人皆有抗 H3、H1及B之有效抗體；(4) 接受流感疫苗注射後之保護率 H3N2、H1N1及B分別為 79.5%、90.6%及81.5%，而反應率分別為64.9%、75.7% 及 73.0%。國內探討注射流行性感冒疫苗 的相關研究甚少，本研究係屬於前驅研究，研究成果將可作為將來政府有關單位對於推行接 種流行性感冒疫苗的決策參考。

Immunocompromised hosts are susceptible to serious complications secondary to influenza virus infection. Several studies have shown that influenza vaccination protects the elderly from hospitalization and mortality. In Taiwan, high-risk groups have been routinely immunized against influenza since October 1998. The main purposes of this study were to evaluate the serologic immune response and adverse effects after influenza vaccination in Taiwan. One hundred and fourteen people were recruited into this study from October 1998 through March 1999. Subjects were requested to complete a questionnaire and undergo serologic tests immediately before and 3 weeks after vaccination. The vaccine contained three types of influenza virus, which were A/Sydney/5/97 H3N2, A/Beijing/262/95 HINI, and B/Beijing/184/93. Of the 114 subjects, 74 completed both questionnaires and underwent both serologic tests (response rate=64.9%). The adverse effects after vaccination included malaise (6.1%), fever (1.8%), and local reactions (1.8%). The percentage of subjects having protective titers (HAI titers > 40) before vaccination were 40.5% for H3N2, 56.8% for HINI, and 63.5% for B. The percentage of subjects having protective titers after vaccination were 87.8% for H3N2, 95.9% for HINI, and 91.9% for B. The protection rates of vaccine were 79.5% for H3N2, 90.6% for HINI, and 81.5% for B, and the response rates were 64.9% for H3N2, 75.7% for HINI, 73% for B. The results of this pilot study will provide the Taiwan government with information for implementing vaccination policies in the future.